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Permit Support Document y j ELECTRICAL PERMIT q CITY OF TIGARD COMMUNITY DEVELOPMENT rearear Permit#: ELC2014-00623 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/30/2014 Parcel: 1 S134BC00200 Jurisdiction: Tigard Site address: 12186 SW SCHOLLS FERRY RD Project: Mud Bay-TI Work Subdivision: GREENWOOD TERRACE CONDO Lot: 17 Project Description: Additional receptacles added for tenant on sales floor&back of house rooms. Installation of light fixtures.Circuit for exterior sign.12/1/14,reprinted to add low voltage for data. Contractor: INDUSTRIAL COMMERCIAL ELECTRIC COMPANY Owner: ATLAS GREENWAY LLC PO BOX 21282 333 NW NINTH AVE, STE 1009 KEIZER,OR 97307 PORTLAND, OR 97209 PHONE: 503-981-2383 PHONE: FAX: 503-981-0053 FEES Quantity Description Date Amount 15 crt Branch Circuits wo/Purchase 10/30/2014 $160.06 Specifics: Service or Feeder 1 ea 12%State Surcharge- 10/30/2014 $19.21 Type of Use: COM Electrical Class of Work: ALT 1 ea Signal circuit or Limited 12/01/2014 $75.00 Energy Panel Type of Const: 0 ea 12%State Surcharge- 12/01/2014 $9.00 Occupancy Grp: Electrical Total $263.27 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 i . e with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. TENTION: Ore!•n law requires you to follow the rules adopted by the Oregon Utility Notificatio enter. \Those rules are set forth in OAR 952-!11-0010 through OAR 9' .91-01!r. ou may obtain�a copy of the rules or direct questions to OUNCrbycatti #3 2.1987 or 1.800.332.2344. Is•ued By: I , /` �� ( '�!l Permittee Sig .ture: ' 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: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' Date: 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. NOV-26-2014 03:46 PM ICEco 5039810053 P. 2 Electrical Permit A licati�� ' EILJF , t,r (tl„t , , ', t11( 1 City of Tigard Rave1VCd y Date/Hy: .4 / /5 Gab Permit No': 1(5,2-0141- co z'3 i 3123 SW Hall Blvd.,Tigard,OR 9722 10 V 2 6 Z 014 Plan Review -- I Phone: 503.718,2439 Fax: 503.5981 Date/By: OtherPeemit: , ,; i., Inspection Line: 503.639.4175 (I f U Date Ready/By: tmic QJ Sec Page 2 for Internet: www,tigard-or.gov ' `- • 1 Notified/Method; _Supplemental information TYPE OF t'O PLAN REVIEW ❑New construction 4 Addition/alteration/replacement Ply check all that apply(aubmir 2 sets of plans w/items checked below): 0 Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition 0 Other: where the available fault current ❑Marina and boatyards. CAtsCOR .C Y OFONSTRUCTION. exceeds 10,000 amps at 150 volts or 0 Floating buildings. Inca to ground,or exceeds 14,000 ❑Commercial-use agricultural ❑ 1-and 2-family dwelling _4 Commcrciaiindustriel ❑Accessory building amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: 0 Fire pump. ❑Installation of 150 KVA or ❑Emergency system. larger separately derived system. JOB SITE..INFOII;MATION AN4 LOCATION ❑Addition of new motor load of ❑"A",•'E" "1-2”,",.3" Job no.: Job site address: a 100HP or more, occupancy. a ' _�a 4 I r t . ['Six or more residential units. ❑Itecreations!vehicle parks. City/State/ZIP: ` flag p. QI-1 Z� ❑Health-Dare facilities. ❑Supply voltage for more than I ❑Hamrdous locations. 600 volts nominal, Suite/bldg/apt,no.: Project name: ,I 4 „ 0 Service or feeder 600 amps or more, FEE SCHEDULE Cross street/directions to job site: oteerieelea I Qty. i Fee."i Total i • New residential single-or multi-family dwelling unit. Includes attached garage. SubdlVISion: Lot no.: 1,000 sq.ft.or less 168.54 4 Ea add'l 500 sq,ft,or portion 33.92 l Tax map/parcel no.: Limited energy,residential - DESCRIPTION OF WORK (with above sq.ft.) 75.00 2 Limited energy,multi-family '- t A/ a 4 OA/• I ►1 a — ■ 1 I, / - a. la 1 111 4 4 O. residential with above aq.R2 75.00 2 Renewable Energy ' 0 See Page 2 M 1. /.I I E� /, ■I a:.. i Services or feeders Installation,alteration,and/or relocation R PROPERTY'OWNER 0 TENANT 200=pa or less 100.70 2 201 amps to 400 amps 133,56 2 Name: 401 amps to 600 amps 200 34 Address: 601 snips to 1.000 amps 301.04 2 Over 1,000 amps or volts 552.26 i 2 City/State/ZIP: Temporary services or feeders installation,alteration,and/or Phone:( ) Fax:( ) relocation 200 amps or lees 59.36 1 Owner Installation:This installation is being made on property that I own which is not "201 amps to 400 amps 125.08 2 intended for sale,lease,rent,or exchange,according to ORS 447,449.670,and 701. 