Permit (17) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit E
Date Issuedd:: 12//21/2021/20-00997
15
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112DD01100
Jurisdiction: Tigard
Site address: 15700 SW UPPER BOONES FERRY RD
Project: Holiday Inn Express Subdivision: 1994-006 PARTITION PLAT Lot: 2
Project Description: (6)branch circuits for emergency light fixtures in corridors and stairwells
Contractor: INFINITY ELECTRICAL CONSTRUCTION LLC Owner:
32700 SE LEEWOOD LN#4A
BORING, OR 97009
PHONE: 503-209-0533 PHONE:
FAX: 503-826-8575
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo/Purchase 12/21/2015 $93.28
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/21/2015 $11.19
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $104.47
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 O 952- 01-0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503. 2.1987 or 1.800.332.234 .
Issued By: 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 ApplicafioECEIVEDnn Received
City of Tigard DEC 21 2015 Date/By: -Permit# 917'7
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review'
Phone: 503.718.2439 Fax: 503.598.100-ry OF TIGARD Date/By: Related Permit
Inspection Line: 503.639.4175 BUILDING DIVISION Ready Date/By: Juris: 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental information
Tyrg
PIANAREV19W
❑New construction Addition/alteration/replacement Please check all that apply(submit I sets of plans w/items checked):
0 Service or feeder 400 amps or more [I Building over three stories.
C]Demolition ❑Other: where the available fault current E)Marinas and boatyards.
K
-,;'-CA:TEG exceeds 10,000 amps at 150 volts or 0 Floating buildings.
OF
ORY
0 1-and 2-fami ly dwelling E]Commercial/industrial El Accessory building less to ground,or exceeds 14,000 [3 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family E]Master builder Other:Motel [I Fire pump. 0 Installation of 150 KVA or
LOCATION [3 Emergency system.JOB SITE INFORMATION AND ys larger separately derived
(3 Addition of new motor load of system.
Job#: Job site address: 15700 SW Upper Boones Ferry Rd I OOHP or more. ❑"A","E",-1-2",-1-3",
City/State/ZIP:Lake Oswego Or 97035 C3 Six or more residential units. occupancy.
0 Health-care facilities. [3 Recreational vehicle parks.
Suite/bldg./apt. TProject name:Holiday Inn Express [_l 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: t, . '1�-1 - -"-•
. .
,,-1 -FEE,SCHEDULE-,- .. . . .
13mription I Qq. I Each I Total
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 /I;z 164 4_11//0 0 Ea.add'I 500 sq.ft.or portion 33.92 1
DESCfV". OX,OF WPIK,,-
Limited energy,residential 75.00 2
Add eMergency light fixtures in corridors and stairwells
with above sq.ft.) —
Limited energy,multi-family 75.00 2
residential with above sq..ft
Renewable Energy 0 See Page 2
El'PR0PERtY,,,,OWNER:
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: 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 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
APPLICANTCONTACT,PERSON Branch circuits-new,alterati or extension,p r panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 7.42 2
each branch circuit
Contact name: B.Fee for branch circuits withola
Address: service or feeder fee,first 1 56.18 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit 5 1 7.42 1 37.10 2
Miscellaneous(service or feeder not included
Phone: Fax: Each manufactured or modular 67.94 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR
Pump or irrigation circle 67.84 2
Business name:Infinity Electrical Construction LLC Sign or outline lighting 67.94 2
Signal circuit(s)or limited-energy
Address:32700 SE Leewood Lane#4A panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP:Boring Or 97009 Each additional Inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:(503)209-0533 Fax:(503)826-8575 Investigation(I hr min) 90.00/hr
Email:Infinityelectllc@msn.com Industrial plant(I hr min) 78.181 hr
Inspections for which no fee is 90.001 hr
CCBLic.: 153274 /b/fPA /Iectrica]Lic.: C1170- I Spprv.Lic.: 2687-S f /19 specifically-I isted(Y2 hr min)
7 ELECTRICAL;,PERMIT.,FEES
Suprv.Electrician signature,required: Subtotal: 93.28
Print name: Jack R Brown Date: 12/18/15 0 Plan Review Required(25%of permit fee):
�7 9
State surcharge(12%of permit fee): t�.
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit. loll, Y*7
L\Building\Permits\ELC-PermitApp_ELkERE.doc Rev 06/17/2015 440-4615T(I l/05/COM/WEB