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Permit y u CITY OF TIGARD ELECTRICAL PERMIT E COMMUNITY DEVELOPMENT Permit#: ELC2015 00169 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/18/2015 Parcel: 2S1026D03200 Jurisdiction: Tigard Site address: 13075 SW PACIFIC HWY Project: Qush Hookah Subdivision: NORTH TIGARDVILLE ADDITION Lot: 35 Project Description: Add(3)new circuits and extend(6)existing circuits.3/23/15:Reprinted permit to include(1)additional branch circuit. Contractor: G&H ELECTRICAL CONSULTING LLC Owner: SANCHEZ,J GUADALUPE PO BOX 12901 ZAVALA, BLANCA E SALEM, OR 97309 10000 SW MOLLY CT TIGARD, OR 97223 PHONE: 503-302-3354 PHONE: FAX: FEES Quantity Description Date Amount 10 crt Branch Circuits wo/Purchase 03/23/2015 $122.96 Specifics: Service or Feeder 1 ea 12%State Surcharge- 03/23/2015 $14.76 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $137.72 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 in accordance 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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those r les are set forth in OAR 952-001-0010 through OAR 952-001-0090. You . a cop ules or direct questions to OUNC by calling 03.232.1987 or 1.800.3 . 344. Issued By: 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: 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. Electrical Permit Application I.(,R 1)I I It I I .I t,\I , City of Tigard Received • IIIII 13125 SW Hall Blvd.,Tigard,OR 97 (� v D Date/B view `P• - i ■ Phone: 503.718.2439 Fax: 503.598 C E�vE Date/B : Related Permit#: ' Inspection Line: 503.639.4175 Ready Date/By: 10 See Page 2 for 1 i`' \r I 1 Internet: www.tigard-or.gov MAR %3 2015 Notified/Method: -1 .. Supplemental Information ❑ pi►rE OF er k .rIGAFin N PLAN REVIEW New construction Addition/alteratvls'O Please check all that apply(submit 2 sets of plans w/items checked): BU IL Ll' ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition ❑Other: V where the available fault current ❑Marinas and boatyards. CATECO9 OF CONSTRUCTION 1 exceeds 10,000 amps at 150 volts or ❑Floating buildings. � i less to ground,or exceeds 14,000 ❑Commercial-use agricultural El 1-and 2-family dwelling ommercial/industrial ❑Access. , . sI a amps for all other installations. buildings. El Multi-family ❑Master builder ❑Other: j�7 ❑Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION • i/ ❑Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: I Job site address: /3075--sw pac; � 100HP or more. ❑"A","E","t-2","1-3", City/State/ZIP: �` ❑Six or more residential units. occupancy. ty !iC�(� ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: 1/ Project name: Q („1 (445 hitt'/� /t o Hazardous locations. 0 Supply voltage for more than `G° ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Tats' New residential single-or multi-family dwelling unit. Subdivision: I Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: - . _ Ea.add'I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 4 - (with above sq.ft.) 75.00 2 L• - - III i. — Limited energy,multi-family residential(with above sq.ft.) 75.00 2 Renewable Energy ❑ See Page 2 ❑ PROPERTY OWNER I• ❑ TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100.70 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:( ) I 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 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 1 ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 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 I ( I 7.42 I74a 12 Miscellaneous(service or feeder not included) Phone:( ) I 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: Sign or outline lighting 67.84 2 C H ��,P ��� wf �� Signal circuit(s)or limited-energy ❑ See Page 2 2 Address: panel,alteration,or extension. g City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) I Fax:( ) 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.: [ Electrical Lic.: I Suprv.Lic.: specifically listed(%hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: '7• 1L Print name: / Date: ❑Plan Review Required(25%of permit fee): / State surcharge(12%of permit fee): Authorized signature: �d� TOTAL PERMIT FEE: - � � �� ��� ��� tThis permit application expires it a permit is not obtained within 180 Print name: ,(� J `V3.tGNL iT�J Date: days after it has been accepted as complete. Number of inspections allowed per permit. I.\Building\Permi ts\ELC_PermitApp_ELR_ERE.doe Rev 04/21/2014 440-4615T(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 I Q . I Each I Total 1 • Ren y Renewable electrical energy systems: Check Type of Work Involved: 5kvaorless 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 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(%z hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): (SEE OAR 918-309-0000) • Number of inspections allowed per permit. Check Type of Work Involved: ❑ Audio and Stereo Systems TI Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1:U3uilding\P ermi ts\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 CITY OF TIGARD ELECTRICAL PERMIT INI S. COMMUNITY DEVELOPMENT Permit#: ELC2015-00169 T I G A R O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/18/2015 Parcel: 2S 102 B D03200 Jurisdiction: Tigard Site address: 13075 SW PACIFIC HWY Project: