Permit q CITY OF TIGARD ELECTRICAL PERMIT
'1 • COMMUNITY DEVELOPMENT Permit#: ELC2015-00702
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/31/2015
Parcel: 25101 DB01000
Jurisdiction: Tigard
Site address: 7080 SW FIR LP 110
Project: Shroyer Office Subdivision: 72ND BUSINESS CENTER Lot: 12
Project Description: (1)new panel and(20)branch circuits for TI
Contractor: JM3 ELECTRICAL&CONSTRUCTION LLC Owner: SHROYER FARMS INC
10500 SW CLYDESDALE TERR PO BOX 789
BEAVERTON,OR 97008 PHILOMATH, OR 97370
PHONE: 503-961-3537 PHONE: 541-929-2694
FAX: 503-718-7268
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 08/31/2015 $100.70
Specifics: amps or less
20 crt Branch Circuits w/Purchase 08/31/2015 $148.40
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 08/31/2015 $29.89
Electrical
Type of Const:
Occupancy Grp:
Total $278.99
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 cordance 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. ENTION: Oreg• I. -quires you to follow the rules adopted by the Oregon Utility Notification Center. es are -t forth in OAR
952-00 -0010 through OAR 9: -001-00:0. •u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.•i • 1.80'.332.2344.
Iss ed By: /A �I/ ,,_,____,/ , Permittee Signature: . -/�Y.., ����
..,"%:,:r <■---...—
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:
CONTR• TOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' 4111 / / _ _ _ Date: 4 .2/5--��
i
LICENSE NO. ` 7 S
Call 503.539.4175 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 I il I I ,I 1
City of Tigard EIVEI D gm Permit Ek��,s c���
itil
• 13125 S W Hall Blvd..Tigard.' ' • Plea Review
■ Phone: 503.7182439 Fax: 503.348.1960 Datt•.;. : Related hermit u:4_ u p&ys-: /73
Inspection Line: 503.639.4175 Ready Dale By: Jura: 0 See Page 2 for
11 G A R I) Internet: www.tigard-ur.gtw AUG 31 2015 Notified Method: Supplemental Information
TYPE t PLAN REVIEW
❑New construction ❑Additiet� (r 1 I . u i,, Please check all that apply(submit 1 sets of Plans w items checked):
❑Demolition ❑aheBIIILDING DIVISION 0 service or feeder 400 amps or more ❑Building over three stories.
where the available fault cement ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at ISO volts or ❑Floating buildings.
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building kt,x to ground.or exceeds 14.000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑rite pump. 0 Installation of 1 SO KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system larger separately derived
d ❑Addition of new motor load of system.
Job#: I Job site address: Oi) c to hr- joy, 100111'or more.
City/StatdZll a f��jj��'' ❑Six or more residential units. occupancy.
Y 2 ❑1 kahh care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: 0yi2 oc-r/C£ ❑Hazardous localionr. ❑Supply voltage for more than
❑Service or kedge 600 amps or more. 600 volts nominal-
Cross street/directions to job site: FEE.TiCIIEDUI.E
Dmcriallan I On. ) Ea* I Tetal I
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parccl#: 1.000 sq.it or less 168.54 4
La.add'I Sts)sq.fl.or ponion 33.92 I
DESCRIPTION OF WORK limited energy,residcntiel
T (with above sq.6.) 75.00
1• Limited energy,multi-family 75
residential(with above sq.l )
❑ PROPERTY OWNER 1 ❑ TENANT Renewable Energy ❑ see Page 2 _
Services or feeders installation,alteration,and/or relocation
Name: 200 amps or Ices / 100.70 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 I,al)amps or,ohs 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
intended for sale,lease,rent,or exchange,according to ORS 447.449,670.and 701. 201 amps to 400 amps 125.08 _
Owner signature: _Date: 401 amps to 599 amps 168.54 _
❑ APPLICANT 1 o CONTACT PERSON Branch circuits—new,alteration,or extension, r panel
A.Fee for branch circuits with
Business name: above service or feeder fee, " 7.42 /gig WI
each branch circuit
Contact name: B.Fee for branch circuits without
Address:
service or*eater fee.OM 56.18 2
branch circuit
City/Stale+ZIP: Each add'!branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Far::( ) Each manufactured or modular
67.84 2
dwelling.service andfor feeder
Enroll: Reconnect only 67.84 2
CONTRACTOR - Pump or irrigation circle 67.84 2
Business name: Z L/e E �tj+ / Sign or outline lighting 67.84
J C Signal •cinvn(s)or limited-Lycra 2
Address: /d�D S,`1). e. y ZA �rraree panel,alteration.or extension. ❑ Page 2
City/State/ZIP: e4 1,,49�DIf 9n X
Each additional al inspection insI I hr on over allowable.2 any of the above
y "v Additional insprchias 1 I hr min) 66.25/hr
Phone:(5p3 € ‘/—353 7 1 Fax:($ j') ,Z/ ' �Z fag Investigation(1 hr min) . 90.00/hr
Email: 3 p/ T r Industrial plant(1 hr min) 78.18,hr
• 451-'v?✓Gr tot ��M4Z -co Inspections for which no fcc is
CCB Lic.: 19 4/ I Elect cal Lic.: C 1 Suprv.Lic.: .j-2-99$ , specific■nvv listed ' hr min) _ 9o.00e hr
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,requir d: Subtotal: 5../
Print name: je/a1,7 Afgrerzo fir-g 22 /s ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): ` 9.9'9
TOTAL PERMIT FEE:
Authorized signature: 7 g
This permit application expires if a permit is not obtained Male 100
I Print name: Date: doss after it has been accepted as complete.
s Number of inspections alkwcd per p crnlit
I.Madding Peima,tiC Pram*Aav ELR ERE der Sc,OF 1':0I5 4404615111 I O5 COS1 N'ER
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
7080 SW FIR LP 110, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00702
Chip Barnett
Violation Summary:
Inspector Contractor