Permit (16) CITY OF TIGARD ELECTRICAL PERMIT
lAt1. COMMUNITY DEVELOPMENT Permit#: ELC2016-00401
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/17/2016
[C Ft)) g Parcel: 25101 DA00105
Jurisdiction: Tigard
Site address: 13009 SW 68TH PKWY A
Project: Extended Stay America Subdivision: VARNS ACRES Lot: 9
Project Description: Building A-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 i 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. ENTION: Oreg n law r ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 1-0010 through OAR 952.0 -009 . ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Iss ed 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' 41/ ' `<t ` _ , Date:
LICENSE NO. - Vi€V 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 OVER F I SE O\I.1
CI O Tl and Received 1-,
ty f g RECEIVED
Date/I3 Permit#: �LCgi/I/1� O/
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
' 2 Phone: 503.718.2439 Fax: 503.598.1 O,C Date/B : Related Permit#: �'�)/�p-COl I/
Inspection Line: 503.639.4175 R��iY 17 lJ ReadyDate/By: Juris.
i'IGnRD � ® SeePage2for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE etgLootNG nIVISION PLAN REVIEW
0 New construction Addition/alteration/replacement lJ Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more ❑Building over three stones.
0 Demolition 0 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-and 2-family dwelling 0.Commercial/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: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: _ Job site address: 3 CO / / g rh p�i ❑Addition of new motor load of system.
(�Gt./ 100HP or more. ❑ A„ E„ 1_2„ 1.3„
❑Six or more residential units. occupancy.
City/State/ZIP: ppe rto,�d 7-/gty'Cid- 0 Health-care facilities. 0 Recreational vehicle parks.
i Suite/bldg./apt.#: I Project name: F--�7�.Te./v4 ed 57 f ieaLL ❑Hazardous locations. 0 600vlolts nomy inal.more than
Y `'� ❑Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. 1 Each 1 Total 1 "
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
d e rock/ 1 �e , /�C 0 I (with e multi-family ft.)
W�- - Limited energy,multti-family
Di--y
/ residential(with above sq.ft.) 75.00 2
nl no
"' I`" ,r-- worz� 4,5 ,i, 4; Renewable Energy 0 See Page 2
❑ PROPERTY OWNER I TENANT 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:( ) I 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] APPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
afi/ A.Fee for branch circuits with
Business n e: —t-go., 6-S t (� above service or feeder fee,
7.42 2
(�� each branch circuit
Contact name: / -7 0 7 cf S 46' /x 73 E. B.Fee for branch circuits without
/`O /`--) Q Q 2 i/�7�� service feeder fee,first 56.18 2
Address: D ,C� 97 > branch circuit
City/State/ZIP: Each add]branch circuit _'' ' 7.42 2
Miscellaneous(service or feeder not included)
Phone:(57:92) 35( - p'(5"22 Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: / 78t aLreTrt`L co G uSign or outline lighting 67.84 2
L hSignal circuit(s)or limited-energy
Address: /45-00 0R.,eaA.) Tr panel,alteration,or extension. ❑ See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP: 14'C1�G.u�t��( *a_ a Additional inspection(1 hr mm) 66.25/hr
Phone:(5(/i). VS'../22Z Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
../9 frit 7/i 47 704 4 Inspections for which no fee is
90.00/hr
CCB Lic.:/6q'' Electrical Lic.:G/61 3 Suprv.Lic.:3(//Q,..5 specifically listed('/hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required:1?"7- Subtotal:
, �� - ff Date:
0 Plan Review Required(25%of permit fee):
Print name:
,SON B r\\
State surcharge(12%of permit fee):
TOTAL PERMIT FEE: 71 ?-3
Authorized signature:
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(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 A, TIGARD, OR, 97223
Commercial - Electrical
120 Electrical rough-in
PASS
ELC2016-00401
Jeff Grove
Violation Summary:
Inspector Contractor
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 A, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00401
Jeff Grove
Violation Summary:
Inspector Contractor