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Permit (188) CITY OF TIGARD ELECTRICAL PERMIT • COMMUNITY DEVELOPMENT Permit#: ELC2016-00067 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/28/2016 Parcel: 1 S135BD01100 Jurisdiction: Tigard Site address: 9780 SW SHADY LN 100 Project: Anitian Subdivision: MEADOW VIEW Lot: 8 Project Description: TI-(7)branch circuits Contractor: WILLAMETTE ELECTRIC INC Owner: SHADY LANE COMMERCIAL BUILDING PO BOX 230547 LIMITED PARTNERSHIP TIGARD, OR 97281 7720 SW WESTGATE PORTLAND, OR 97225 PHONE: 503-624-3631 PHONE: FAX: 503-624-2938 FEES Quantity Description Date Amount 7 crt Branch Circuits wo/Purchase 01/28/2016 $100.70 Specifics: Service or Feeder 1 ea 12%State Surcharge- 01/28/2016 $12.08 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $112.78 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTIO on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-001 ro�=LA)allt4 001- ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued(By-. 4�x Permittee Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale,lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' Date: a LICENSE NO. o�el ZItP 5 Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Electrical Permit Appliatl>� ' OFFICE USE ONLY Received 11 City Of Tigard - Date/By: Permit#: leo(0169" 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.59$W60ff Date/By: Related Permit#: 4U,P''616 0036 Inspection Line: 503.639.4175 "'" t` Ready Date/By: Juris: 0 See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information ❑New construction O'Additi $t kr e°rrtehY' Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more [IBuilding over three stories. El Demolition El Other: where the available fault current ❑Marinas and boatyards. exceeds 10,000 amps at 150 volts or ❑Floating buildings. El1-and 2-family dwelling �Commercial/industrial El Accessory building less to ground, exceeds El Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or El Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Z 6 g Job site address: 9 72f 0 S cn. S 4 d of L a, e 100HP or more. ❑"A","E","1-2","1-3", City/State/ZIP: T i Z,, , C IL 9Z Z J El Six or more residential units. occupancy. / ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Project name: ❑Hazardous locations. ❑Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: Description I Qty. 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#: Ea.add'1500 sq.ft.or portion 33.92 1 Limited energy,residential 75.00 2 with above sq.ft. Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Ener ❑ See Pa e 2 mono=Q 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 ,� Branch circuits—new,alteration,or extension, er panel ` � 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 Address: service or feeder fee,first 56.18 S 6 i 2 branch circuit City/State/ZIP: Each add'1 branch circuit 1 6 1 7.42 1 2 Miscellaneous service or feeder not included Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2 Email: dwelling,service and/or feeder Reconnect only 67.84 2, © ,: Pump or irrigation circle 67.84 2 Business name: 8 Tj-t 67 1 e c �A nc Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address: B 2 3 O ty panel,alteration,or extension. ❑ See Page 2 2 City/State/ZIP: S �L fl� 7 Z�� Each additional inspection over allowable in an of the above Additional inspection(1 hr min) 66.25/hr Phone:(T1,T 162 _ 3 Ii 3 - Fax:X'-3) d Z y— Z Investigation(I hr min) 90.00/hr Email: Industrial plant(I hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: 7,C* Electrical Lic.:3 'L�3 G Suprv.Lic.: Z y y 6,r specifically listedY2 hr min Suprv.Electrician signature,required_ Subtotal: 160 .7V Print name: Date: 1-17-111 ❑Plan Review Required(25%of permit fee): paoiZ State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: /y 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. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(I1/05/COM/WEB 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 9780 SW SHADY LN 100, TIGARD, OR, 97223 Commercial - Electrical 199 Electrical ﬁnal PASS - No C of O ELC2016-00067 Jeff Grove Violation Summary: Inspector Contractor