Permit 71 ._ „ CITY OF TIGARD ELECTRICAL PERMIT
g - COMMUNITY DEVELOPMENT Permit#: ELC2015-00975
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/14/2015
Parcel: 2S 112AA00400
Jurisdiction: Tigard
Site address: 14280 SW 72ND AVE
Project: Leifs Auto Collision Subdivision: MILLMONT PARK Lot: 49
Project Description: (1)branch circuit for mix room computer.
Contractor: MOUNTAIN F ENTERPRISES INC Owner: ICON OWNER POOL 1 WEST LLC
25973 S MOEHNKE LN BY RYAN
BEAVERCREEK, OR 97004 PO BOX 460169
HOUSTON, TX 77056
PHONE: 503-313-0761 PHONE:
FAX: 503-632-5521
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 12/14/2015 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/14/2015 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 issuanc or if work is suspended or more the 180
days. ATT ' •`I: li, •.on law requires you to follow the rules adopted by the Oregon Utility Notification Ck ter. Those rules ar et forth in OAR
952-001-r/10 through OAR '52- 090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.237 1.80 332.23
Issue. =y: _/ \ V Permittee Signature: . / ( _l'
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 T R INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' _ al/i. _ Date: /A V4S.
LICENSE NO. 3 7 f S
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 ApplicatIE CEIVEP FOR OFFICE USE ONLY
CityofTigard Received ueo�/S-� 975
g Date/By: �Z �u �� (.L� Permit n: �
•
;� 13125 SW Hall Blvd.,Tigard,OR 9M3r 1 4 ;^ Plan Review
Phone: 503.718.2439 Fax: 503.59 1960 Date;'By: Related Permit 5:
Inspection Line: 503.639.4175 ii qty Ready Date/By: Juris: ® See Page 2 for
TIGARI) Internet: www.tigard-or.gov l l l`Y UI 11VAKU Notified/Method: I Supplemental Information
TYPEB#4101I4G DIVISl01N PLAN REVIEW
0 New construction ❑Addition/alteration/replacement Please check all that apply(submit 1 sets of plans w items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or 0 Floating buildings.
0 I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground.or exceeds 14.000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#: Job site address: / Z ffD SlA) 77 -1.64 10011P or more. ❑"A","E","1-2" "i-3"
City/State/ZIP: 2 ? ❑Six or more residential units. occupancy.
/y/ 4 d ! ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: kE,ft.5 ofuro & LI s/O'J 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Descripl ion I Q13. 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 75.00 2
•Ci I/04 i /t__ OW /� /�� �-" (with above,q. t)
! G{/tM/I NT`Y Limited multi-familyenergry, 75.00 2
// residential(with above sq.ft.) ,
Renewable Energy• i 0 See Page 2
0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address:
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 1
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 2
APPLICANT Branch circuits—new,alteration,or extension,per panel
0 ❑ CONTACT PERSON A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without �j �j
service or feeder fee,first / 56.18 —gyp e it 2
Address: branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) 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: 070,./4770.0IJ, -'- •1_.,2-ze. '2&4/`i"-t44r4)`/nhl ,Kket • Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: 2 S-1'1 5 S. imp 6,-,/,vici6 z-/v. panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: p f Each additional inspection over allowable in any of the above
ty � �C��—f�'C /" Additional inspection(I hr min) 66.25/hr
Phone:633) Fax:
3i 2� on, (1E73) 6,3 2 �S-2 f Investigation(I hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: AOiiJ7 .,a f-Ze) 0 6,144-Ic inspections for which no fee is
"iv it/ 90.00/hr
5 93-L Electrical Lic.:5
CCB Lic.:� .5y 1.-e Suprv. Lic.: 3�Z/5 specifically listed('_hr min)
i — ELECTRICAL PERMIT FEES
Suprv. Electrician signature,requires 41' F_ Subtotal:
Print name: g-
r-
f_ -1 t.) _/S 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): to.Q
TOTAL PERMIT FEE: (, Zr Z
Authorized signature: L
This permit application expires if a permit is not obtained within 180
Print name: E. Date: days after it has been accepted as complete.
* Number of inspections allowed per pennit.
I:BuildingPermits'ELC PcrmitApp_ELR_ERE.doc Rev 06,17,2015 440-4615T(III05/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
Description Qir. I Each I Total I *
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n Audio and Stereo Systems* 15.01 to 25 kva 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
n G• arage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
n Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
n 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(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(Y 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:
n Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n D• ata Telecommunication Installation
❑ Fire Alarm Installation
n I-IVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n M• edical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Buitdme\Permits\tiLC_PennitApp_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
14280 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00975
Jeff Grove
Violation Summary:
Inspector Contractor