Permit CITY OF TIGARD ELECTRICAL PERMIT
'`111 e . COMMUNITY DEVELOPMENT Permit#: ELC2015-00703
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: Low voltage for data.
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 Signal circuit or Limited 08/31/2015 $75.00
Specifics: Energy Panel
1 ea 12%State Surcharge- 08/31/2015 $9.00
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $84.00
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 acco •-• - • h 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. ATT. • ION: Oregon -w requires you to follow the rules adopted by the Oregon Utility Notification Center. Those in OAR
952-001 .010 throug OAR 952-0, -00'.You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987,:.---•
Issu•• By: / Cy Permittee Signature: V
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:
ONTRACTO` INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' !. = ..� _ Date:
LICENSE NO. 15-79F5
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 Applicati I ()It OFFICE USE ONLS
�ECEIVE� Received d/ � ,� �j
City of Tigard Date/B : 8[.M �i:% Permit N. �I 5- 7Q3
't 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie
Phone: 503.718.2439 Fax: 503.598.1 Q 2015 Date/B : Related Permit#: .P�DiS�d%7 ,
Inspection Line: 503.639.4175 Ready Date/By: 1uris: RI See Page 2 for
TIGARP Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE Q�j� iitj PLAN REVIEW
❑New construction ❑AdditiotlfA r<1 �'. .r!altIOi\ Please check all that apply(submit,sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑Floating buildings.
❑ I-and 2-family dwelling ❑Commercial/industrial El 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
Job#: I Job site address: �7a6,0 5 / ❑100H Addition of new motor load of system.
• �/r �-!/d 100HP or more. ❑.•A•• ••E„ ..1.2„••1_3„
City/State/ZIP: /,' Q✓� R-22 3 ❑Six It more residential tie. units. Recreational// ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: "O I Project name: t yj2 e CA., ❑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 Q■. I Each I Total I `
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'l 500 sq.ft.or portion 33.92 I
DESCRIPTION OF V4'ORK Limited energy,residential
/_ .// 75.00
�� ( Limited energy,multi-family 75.00
residential(with above sq.ft.)
Renewable Energy ❑ Sec Page 2
❑ PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 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:( ) 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 Branch circuits—new,alteration,or extension,per panel
_ __ ❑ I 0 PERSON
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZiP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax: :( ) Each manufactured or modular
67.84 2
Email: dwelling,service and/or feeder
Reconnect only 67.84 2
CONT CTppR Pump or irrigation circle 67.84 2
Business name: ,7'%_` Sign or outline lighting 67.84
Address: / j' �j r Signal circuit(s)or limited energy ❑ See Page 2 ! 2
D f - 'bJ (/ es t j r,acei panel,alteration,or extension.
City/State/ZIP: ��/State/ZIP: 977 t/ (, Each additional inspection over allowable in any of the above
V. Q Additional inspection(1 hr min) 66.25/hr
Phone:(5-01) l iriF, 3 I Fax:( ) Investigation(1 hr min) 90.00/hr
Email: _TM 1 P/fr Ala,/'i'O m Industrial plant(1 hr min) 78.18/hr
r/� n n Inspections for which no fee is 90.00/hr
CCB Li /4,,Q '1 Elec cal Lie.: ' j Suprv. Lie.: 3.��1_ specifically listed( hr min)
( ( signature, ELECTRICAL PERMIT FEES
Suprv.Electrician si required: Subtotal: _
Print name: I Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature:
TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained ssithin 1811
Print name: Date: daps after it has been accepted as complete.
Number of inspections allowed per permit.
1:'Building.Permits,.ELC_PermitApp_ELR ERE.doc Rev 06/17/2015 440.4615T(lI/OS/COM/WEB
■
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY, FEE SCHEDULE
w .
Fee for all residential systems combined: $75.00 I ��'` 1 Each ,vial �
Renewable Renn ewwaable electrical energy systems:
Check Type of Work Involved: s kva or less 100.70
5.01 to 15 kva 133.56 2_
El Audio and Stereo Systems* 15.01 to 25 kva 200.34
Wind generation systems in excess of 25 kva:
n Burglar Alarm 25.01 to 50 kva 301.04 _
50.01 to 100 kva 552.26
Garage Door Opener* >100 kva(fee in accordance 552.26
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
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
I I Other: Each additional inspection is 6625/hr
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specilicall■ listed('_hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
y • 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
El Intercom and Paging Systems
n Landscape Irrigation Control*
Medical
Nurse Calls
I I Outdoor Landscape Lighting*
Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
InBuilding,Pennits\ELC PermitApp_ELR_ERE.doc Rev 06 17 2015
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
ELC2015-00703
Jeff Grove
Violation Summary:
Inspector Contractor