Permit IIq CITY OF TIGARD ELECTRICAL PERMIT
$ - COMMUNITY DEVELOPMENT Permit#: ELC2015-00227
Date Issued: 04/08/2015
TtGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S136AD04000
Jurisdiction: Tigard
Site address: 11509 SW PACIFIC HWY
Project: Six Demon Bag Subdivision: VILLA RIDGE Lot: 7
Project Description: (5)branch circuits for lights and outlets for new tenant.
Contractor: ALPINE ELECTRICAL OF OREGON INC Owner: PACIFIC TERRACE COMMERCIAL LLC
2915 22ND ST SE BY SMITH, EDITA M
SALEM, OR 97302 833 NW 170TH DR
BEAVERTON, OR 97006
PHONE: 503-991-9601 PHONE:
FAX:
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo/Purchase 04/08/2015 $85.86
Specifics: Service or Feeder
1 ea 12%State Surcharge- 04/08/2015 $10.30
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $96.16
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 ' coroa •ith 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. TTENTION. Orego law requires you to follow the rules adopted by the Oregon Utility Notification Cente. Those rules are set forth in OAR
952 01-0010 through OAR 952- 00•I ou may obtain a co y of the rules or direct questions to OUNC by calling 503.232.19 or 1.80 . .2344.
I ued By: ■ Permittee Signature: )<'
OWNER INSTALLATION ONLY GGG
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
l
SIGNATURE OF SUPR.ELEC' 4 4 / Date: 4/4//6—
LICENSE NO. i/774'
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.
tECEIVEII
Electrical Permit Application I.()1( mi.I( I I tif. ON 1
74 City of Tigard 1PR 8 2015 Received e Permit 6:tie;a5�'�0�7 g Date/B :iv
13125 SW Hall Blvd.,Tigard,OR 9722 Plan Review
1 Phone: 503.718.2439 Fax: 503.598.1960 +, I\ u,` DDate/I3 : Related Permit 6:
Inspection Line: 503.639.4175 CITY OF FIGARO Ready Date/By: lugs' 0 See Page 2 for
I k, \I:D Internet: www.tigard-or.gov Notified/Method: Supplemental Information
E ODING DIVISION PLAN REVIEW
❑New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
El Demolition ❑Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current ❑Marinas and boatyards.
CATEG9RY OF CONSTRUCTION exceeds 10,000 snips at 150 volts or ❑Floating buildings.
-❑ 1-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
f�SC' (AJ P/� ( `f/ ❑Addition of new motor load of system.
Job#: Job site address: S L Y [�� 100HP or more. ❑"A","E","1-Y',"t-3",
City/State/ZIP: / ()IL Z3 �1 ❑Six or more residential units. occupancy.
�1 ci � � 0 Health care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: .. / x veNO^)—{`} ❑Hazardous locations. ❑Supply voltage for more than
'�I /f Y 1� Hwy 9 y ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: sr (,{f FEE SCHEDULE
IN(A , 1 7/iC- b 1 /( li p` ,I i. ,/„ Description I Qty. I Each I Total I "
1 LL/l/, p r�' II�lV /'/ l/(� 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 _
75.00 2
UA v Sf f.f f " GVj/ -t i T r r j K( V S (with above sq.ft.)
Limited
energy,multi-family
75.00 2
/414/61 p,f,, //rL 001-15-T3 residential(with above sq.ft.)
V"1/li E Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER TENANT _Services or feeders installation,alteration,and/or relocation
Name: �Vf ckr srm 200 amps or less 100.70 2
I(r Co _c • I r`,, I�r e -0 201 amps to 400 amps 133.56 2
Address: (( "V I �I l[. �iy -
401 amps to 600 amps 200.34 2
City/State/ZIP: 1 6,4 f Ic� 601 amps to 1,000 amps 301.04 _ 2
Phone:(pi ) ��(,•- 009-i' I Fax:( ) Over 1,000 amps or volts 552.26 2
�(�I�S'Kt2�,1SrffDV GMA/L L�� 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,
7.42 2
each branch circuit
Contact name: L_utif S Olt B.Fee for branch circuits without
service or feeder fee,first 56.18 / 2
Address: PQ &X if branch circuit ,
City/State/ZIP: /t/l l( i U�_ rho( Each add'I branch circuit 7.42 Li^ 2
Miscellaneous(service or feeder not included)
Phone:(Ss ) ,0 D(7 I Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: /I,„G/f1J( ,(ayl aKL or over /o, Sign or outline lighting 67.84 2
Address: _1(S 2 UvO Si e !
Signal circuit(s)er n or limited-energy ❑ See Page 2 2
(( `! panel,alteration,or extension.
City/State/ZIP: _/�",, �/L q'3 d2 Each additional inspection over allowable in any of the above
i (��i1/� l Additional inspection(1 hr min) 66.25/hr
Phone: ) Fax:( ) Investigation(1 hr min) 66.25/hr
I/ Industrial plant(1 hr min) 78.18/hr
Email: ,,lll�(� �lj l f r�/� ��' Inspections for which no fee is
CCB Lic.:Z(J S ?'Tc/ Electrical Lie.: 0L-f-5 Suprv.Lie.:111-16 s specifically listed(%hr min) 90.00/hr
r ` ( ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: ,j/�j' 710/ Subtotal: �js•S(
Print name: Q ( ft Demn/P_S Date: 7/ZotS ❑Plan Review Required(25%of permit fee):
'" `"'1�. State surcharge(12%of permit fee): 10. j0
Authorized signature: TOTAL PERMIT FEE: 96. lb
,j This permit application expires if a permit is not obtained within 180
Print name: paK T ► 017,7/ Date: /�/�(S days after it has been accepted as complete.
'�I 66 / * Number of inspections allowed per permit.
1:\Buildinng\\Permits\ELC_PermitApp_ELR_ERE.doe Rev 04/21/2014 440-46151(11/05/COM/WEB
'3N
• 0 7
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 Renewable f Qty. I Each I Total I
3' 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 to25kva 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 Other: Each additional inspection is 66.25/hr
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page I): I
Fee for each commercial system: $75.00 • 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
El Landscape Irrigation Control*
❑ Medical
El 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
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
11509 SW PACIFIC HWY, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00227
Jeff Grove
Violation Summary:
Inspector Contractor