Qush Hookah Subdivision: NORTH TIGARDVILLE ADDITION Lot: 35 Project Description: Add(3)new circuits and extend(6)existing circuits. Contractor: G&H ELECTRICAL CONSULTING LLC Owner: SANCHEZ, J GUADALUPE PO BOX 12901 ZAVALA, BLANCA E SALEM, OR 97309 10000 SW MOLLY CT TIGARD, OR 97223 PHONE: 503-302-3354 PHONE: FAX: FEES Quantity Description Date Amount 9 crt Branch Circuits wo/Purchase 03/18/2015 $115.54 Specifics: Service or Feeder 1 ea 12%State Surcharge- 03/18/2015 $13.86 Type of Use: COM Electrical Class of Work: ALT 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 in accordance 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. ATT N: on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR o 952-001- 010 through OAR 52-0 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issue By: k / 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: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' _ Date: gidity 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. Electrical Permit ApplicationRECEIVED 1 1112 ()I I II I I ,1 tI\I 1 City of Tigard Received e : if/5"eCa Date/B : Permit 4. • 13125 SW Hall Blvd.,Tigard,OR 97223 MAR 1 8 2015 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/ Related Permit#: Inspection Line: 503.639.4175 Ready Date/By: Juris: ® See Page 2 for f I1 CITY OF TIGARD Notified/Method: Supplemental Information Internet: www.tigard-or.gov BUD DING DIVISION Pp TYPE OF WORK PLAN REVIEW . ❑New construction I Addition/alteration/replacement Please check all that apply(submit I 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 dwelling 'J Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 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 �/�' ❑Addition of new motor load of system. Job#: Job site address:/3 075 SW iP C Al4 ilk y. I00HP or more. ❑"A","E","t-z "t-s", City/State/ZIP: Q'7 2 ✓ ❑Six or more residential units. occupancy. tY 1rii/ / O ( / L 3 ❑Recreational vehicle parks. 0 facilities. P Suite/bldg./apt.#: Project name: p15# t TAR- ❑Hazardous locations. ❑Supply voltage for more than ❑Service or feeder 600 amps or more 600 volts nominal. Cross street/directions to job site: J.-0U 1...)(09-- FEE SCHEDULE Description I Qty. I Each I Total I • New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add'I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential MS3 / n (with above sq.ft.) 75.00 2 / ��w C z �r. r �� = �' Limited energy,multi-family /q�,�� residential(with above sq.ft.) 75.00 2 6 c2 Clete /1 / Renewable Energy _ ❑ See Page 2 ❑ PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100.70 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, .er panel A.Fee for branch circuits with Business name: G ��as�d7 `LC above service or feeder fee, 7.42 2 ��-/ each branch circuit Contact name: /ilU'! S dt4 B.Fee for branch circuits without / Address: Q 12g service or feeder fee,first G 56.18 -/Q 2 i . Q QQ �f branch circuit City/State/ZIP: ©11 7 3D/ Each add'I branch circuit $ 7.42 .2�0 2 4/ Miscellaneous(service or feeder not included) Phone:(frO3)3 1 3—160 Z Fax: ( ) Each manufactured or modular 67.84 2 f :. /M,,,� Al dwelling,service and/or feeder Email:h�/�'e Ct�' h—ee ca,(i� 1 Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: & ,.„,� B Redrew i" (oi �4, /LC Sign or outline lighting 67.84 2 '"f Signal circuit(s)or limited-energy ❑ See Page 2 2 Address: P 0, Ay; i.z q0/ panel,alteration,or extension. City/State/ZIP: 7G� / `� 3©, Each additional inspection over allowable in any of the above Additional inspection(I hr min) 66.25/hr Phone:(903) 7 p 3 —/6622_,_ Fax:( ) Investigation(1 hr min) 66.25/hr - / P I Industrial plant(1 hr min) 78.18/hr Email: n, co y_ej /•-e te i Co Inspections for which no fee is 90.00/hr CCB Lic.:213C-/-514,. Electrical Lic.:G O 3 sup.,Lie.:S n75 specifically listed C%2 hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: h Print name: veil /,,,,; X51,wa.� Date: 3 I frI ❑Plan Review Required(25%of permit fee): — �"'"r State surcharge(12%of permit fee): / .S(cy Authorized signature: TOTAL PERMIT FEE: /a9.yp ,......<;:„..-- _��- This permit application expires if a permit is not obtained within 180 Print name:> �,i ' ce 14 Date: 3,—/5 /b days after it has been accepted as complete. * Number of inspections allowed per permit. 1:1Building\Permits\ELC_PermitApp_ELR_ERE.d ev 04/21/2014 440-4615T(1I/OS/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 I Q . I Each I Total 3' Renewable ry electrical energy systems: Check Type of Work Involved: 5 kvaorless 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 552.26 2 with OAR 918-309-0040) ❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over25 7.42 3 n Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: n Other: Each additional inspection is 66.25/hr charged at an hourly(I hr min) Inspections for which no fee is 90.00/hr 1 specifically listed(''/hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 Subtotal per Page 1): y ' Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1:\Building\Permits\ELC_PermitApp_ELR_ERE.doe 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 13075 SW PACIFIC HWY, TIGARD, OR, 97223 Commercial - Electrical 199 Electrical final PASS - No C of O ELC2015-00169 Jeff Grove Violation Summary: Inspector Contractor