Permit CITY OF TIGARD ELECTRICAL PERMIT
.111
s. ' COMMUNITY DEVELOPMENT Permit#: ELC2016-00418
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/23/2016
TIGARD g Parcel: 2S101AA09100
Jurisdiction: Tigard
Site address: 12447 SW 69TH AVE
Project: Consumer Cellular-Building C Subdivision: WEST PORTLAND HEIGHTS Lot: A
Project Description: Retro-fit lights to LED lighting kits,installed in existing light fixtures(825 lights)
Contractor: TRI PHASE ELECRIC SUPPLY CO Owner: SDC TIGARD CORPORATE CENTER INC
2238 NE COLUMBIA BLVD ATTN:ANDREW HARPER
PORTLAND, OR 97211-1931 101 CALIFORNIA ST,26TH FLOOR
SAN FRANCISCO, CA 94111
PHONE: 503-288-2770 PHONE:
FAX:
FEES
Quantity Description Date Amount
11 crt Branch Circuits wo/Purchase 05/23/2016 $130.38
Specifics: Service or Feeder
1 ea 12%State Surcharge- 05/23/2016 $15.65
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $146.03
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. ATT OTT :Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001- 10 through OAR 9 2- 0.'c 00••. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issu d By: K._ 4 Permittee Signature: r
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' `ligdr /-� Date: 5-/:A� 6
LICENSE NO. V 7 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 Applic sv � FOR OFFICE tsl:
( IA
of Tigard 9' Date/Be� �� , Permit#: EtX�/‘-0,0 /
13125 SW Hall Blvd.,Ti ard,OR 97223
IIIIIPlan Review •
= g Phone: 503.718.2439 Fax: 503598p04 J 2016 Date/B : Related Permit#: u �lG��i3(J
Inspection Line: 503.639.4175 1 Ready Date/By: Juris ® See Page 2 for
T I G A R D Internet: www.tigard-or.govp� Notified/Method: Supplemental Information
TYPE t3Pir�(�1 ii6ARD PLAN REVIEW
❑New construction 0 AdditioituarDIVAION Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ 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.
El1-and 2-family dwelling ❑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: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
��" 47 51,' L A B ❑Addition 0Hmf oew motor load of system.
Job#: Job site address: � N V„ D9�., 14 100HP or more. ❑"A","E","1-2","1-3",
❑❑Health-care facilities.Six or more residential units. occupancy.
City/State/ZIP: fes,���V» p> Z-- 0 Recreational vehicle parks.
I
Suite 1 g apt.#: Aft le Project name:/OA Ai a l? R I 0 Hazardous locations. 0 Supply voltage for more than
/'� ❑Service or feeder 600 amps or more. 600 volts nominal.
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
(with above sq.ft)
�'B�it i(Th `(t ��I-S To t k1-s(1,� k v 5 Limited energy,multi-family 75.00 2
t ( 111 l residential(with above sq.ft.)
i ti 51 4 fit,'t&' t h el 1.5 ff L7 c Yfu r ('815 LT'S) Renewable Energy 0 See Page 2
0 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 133.56 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,per panel
0 APPLICANT ❑ CONTACT PERSON 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
service or feeder fee,first / 56.18 2
Address: branch circuit
City/State/ZIP: Each add'I branch circuit /D 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) 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: Tie ie(-P64...
P1L�5 Lt S app�� c_ b Sign or outline lighting 67.84 2
/ (' Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: Z.. L 3' ,t,t&_ CQ�44(yo.. i>t j 12 panel,alteration,or extension.
p65 1L ! 0% 5 '7 ;( Each additional inspection over allowable in any of the above
City/State/ZIP: ( ,� O` j 4 3
Additional inspection(1 hr min) 66.25/hr
Phone:(30 )2ere'-')?7() Fax:(7 3) -C ii—).7 6 Investigation(1 hr min) 90.00/hr
+,
(� kI� Industrial plant(1 hr min) 78.18/hr
Email: -if @ -p 6-5 id t co M. Inspections for which no fee is
CCB Lic.: 1312-8 „,_, Electrical Lic.: (.-$5-.7 33
Suprv. Lic.: 1. 7 s
specifically listed(%z hr min) 90.00/hr
3/A4/// 7/4.7 (0/,//0 ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal: /30.34
Print name: 4(Nw„l yI Date: _)1,3-4 c:, ❑Plan Review Required(25%of permit fee): —�-
V State surcharge(12%of permit fee): 13,10'S-
Authorized signature: ,,v4-4"...---- TOTAL PERMIT FEE: pile .03
This permit application expires if a permit is not obtained within 180
Print name: o6 ,(/AA-y- A 5 Date: 9-,-)1`34 Ldays after it has been accepted as complete.
* Number of inspections allowed per permit.
1\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 440-46151(11/05/COM/WEB