Permit (115) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2016-00011
13125 SW Date Issued: 01/11/2016 Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S135DA03500
Jurisdiction: Tigard
Site address: 11481 SW HALL BLVD 100
Project: HCC Subdivision: METZGER ACRE TRACTS Lot: 19
Project Description: Electrical for TI:Installing(5)branch circuits.
Contractor: GARY'S ELECTRIC CO LLC Owner: BECKAL LLC
1401 SW WALLULA DR 7100 SW GABLE PKWY
GRESHAM, OR 97080 PORTLAND, OR 97225
PHONE. 503-465-8145 PHONE.
FAX 503-465-8517
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo/Purchase 01/11/2016 $85.86
Specifics: Service or Feeder
1 ea 12%State Surcharge- 01/11/2016 $10.30
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $96.16
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 it work is not started within 180 days of issuance, or it 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 at forth in OAR
952001-0010 through OAR 952-001-0090. You n o es or direct questions to OUNC by calling 5q9, 2.1987 or 1if.800.33 .2344.
Issued By: Fermi ee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I awn which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4176 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept In a conspicuous place on tho job site until completion of the project.
Approved plans are required on the job site at tha time of each inspection.
Electrical Permit A licatio CE1v 'p
City of Tigard ,i 2p RD ei,� // /(a Permit � 1(o—eTzill
13125 SW Hall Blvd.,Tigard,OR 97223 N Plan Review
I
Phone: 503.718.2439 Fax: 503.598.1960 -,A L�A�D e/B : Related Permit k: je—ot
Inspection Line: 8503.639..4175 (j1\ t QF Dw1tJ+` Dme/By: rwi.: 0 See Page 2 for
Internet: www.ti ardor. ov NG Notified/Melhod: Supplemehnl Information
TYPE OF 1`r PLAN REVIEW
❑New construction Addition/alteration/replacement please s }
check all that apply(submit 2 sets of plans w/ftemchecked
❑Other: where
Service or feed400 amps or more ❑Building over three stones.
E] Demolition
where the available fault current ❑Marrs and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or [I Floating buildings.
❑ 1-and 2-family dwellingCommercial/industrial E]Accessory building less to ground,or exceeds 14,000 ❑Com i ercW-ase agricultural
amps for all other installations. buildings.
❑ Multi-family E] Muster builder E]Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency systemlarger separately derived
6 ❑Addition of new motor load of system.
Job#: Job site address: S Q1 ❑
IOOHPormore. "A3"
","E","1.2","1- ,
City/State/ZIP: f tier ❑Six or more residential units. occupancy.
❑Healthcare facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ❑Hmordous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
DrMri rich ITOW
New residential single-or multi-family dwelling unit
#: Includes attached garage.
Subdivision: TLot
1,000 sqft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft or portion 33.92 1
T DESCRIPTION OF WORK Limited energy,residential
S C. •PCV .4~ +Or with above s .ft. 75.00 2
., Limited energy,multi-family
residential with above .ft.) 75,00 2
Renewable Ene ❑ See Pa e 2
[I 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 133.562
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 30104 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 12508 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
❑ APPLICANT ❑ CONTACT PERSON Branch circuits-am,alterati or extension,per 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 without
Address: service or feeder fee,first 56.18 /
branch circuit S{pr/ 2
City/State/ZIP: Each add']branch circuit L4742 k 2
Miscellaneous service or feeder not included
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67'84 2
Email: Reconnect only 6784 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: �` ,S E lei�'fxlkC C I 0 L ` Sign ortmime lighting 67.84 2
'•1 n Signal circulus)or limitedcnergy
Address: Q W Q 1 V j Npanel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: ('(,$ Q 9 7 �O Each additional ins ction over allowable in an of the above
I I// Additional inspection H hr min) 66.25/hr
Phone:(50.3) q tC T- p p 1 Liy Fax:6Q3 ) �- Investigation H hr min) 90.00/hr
Email: GO S tipr V 01 tip kG OVvI Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 9p Op/hr
CCB Lic.:)0103 4 Electrical Lic.:C j 010 Suprv'Lic.: ygs $ specifically I steel 'h hr min
„ ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: 77 1 Subtotal:
Print name: r K ` fl0 R Dater d /IZ0 [3 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): Q. 0
Authorized signature:
TOTAL PERMIT FEE: i
This permit aPPlintioo expires if a permit]snot obtained vo 'a 180
Print name: Date: dap after it has been accepted as complete.
• Numbm of inspections allowed per permit.
Itauildie@T.ts C PennitApp ELa ERE.doc ae WIM015 a464615T(I IIOSICOM/WEa
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
11481 SW HALL BLVD 100, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00011
Jeff Grove
Violation Summary:
Inspector Contractor