Permit (17) CITY OF TIGARD ELECTRICAL PERMIT
III s' COMMUNITY DEVELOPMENT Permit#: ELC2016-00402
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/17/2016
TIGARD g Parcel: 2S101DA00105
Jurisdiction: Tigard
Site address: 13009 SW 68TH PKWY B
Project: Extended Stay America Subdivision: VARNS ACRES Lot: 9
Project Description: Building B-detach and reattach(2)branch circuits for dry rot repair.
Contractor: TABER ELECTRIC CONTRACTORS LLC Owner: BRE/HV PROPERTIES LLC
1500 OREGON ST TAX DEPTARTMENT
ASHLAND, OR 97520 EXTENDED STAY HOTELS
OP BOX 49550
CHARLOTTE, NC 28277
PHONE: 541-218-1222 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 05/17/2016 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 05/17/2016 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 thr. • ••- '52-0 - 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: , _ r .d Aida. Permittee Signature: ( 71
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' �1 7 , Date:
LICENSE NO. 34/9 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 Application FOR OIFI( l ISE ON Ll
City of Tigard RECEIVED Received _� / f 04) 'Da A,
Permit#: I(�
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
I Phone: 503.718.2439 Fax: 503.598.1 Date/B Related Permit#: ` '�
Nt�Y 1 7 2016 �,,, oa/
Inspection Line: 503.639.4175 Ready Date/By: Juris• 63 See Page 2 for
II G l D Internet: www.tigard-or.gov CITY OF TIGARp Notified/Method: Supplemental Information
TYPE i+x. 'B*JG nIVISION PLAN REVIEW
El New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
1:1I-and 2-family dwelling jal Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family ❑Master builder ❑Other: ['Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: I Job site address: /3009 / $Th fig n l- ❑Addition mf oew motor load of system.
�'�� !7 f " ✓/ 1 Six or or more. ❑occupancy.
City/State/ZIP: Rp 7 4. '� ed. / ❑Health-care more residentialatie. units. Recreational vehicle
r� �-% ❑ facilities. ❑ parks.
Suite/bldg./apt.#: I Project name: f-- Tend e ( S �D� ❑Hazardous locations. 0 600p1olty s ome al.for more than
Y M. ❑Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. 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'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
d c� - (with above sq.ft.)
e !0c ii 3 �1p�c « h
i -C w 1 - rex- Limited energy,multi-family
75.00 2
1'- •7- t- o i/ t, dresidential(with above sq.ft.)
r �� Renewable Energy 0 See Page 2
0 PROPERTY OWNER ❑ T 'ANT 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
t'isl APPLICANT I 0 CONTACT PERSON Branch circuits-new,alteration,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:----7.71. M4 1 /Ji01 (_ B.Fee for branch circuits without
/7 D 7, / / ��, ^4 ^ l service or feeder fee,first 56.18 2
Address: '-1 a `-C JLD xf 4-d branch circuit _
City/State/ZIP: s I c,J£/L(- o2 ?7 3 gy_9 7?-7— Each add'1 branch circuit .....L.,. 7.42 2
Miscellaneous(service or feeder not included)
Phone:M ) 351-q/ 5'2j Fax: :( ) Each manufactured or modular 67.84 2
Email: dwelling,service and/or feeder
Reconnect only 67.842
CONTRACTOR Pump or irrigation circle 67.84 -2
Business name: l B�� �L�.c-ry.tG co uc Sign or outline lighting 67.84 2
v J�� Signal circuit(s)or limited-energy
Address: !5-0, ORUopa„� s'7 panel,alteration,or extension. ❑ See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP: t/�
145111.145111.04,44�. � 4iti 5-2,0 Additional inspection(1 hr min) 66.25/hr
Phone:(5/I)• v 5/a.12zZ Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:
Inspections for which no fee is 90.00/hr
CCB Lic.:/6r -7 Electrical Lic.:(4,06-3 Suprv.Lic.:3tllgS specifically listed(%hr mm)
7 ELECTRICAL PERMIT FEES
7?/7-
Suprv. Electrician signature,required: `-- Subtotal:
Print name: eN `T/q8
Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE: �7t.?-5
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.
1\Building\Permits\ELC PermitApp.ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/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
13009 SW 68TH PKWY B, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00402
Jeff Grove
Violation Summary:
Inspector Contractor