401 amps to 599 amps 168.sa Owner signature: Date: Branch circuits—new,alteration,or extension,per panel A.Fee fbr branch circuits with ■: APPLICANT ❑ CONTACT PERSON C above service or fader fee, Business name: Ivlautt--in.l Cr mvvevr iiE EIteti,�[, each branch branc circuit 7.42 ' B.Pee for branch circuits without Contact name: .1—bY� by 'r l,, service or feeder tee,first 56.18 2 '►`, _ .-4 branch circuit Addre66: 1 it A Iii C. I"I • ., l • I ' Each add'l branch circuit _ 7.42 2 •City/State/ZIP: Miscellaneous(service or feeder not ioclad (A)l��.)h Ii i F i ��0�l Each manufactured or modular 67.84 2 Phone:(OOQ )gel- Z-c6�a Fax::(5*) 943 i 0063 dwelling service and/or feeder Reconnect only 67.84 2 =R•1 La i ' s -. ' Iii el•I Pump or irrigation circle 67.84 2 . . CONT#C1'OR Sign or outline lighting . 67.84 . —...--1 Business name: 1 y iii epm f L7Jt iA BE1-1"y°L f , Signal cirouit(a)or limited-energy I See portal,alteration,or extension. Ilse 2 "1 5 2 Address: ' f,./ U e]. I / r. i f 4 - " , i eq Each additional inspection over allowable in any of the above City/State/ZIP: _Additionalinspection(Ihrmin) 66.25/hr C . 1 I I r Investigation(1 hr min) 66,25/hr . Phone'(5 176)CI O,1 Fax:(Stf ci I DO 53 Industrial plant(l hr min) 78.1 8/hr Inspections for which no fbe is 80,001 hr CCB Lie.: I IQ�}.,D`� Electrical Lic.: G52„ Suprv.Lic.: ISS I tS specifically Bated(S5 hr min) _ — L . ELECTRICAL PERMIT FEES Suprv, Electrician signature,required: Subtotal: ' 15. 00 Print name: 1,�. _l1. Date: \ Plan review(25%of permit fee);` ' ' i' J 1' '��'f State surcharge(12%of permit fee): 41 , Authorized signature: TOTAL PERMIT FEE: 00 This permit application expires if a'permit I.net obtained Ithln 180 Print name: —ityyt fir • Date: I(,2L(•14 J J days after It bee been accepted es complete • Number of inspection'allowed per permit. I15LildinglPe rlta\ELC_PermitApp..P.LR11R6.der Rev 05/21/2013 440-4413T(Il%o5/COM/WEB NOV-26-2014 03:47 PM ICEco 5039810053 P. 3 Electrical Permit Application-City of Tigard Page 2-Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORT(QNLYt • FEE SCHEDULE Fee for all residential systems combined........ $75.00 - • , I Q . Bee i Total • Renewable electrical energy systems: Check Type of Work Involved: 5 kva orless 100.70 f 2 5.01 to 15 kva 13156 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 ❑ Burglar Alarm Wind generation systems In excess of 25 kva: 25,01 to 50 kva 301.04 2 ❑ Garage Door Opener* 50.01 to 100 kva • 552.26 0 t,lcva(fee in accordance with 552.26 :3 OAR 918-309-0040 ❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 ME 7.42 © ❑ Vacuum Systems* X100 kva—no additional charge 0.0 3 Each additional in■pection over allowable In any of the above: ❑ Other: Each additional inspection is charged at an hourV hr min) 66.25/hr Inspections for which no fee is 90.00/hr specifically listed(r4 hr min) COMMERCIAL WOItItONLY: . ELECTRICAL PERMIT:FEES Fee for each commercial system $75.00 Subtotal: (SEE OAR 918-309-0000) Plan review.if required(25%of permit fee): - Slate surcharge(12%of permit fee); Check Type of Work Involved: TOTAL PERMIT FEE; This permit application expires If a permit Is net obtained within ISO [] Audio and Stereo Systems days after It has been accepted as complete. Number of inspections allowed per permit' El Boiler Controls ❑ Clock Systems K.Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical n Nurse Calls ❑ Outdoor Landscape Lighting* n Protective Signaling ❑ Other • Total number of commercial systems: 1_ *No licenses are required. Licenses are required for all other installations 1.1tuildinglPemlits\ELC_PennitApp ELR_ERH.doc RevOS/21/2013 NOV-26-2014 03:46 PM ICEoo 5039810053 P. 1 i INDUSTRIAL COMMERCIAL„ELECTRIC COMPANY E29030 SW Town Center Loop East I C E c„ Suite 202#159 —� — Wilsonville,OR 97070 FA Ear.?a�5 FAX 503.981-0083 I ELECTRICAL CONTRACTOR FAX Date: 11 Zto.11 NIA of r rA To: iZidi,o5CQdeStilvicicsv, From: Industrial Commercial Electric Attn: i-31,5i . rnrle , Phone: 503-981-2383 FAX: .513 rqr� i q t,,,o FAX: 503-981-0053 Phone: 50s , 9 Pages: (Including this one) Notes: lie ce add 6-�-.- c- c1 te ■"-,-, 4ce4 d +1, p I.Eritse t"o c - " e-hn 'Eoeke -r F 0S. °I I , "7.Zebe6 Telak4. you Industrial Commercial Electric Company OFFICE 503-981-2383 FAX 503-981-0053 kristin(gicecoelectric.com