Permit CITY OF TIGARD ELECTRICAL PERMIT
_ COMMUNITY DEVELOPMENT Permit#: ELC2015-00198
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/3112015
TIGARD Parcel: 2S112AC03000
Jurisdiction: Tigard
Site address: 14775 SW 74TH AVE
Project: Fanno Creek Business Park Subdivision: 2003-010 PARTITION PLAT Lot: 1
Project Description: (2)200 amp service and(10)branch circuits for power to shop area for equipment
Contractor: NORTH RIVER ELECTRICAL CONSTRUCTION Owner: MJR INVESTMENTS LLC
PO BOX 780 12665 SW 69TH AVE
BORING, OR 97009 TIGARD, OR 97223
PHONE: 503-658-1911 PHONE.
FAX: 503-658-8783
FEES
Quantity Description Date Amount
2 ea Services or Feeders-200 03/31/2015 $201.40
Specifics: amps or less
10 crt Branch Circuits w/Purchase 03/31/2015 $74.20
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 03/31/2015 $33.07
Electrical
Type of Const:
Occupancy Grp:
Total $308.67
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 rules are set forth in OAR
952-001-0010 through•'- 9 -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
_—
Issued By: �►�//lam — Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent
OWNER' SIGN/ Date:
CONTRACTOR INSTALLATION ONLY
SI N AIR • SUPR.ELEC' Date:
LICENSE NO. ��/ S-
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 RECEIVE FOR OFFICE USE ON I l
City of Tigard RECEIVE �Ir� ed t�_i/ -90/9,
,3 / �.J 1.7'r Permit#
1111
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
• Phone: 503.718.2439 Fax: 503.598.1960 MAR 3 1 2015 Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: linSI RI See Page 2 for
I I t''\ I1 Internet: www.tigard-or.gov CITY OF TIGAR
' otifed/Method: Supplemental Information
/TYPE OF WONSUILDING DIVISION PLAN REVIEW
❑New construction mf 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.
CATESORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling 110 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
Addition of new
Job#: I Job site address: /'/7 7 S— ,S2,,.) 7' ' ' ❑100HP or more.motor load of system.
City/State/ZIP: ) ❑Six or more residential units. occupancy.
ty 1 I' '— G~ �y.t.- ❑Recreational vehicle parks.
❑Health Health-care facilities. P
Suite/bldg./apt.#: I Project name: / Hazardous locations. ❑Supply voltage for more than
�J Service or feeder 600 amps or more 600 volts nominal.
Cross street/directions to job site: a, ,' Ilry FEE SCHEDULE
Description I Qty. I Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision: I 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
(with above sq.ft.) 75.00 2
�+°-.mot x^ �r^�7r�°C^w..T— �,?"''^�l Limited energy,multi-family '
residential(with above sq.ft.) 75.00 2
S&f� �' 14 / ' ��v``Pp'�y Renewable Energy CI See Page 2
��❑ PROPERTY OWNER 1 ❑ fENA1VT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 12 100.70 ?b/,civ 2
Address: 201 amps to 400 amps 133.56 i 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 I ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit fie:, 7.42 .2,i. 2
-
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
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 67.84 2
Email: /1(0/Z.7-6` Al Y a£Z�C f( dw lin ct only and/or feeder
connect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:/ �rX.L /hc. ��s tL Sign or outline lighting 67.84 2
- Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: /0. 5 , ,s.'d A. -, panel,alteration,or extension.
City/State/ZIP: G9..5 erzs ...? 91009' Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:(• j G s.- ' /1/) ( Fax:( ) G{-red - ,el✓1 Investigation(I hr min) 66.25/hr
Email: Industrial plant(1 hr min) 78.18/hr
i
��r1.,,:,,A_ .s4-7 A/C� .a--A--- i C.-0^'�. Inspections for which no fee is
CCB Lic.: 3 J _ --7,e, I p specifically listed(%2 hr min) 90.00/hr
�. 3 7 Electrical ic.: Suprv.Lic.:$4/S 7
77 ELECTRICAL PERMIT FEES
Suprv.EIec4I g4ature,requir 7///�7 /p//I/4p Subtotal: 0275,4,D
Print name:5k�� r/`�s Date: J„36„J ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 33 0 7
Authorized signature: TOTAL PERMIT FEE: 3D f,67
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.
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. f Each I Total I
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 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 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:
n Each additional inspection is
I Other: charged at an hourly(1 hr min) 66.25/hr •
Inspections for which no fee is 90,00/hr
specifically listed(%S hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00
* Number of ins
(SEE OAR 918-309-0000) pections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
n 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.doc Rev 04/21/2014