Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2015 00142
Date Issued: 03/10/2015
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S102AA03301
Jurisdiction: Tigard
Site address: 12345 SW HALL BLVD 11
Project: Tigard Terrace Apartments Subdivision: TIGARD HIGHWAY TRACTS Lot: 24
Project Description: Unit#11,(1)panel replacement and(2)branch circuits.
Contractor: A TO Z ELECTRIC Owner: KC TIGARD TERRACE LLC
10117 SE SUNNYSIDE RD, F36 11030 NW 2ND CT
CLACKAMAS, OR 97015 PORTLAND,OR 97231
PHONE: 503-481-5061 PHONE:
FAX: 503-907-5483
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 03/10/2015 $100.70
Specifics: amps or less
2 crt Branch Circuits w/Purchase 03/10/2015 $14.84
Type of Use: MF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 03/10/2015 $13.86
Electrical
Type of Const:
Occupancy Grp:
Total $129.40
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 ccordance 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: Oregon -w re. res •u to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-0 1-0010 through OAR 952-# -009# Y. ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Iss ed By: I Permittee Signature: /\
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:
CO T: •CT•: NSTALLATION ONLY
F
Ct
SIGNATURE OF SUPR.ELEC' 411 / / Date: , /
LICENSE NO. 6 7 5
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.
Electrical Permit ApplicatiCEIVED ,),,0. I. I til:ON I.)
City of Tigard BAR 10 2015 Date/B ea ���Ait. �'L '/5-60 L
Ci o Permit#
• 13125 SW Hall Blvd.,Tigard,OR 972 Plan Review
Phone: 503.718.2439 Fax: 503. Date/B : Related Permit II:
Inspection Line: 503.639.4175 t °OF TIGARD Ready Date/By: tuns: Hi See Page 2 for
r.I 1 Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction )2<ldition/alteration/replacement Please check all that apply(submit a 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.
❑ 1-and 2-family dwellingommercial/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
Job#: Job site address: /2 5(ie S� I> ' t ❑100H Addition of new motor load of system.
IOOHPormore. ❑"A" "E" "1-2" "1-3"
City/State/ZIP: 7 "' . ❑Six or more residential units. occupancy.
❑�+ �/ ❑Health-care facilities. Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ❑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#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
P/,. _ / Q_ ^f
(with ne gy, fl i 75.00 2
Ki�P� '(.('/(J Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less / 100.70 /a.lO 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 I own which is not 200 amps or less - 59.36 1
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 '/
Business name: above service or feeder fee, 2 ' 7.42 !f'f'$S/ 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'l 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: 04— 2 a' —e„,t.40_.. Sign or outline lighting 67.84 2
/C")/f? c ` S Go12 /F Signal circuit(s)aler on or limited-energy
0 See Page 2 2
Address: panel,alteration,or extension.
City/State/ZIP: CloSeL4444,44 ice 47o/S- Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:MS) Z325-_9353 Fax:esbN 2`/ Z 30 Investigation(1 hr min) 66.25/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: j 46-6I41,1 Electrical Lic.: z.4.cie,e,t S ,_1 'c.: 475 specifically listed('A hr min)
' i
Suprv.Electrician signature,required: / ELECTRICAL PERMIT FEDSubtotal: l/4-6-q
Print name: . 'i L I II at-. Vi(2c ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): /3.Flo
Authorized signature: TOTAL PERMIT FEE: /919•Yd
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permits\ELC_PennitApp_ELR_ERE.doc Rev 04/21/2014 440-4615T(I 1/05/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
Fee for all residential systems combined: $75.00
Description n wa I Qty. : Each I Total
3' Renewable electrical energy systems:
Check Type of Work Involved: Skvaorless I00.70 2
5.01 to 15 kva 133.56 2
El 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 55226 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
El Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any_of the above:
El Other: Each additional inspection is 66.25/hr 1
charged at an hourly(I hr min) •
Inspections for which no fee is 90.00/hr
specifically listed('A hr mm)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1): I
Fee for each commercial system: $75.00
(SEE OAR 918-309-0000) Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc 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
12345 SW HALL BLVD 11, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00142
Herb Stabenow
Violation Summary:
Inspector Contractor