Permit (39) CITY OF TIGARD ELECTRICAL PERMIT
`x'11 ' COMMUNITY DEVELOPMENT Permit#: ELC2016-00264
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/04/2016
Parcel: 2S112DD00400
Jurisdiction: Tigard
Site address: 15954 SW 72ND AVE
Project: Environmental Controls Subdivision: None Lot: None
Project Description: (6)branch circuits and low voltage for data telecommunications system.
Contractor: ENVIRONMENTAL CONTROLS CORP Owner: PACIFIC REALTY ASSOCIATES L P
15860 SW UPPER BOONES FERRY RD 15350 SW SEQUOIA PKWY#300-WMI
LAKE OSWEGO, OR 97035 PORTLAND, OR 97224
PHONE: 503-544-9819 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Limited Energy 04/04/2016 $75.00
Specifics:
6 crt Branch Circuits wo/Purchase 04/04/2016 $93.28
Service or Feeder
Type of Use: COM 1 ea 12%State Surcharge- 04/04/2016 $20.19
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $188.47
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. Yo •• •• rules or direct questions to OUNC by calling 503.232.1987 or 1..800.332.2344.
Issued By: ��_ Permittee Signature: 4/37
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application Foli orrlcl: 1 St:c)\l.l
Cl O{Tl and Received ,Ili `J J g /il8N
Date/B : ff//�jg
lifi
w 13125 SW Hall Blvd.,Tigard,OR 972 Plan Review
= Phone: 503.718.2439 Fax: 503.598.(960 V$ Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: ® See Page 2 for
1 I( ARD Internet: www.tigard-or.gov Notified/Method: Supplemental Information
P * 1' v
..: ;i7.:, E°F,*141411%x.11 _ , ,1 £' � " v.,
❑New construction ad Addition/alteration,tie Please check all that apply(submit 2 sets of plans w/items checked):
❑ Demolition 0 Other:
` �� 0 Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
" . :N'$ Uc[o]1T ," ,'-'''' exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling C1t' �ommercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOBCATI9N" I. `' 0 Emergency system. larger separately derived
� Q �,-,�. .,.-� .
❑Addition of new motor load of system.
Job#:/51 SU f Job site address: /59.5w Sw 72• Av>L 100HP or more. ❑"A","E","1-2","1-3",
❑Six or more residential units. occupancy.
City/State/ZIP: Ted,/ ei-c."07., 9 7 2-2-14 ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: E V v��wIK(etT.,' ❑Hazardous locations. 0 Supply voltage for more than
ti t r/G /�♦ 600 volts nominal.
0 Service or feeder 600 amps or more.
Cross street/directions to job site: ���� ��tssa� 'r� rd ; r," . 'SCHEDULE ,
Description I Qty. (' 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 sqft.or portion 33.92 1
.DESCRIPTION OF WORK Limited energy,residential
,/ // (with above sq.ft.) 75.00 2
/aw Yo/r� tYu/01 G-- �t✓L� �r� LSF{o. Limited energy,multi-family 75.00 2
JJ residential(with above sq.ft.)
Crop ,P•4-5U_ Renewable Energy 0 See Page 2
0 PROPERTY OWNER I 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 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 I [ CONTACT PERSON circuits—new,alteration,or extension,per panel
0A.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
service or feeder fee,first i 56.18 �/ ib! 2
Address: branch circuit V
City/State/ZIP: Each add'I branch circuit 5 7.42 g1, 10 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: e-AyVt .,„..„„' / CUypl,4 C,y p Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy 0.4.-...;Page 2 7 1 2
Address: panel,alteration,or extension. J
/58Lo Sw i11.QPer beasts let r..... d
r
Each additional inspection over allowable in any of the above
City/State/ZIP: L.Ac 654.,t.76 Oif.c.7..s• q T635 Additional inspection(1 hr min) 66.25/hr
Phone:(f,3 ) iy_9 /g I Fax:(5'3 ) 62,, _4(21 Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
�G rr� e G�a A-. c/. C1 � Inspections for which no fee is 90.00/hr
CCB Lic.: 20 l2.O Si- I hElectrical Lic.: X e-3 Suprv. Lic.: Lr0q-7S specificallylisted(/�hrmin)
Suprv.Electrician sip�tlpature,required: ii//7 / ELECTRICAL
EC FEES
��y ,e,Vi-7-- -,-..)
t!it, Subtotal: d
Print name: JL��!'Y C..S �6 A Ga.JS Date: 3/3 r/G 0 Plan Review Required(25%of permit fee): g`y . .aD
State surcharge(12%of permit fee): 20. J ?
Authorized signature: e.... TOTAL PERMIT FEE: / .47
g "rN �� w /� �� This permit application expires if a permit is not obtained wit m 180
Print name: c _, <c w /.�G u fh a rH� Date: 3/7 r/14 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELRERE.doc Rev 06,172015 440 4615T(11,05,COM,WEB
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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
15954 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00264
Chip Barnett
Violation Summary:
Inspector Contractor