Permit CITY OF TIGARD ELECTRICAL PERMIT
INa. ' COMMUNITY DEVELOPMENT Permit#: ELC2016-00419
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/23/2016
T f t�A R,�� g Parcel: 2S 101 AA03800
Jurisdiction: Tigard
Site address: 12259 SW 69TH AVE
Project: Consumer Cellular-Building B Subdivision: WEST PORTLAND HEIGHTS Lot: B
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. ATTENTION: Ore on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 thro OAR -00 90. 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: 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' - i Ngi/�j , 4 Date: 5--3//6
LICENSE NO. 47/ 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 A licatioTEIVED
FOR OFFICE: I SE ONLI
City of Tigard Date/Bea � • % Permit#: e4c4 Oo „,F
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review n
: M Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#: /3�0'97e)l(P_60/A
Inspection Line: 503.639.4175 '''):/ 2 3 2016 Ready Date/By: Juris H See Page 2 for
TI G A R D Internet: www.tigard-or.gov ll��LL r Q Notified/Method: Supplemental Information
TYPE Ot,4 ,k)F l ARD PLAN REVIEW
❑New construction ❑Addltl0 a I Please check all that apply(submit 2 sets of plans w/items checked):
t)U �� � "��� ❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
0 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building
less to ground,or exceeds 14,000 El Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: Job site address: O -1 q 5th j l �err�� ❑Addition of new motor load of system.
1— t+ A.�i Iix or or more. ❑occupancy.
City/State/ZIP: f 1
0 Six or more residential units. occupancy.
y f /� 2Recreational vehicle
��/TK� 0Health-care facilities. 0 parks.
Suite 1 g apt.#: Project name:I Uvtl(li e e R ❑Hazardous locations. 0 Supply voltage for more than
L� 0 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.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 I
DESCRIPTION"OF WORK Limited energy,residential 75.00 2
t r (.x / t . / -l (with above sq.ft.)
�'B�Kv f`� (�S �� L {� 1 l �t�l N� K `� 5 Limited energy,multi-family 75.00 2
t C tt residential(with above sq.ft.)
I 1%514(140 e h eI t. 'h� Li- C ' `a h Pg 19 Lrsa Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 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
0 APPLICANT
❑ 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: B.Fee for branch circuits without
service or feeder fee,first / 56.18 2
Address: branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) 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: Tie(-/. 4 5�- E Lt S apply c 6 Sign or outline lighting 67.84 2
I( �" /� ,j.� Signal circuit(s)or limited-energy
Address: Z'_?cc
Adt&._ C,�,,(}>`/,.. (� L( V panel,alteration,or extension. 0 See Page 2 2
VV v V Each additional inspection over allowable in any of the above
City/State/ZIP: �6 ,� ji Additional inspection(1 hr min) 66.25/hr
Phone:(S* )-4_7.8._.)?-70 Fax:(7b)) �b �X�6 3 Investigation(I hr min) 90.00/hr
�+(� Industrial plant(1 hr min) 78.18/hr
K
Email: �U ,V 0 TP&5 ea e CO M Inspections for which no fee is
J specifically listed %z hr min) 90.00/hr
CCB Lie.: 0.128 .... Electrical Lie.: (.—gam Suprv. Lie.: L 33? $ pe Y (
ELECTRICAL PERMIT-SubtotaFEESl: l,0.
Suprv. Electrician signature,required: 2
Print name: -3.25,4(x./ A,1 x� Date: _)_0-4 � ❑Plan Review Required(25%of permit fee):
`� V State surcharge(12%of permit fee): f S.65—
TOTAL PERMIT FEE: e>5
Authorized signature: ,v(.4/..— l �
This permit application expires if a permit is not obtained within 180
Print name: 6 ,(/�1.��~� s Date: 9,-).1,3.4 days after it has been accepted as complete.
0 Number of inspections allowed per permit.
I\Building\Permits\ELC_PermitApp_ELR_ERE doc Rev 06/17/2015 440-46151(1 I/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
12259 SW 69TH AVE, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00419
Chip Barnett
Violation Summary:
Inspector Contractor