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Permit
p CITY OF TIGARD ELECTRICAL PERMIT lig I[ COMMUNITY DEVELOPMENT Permit#: ELC2014-00693 T t t.;A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/03/2014 Parcel: 2S102AC00700 Jurisdiction: TIGARD Site address: 12550 SW MAIN ST 120 Project: All Tech Subdivision: BURNHAM TRACT Lot: 1 Project Description: (1)service and(10)branch circuits for TI Contractor: FUZION ELECTRIC LLC Owner: DOLAN&CO LLC 1335 SW 197TH AVE BY FLORENCE T DOLAN ALOHA, OR 97006 4523 NE DAVIS ST PORTLAND, OR 97213 PHONE: 503-528-6033 PHONE: FAX: 866-284-0482 FEES Quantity Description Date Amount 1 ea Services or Feeders-200 12/03/2014 $100.70 Specifics: amps or less 10 crt Branch Circuits w/Purchase 12/03/2014 $74.20 Type of Use: COM Service or Feeder Class of Work: ALT 1 ea 12%State Surcharge- 12/03/2014 $20.99 Electrical Type of Const: Occupancy Grp: Total $195.89 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law. All work will be done -- • • • e with approved plans. This permit will expire if work is not started within 180 days of issuance, or if wor is -uspended for more the 180 days ATTENTION: Or-.•n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Th• les are set forth in OAR 95 001-0010 through OAR 9 -P• -,r9r You may obtain a copy of the rules or direct questions to OUNC by call'•• • . . •:• or 1.800 . 344. i ` I ued By: / ' r� "� Permittee Signature: � nLiLT: OWNER INSTALLATION ONLY ' The installation is being made on property I own which is not intended for sale,lease or rent. OWNER'S SIGNATURE Date: I NTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' _ Date: i///f Allitt•.x -..111•1A LICENSE NO. Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. RECE1VL1 Electrical Permit Application FOR OFFICE USE ONLY i . ill City of Tigard f J F l. 2 2014 Received ©�� • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 50354811 r Date/B : Related Permit#: 4,4/9,'0/(� �v A Inspection Line: 503.639.4175 �1 I ■ �r lvA�� Ready Date/By: ro^s ® See Page 2 for T I(;;1 R D Internet: www.tigard-or.gov BUILDING f DIVISION Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑New construction [ Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. ❑ I-and 2-family dwelling Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived �1, ❑Addition of new motor load of system. Job 4: Job site address: 1 2.55 0 5 w / 'l tt t 4 10OHP or more. ❑"A","E","1-2","I-3", occupancy. CiCity/State/ZIP: ✓ Six or more residential units. P Y ty / i,k d "r�.- ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.4: Project name: -re d.„1/4. ❑Hazardous locations. ❑Supply voltage for more than \ ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total I • New residential single-or multi-family dwelling unit. Subdivision: Lot 4: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel 4: Ea.add'I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 -TT (with above sq.ft.) 1 New S>< Limited energy,multi-family residential(with above sq.ft.) 75.00 2 I Renewable Energy ❑ See Page 2 ❑ PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 1 100.70 /2."7C 2 Address: 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This installation is being made on property that 1 own which is not 200 amps or less 59.36 I intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 ❑ APPLICANT I ❑ CONTACT PERSON ,_Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with 742�O �71/2°71/2° 2 Business name: above service or feeder fee, 7 each branch circuit _ Contact name: B.Fee for branch circuits without service or feeder fee,first 56.18 2 Address: branch circuit City/State/ZIP: Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: - ��, a 4t►mL iu xi dj Ea677Zt C . Sign or outline lighting k 67.84 2^ Address: L (��/ Signal circuit(s)or limited-energy ❑ See Page 2 2 ��'3 J� t \ I Ac,-e- panel,alteration,or extension. City/State/ZIP: � o 0-12_ 4A..7 cD 3 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(503 Zg 6003-5 Fax:( ) Investigation(1 hr min) 66.25/hr Industrial plant(1 hr min) 78.18/hr Email: ✓e ,` -Z to," e lC c'c{j mow\ Inspections for which no fee is 90.00/hr CCB Lic.: k8S Electrical Lic.: 0.5911 Suprv.Lic.: S5 2- -5 specifically listed(Y hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,requi � Subtotal: /7 q.qe Print name: <%?�,�f� ��...„ '� Date: `2.3- i ❑Plan Review Required(25%of permit fee): ..!' State surcharge(12%of permit fee): 024).9? '<b Authorized signature: TOTAL PERMIT FEE: /9 S. This permit application expires if a permit is not obtained within 180 Print name: .-{� .)c4,--\. Date:t a_. 5 - j ti days after it has been accepted as complete. • Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.docx Rev 04/21/2014 440-4615T(1 i/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Description Qty. I Each I Total Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(Y2 hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 • Subtotal(Enter Page t): y • Number of inspections alllowed owed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: n Audio and Stereo Systems I Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation n Fire Alarm Installation ❑ HVAC Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* H Medical n Nurse Calls I Outdoor Landscape Lighting* Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Buildinsffenni ts\ELC_PermitApp_ELR_ERE.docx Rev 04/21/2014 Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 12550 SW MAIN ST 120, TIGARD, OR, 97223 Commercial - Electrical 199 Electrical final PASS - No C of O ELC2014-00693 Jeff Grove Violation Summary: Inspector Contractor