Permit CITY OF TIGARD ELECTRICAL PERMIT
R • COMMUNITY DEVELOPMENT Permit#: ELC2015-00318
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/14/2015
Parcel: 1 S126DC04800
Jurisdiction: Tigard
Site address: 9495 SW LOCUST ST A
Project: Baker Research Center Subdivision: LEHMANN ACRE TRACT Lot: 4
Project Description: Electrical for TI:(1)200 amp service,(1)400 amp service,and(79)branch circuits.
Contractor: TICE ELECTRIC Owner: MATHESON, ROBERT T REVOCABLE TRU
5405 N LAGOON AVE. BAKER,JAMES
PORTLAND, OR 97217 BAKER, DIANE R
1030 NW JOHNSON ST#610
PORTLAND, OR 97209
PHONE: 503-872-8230 PHONE: 503-379-0106
FAX: 971-230-3330
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 05/14/2015 $100.70
Specifics: amps or less
1 ea Services or Feeders-201 to 05/14/2015 $133.56
Type of Use: COM 400 amps
Class of Work: ALT 79 crt Branch Circuits w/Purchase 05/14/2015 $586.18
Service or Feeder
Type of Const: 1 ea Plan Review Electricial 05/14/2015 $205.11
Occupancy Grp: 1 ea 12%State Surcharge- 05/14/2015 $98.45
Electrical
Total $1,124.00
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 0•" 9'2-s• s s•r. -u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
� �
Issued By: t //r��� 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 FOR mulct,: usi:()NIA
City of Tigard (`E�VED Received �� `
III DDate/By: i� x Permit No.:
• 13125 SW Hall Blvd.,Tigar ff 3 Plan Revie I�►
>s Phone: 503.718.2439 Fax: 503.598.1 60 4 015 Date/B : / _MIMI Other Permit:S /, I.
T I G A R D Inspection Line: 503.639.4175 OM Date Ready/:y: • 10 See Page 2 for
Internet: www.tigard-or.gov ^pD Notified/Method: jy� �` Supplemental Information
f:C�
"'-.= a'e x i< TYPE�'.y'{� -7nr'7.Az,",01\1 N 4 j""rt `y' PLAN REVIEW
'.;.;'3.'t;,:..-''
❑New construction 0 ]Mil i-1 ." Please check all that apply(submit 2 sets of plans w/items checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other:
where the available fault current ❑Marinas and boatyards.
¢ ,"` " `* DRY' ttota l ttie D 1 r `,-.-.%'':',':;...-.1',-;•-;:; 'ti q• exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ I-and 2-family dwelling ®Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑ Multi family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JO$ SITE. INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
0 Addition of new motor load of ❑"A" "E" "I-2" "I-3"
Job no.: t y 4 5-ti I Job site address:9495 SW Locust St IOOHP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97223 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: I Project name: Baker Research Center ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:Greenberg Rd Description I Qty. I Fee. I Total I
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
75.00 2
' k DESCRIPTION OF,WORK. (with above sq.ft.)
Limited energy,multi-family 75.00 2
Minor remodel of existing space including removal and replacement of existing residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
branch wiring and additional circuits to accommodate new and existing loads Services or feeders installation,alteration,and/or relocation
200 amps or less 1 100.70 100.70 2
® PROPERTY'OWNER. ❑ TENANT' ` .
201 amps to 400 amps 1 133.56 133.56 2
Name: Dr.James Baker 401 amps to 600 amps 200.34 2
Address:9495 SW Locust St 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP:Tigard,OR 97223 Temporary services or feeders installation,alteration,and/or
Phone:(503)379-0106 I Fax:(503)715-1378 relocation
200 amps or less 59.36 l
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 168.54 2
Owner signature: Date: Branch circuits—new,alteration,or extension,per panel
® APPLICANT I ❑ CONTACT PERSON A Fee for branch circuits with
above service or feeder fee, 79 7 42 586.18 2
Business name:Tice Electric Company each branch circuit
B.Fee for branch circuits without
Contact name:Tim Zumwalt service or feeder fee,first 56.18 2
branch circuit
Address:5405 N.Lagoon Ave Each add'I branch circuit 7.42 2
City/State/ZIP: Portland,OR 97217 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(503)233-8801 I Fax: :(503-)872-8292 dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail:timz@ticeelectric.com Pump or irrigation circle 67.84 2
' CONTRACTOR Sign or outline lighting 67.84 2
Business name:Tice Electric Company Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address:5405 N Lagoon Ave Each additional inspection over allowable in any of the above
City/State/ZIP:Portlane,OR 97217 Additional inspection(I hr min) 66.25/hr
Investigation(I hr min) 66,25/hr
Phone:(503)233-8801 I Fax:(503-)872-8292 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 166 I Electrical Lic.: 26-126C Suprv.Lic.: 3940-S specifically listed('/2 hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: ,adivi Subtotal: ..22A44 �u
Print name: 606 /6�ar.ds� Date: 4/24/15 Plan review(25%of permit fee): •...242:G1-- , , u
State surcharge(12%of permit fee): -1.164& q Let5
Authorized signature: TOTAL PERMIT FEE: -13275//, /may,R
Print name: Date: 4/24/15 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
" Number of inspections allowed per permit.
1:1 Building1Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(11/05/COM/WEB
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