Permit CITY OF TIGARD ELECTRICAL PERMIT
`' 3 COMMUNITY DEVELOPMENT Permit#: ELC201500479
TWARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/18/2015
Parcel: 2S 102 DA00401
Jurisdiction: Tigard
Site address: 13125 SW HALL BLVD
Project: CITY OF TIGARD Subdivision: BARNUM PARK Lot: 9
Project Description: Rewiring electrical for office remodel in the Permit Center.
Contractor: E C COMPANY Owner: TIGARD, CITY OF
PO BOX 10286 13125 SW HALL
PORTLAND, OR 97296 TIGARD, OR 97223
PHONE: 503-224-3511 PHONE:
FAX: 503-295-3012
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 06/18/2015 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 06/18/2015 $6.74
Type of Use: COM Electrical
Class of Work: ALT 1 ea Investigation Fee 06/18/2015 $90.00
Type of Const: 1 ea Investigation 12%State 06/18/2015 $10.80
Surcharge
Occupancy Grp:
Total $163.72
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through••; 952-001-0090. You may ob='i a copy of the r - • -ct questions to OUNC by calling 503.23.11987 or 1.800.332.2344.
Issued By: — — s – -- - - Per -e Signature: '"G' ,
AKIO OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard �1`f�� Received •
!i Permit#: p— „i
lig Date/B / • _ _
13125 SW Hall Blvd.,Tigard,OR v •• G Plan Review
■ G Related Permit#:
Phone: 503.718.2439 Fax: 503. el p1C� Date/By:
Inspection Line: 503.639.4175 `,A, 1$ 2 Ready Date/By: mrisr El See Page 2 for
I I U:11:1) Internet: www.tigard-or.gov ,U-/'- O Notified/Method: iwc. Supplemental Information
TYPE OF W pF IA 1vr'It`s‘014 PLAN REVIEW
❑ New construction 14 Addition/alterr NOV* ant 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 � ler: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑Floating buildings.
❑ I-and 2-family dwelling %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
Job#: J Job site address: 13 J 2 5 C l,,./ e'{ L v D ❑1001-1 Addition of new motor load of system.
I OOHP or more. ❑"A" "E" "1-2","1-3",
City/State/ZIP: ITG t 0 g 9 7 Z.2- ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: f Project name: 1).61_/ ' c- V'-'L 4 ❑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'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
t .f / , / / w��/ ,�/ (with above sq.ft.) 75.00 2
j/ i L lJ R Y(LG /^/A/--� 46 W/"/"EC.z Limited energy,multi-family •
residential(with above sq.ft.) . 75.00 _
Renewable Energy _ ❑ See Page 2
PROPERTY OWNER ❑ TENANT _ Services or feeders installation,alteration,and/or relocation
Name: C/„Tj' i T�6-Ak i) 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 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Ps amps amps to 599 s 168.54 2
Owner signature: Date: P
Branch circuits—new,alteration,or extension,per panel
APPLICANT I ❑ CONTACT PERSON A.Fee for branch circuits with
irgf Business name: D /4-1P ^/t? above service or feeder fee.
7.42 -
each branch circuit
Contact name: D A B./ ‘ AD l (J'{�v' B.Fee for branch circuits without
Address: t r 2 r A/1� 7u vd- branch it feeder fee,first ' 56.18 57{ v
/ branch circuit /� v
City/State/ZiP: pi O 1KT�A ND o 2 1, 7 f.!0 Each add'1 branch circuit 7.42 2
�J _Miscellaneous(service or feeder not included)
Phone:($(. ) 5-77^ 37Z ct Fax: :( ) Each manufactured or modular 67.84
dwelling,service and/or feeder
Email: 0,n i e' (n/1 -C -ca- C p� Reconnect only 67.84
lug" �s CONTRACTOR Pump or irrigation circle 67.84 -
Business name: C./� c�M DPn f� Sign or outline lighting 67.84 _
(i Cif/ { Signal circuit(s)or limited-energy I3 See Pa e 2
Address: �It? i it/ L,/ I/e/ -A A) panel,alteration,or extension. Page
Q 0 PL-A � a 9 7 z- I Q Each additional inspection over allowable in any of the above
_ ) Additional inspection(1 hr min) 66.25/hr I
Phone:( ) I Fax:( ) investigation(1 hr min) i 90.00/hr. eqd
Email' 4,,.„,...„&:1e.r ' e �� _CO. GQ�► Industrial plant(1 hr min) 78.18/hr-
Inspections for which no fee is �/hr
CCB Lic.: a 9737 Electrical Lic'k5C..— Suprv.Lic.:5et 1$S specifically listed('/^-hr min)
Ai ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: �(Q 1 JV. Date:Gi tE(` t� ❑Plan Review Required(25%of permit fee):
f State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE: (6 3,7a
This permit application expires if a permit is not obta ned within 180
Print name: Date: days after it has been accepted as complete.
' Number of inspections allowed per permit.
IP Building'Permits`ELC_PermitApp_ELR_ERE.doc Rev 06,172015 440-4615T(I 105('OMM1HEB
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 Qty. Each I Total
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70
5.01 to 15 kva 133.56
n Audio and Stereo Systems* 15.01 to 25 kva 200.34
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
El 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
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specificallc listed('_hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page I):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
El Audio and Stereo Systems
Boiler Controls
I Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
HVAC
Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
I Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
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