Permit (42) CITY OF TIGARD ELECTRICAL PERMIT
I,. .7COMMUNITY DEVELOPMENT Permit#: ELC2016 00426
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/24/2016
t<�.A.Ei-O 9 Parcel: 2S102AA03301
Jurisdiction: Tigard
Site address: 12345 SW HALL BLVD 25
Project: Tigard Terrace Apartments Subdivision: None Lot: None
Project Description: Unit#25-(1)panel replacement and(2)branch circuits.
Contractor: ELECTRICAL WIRING BY JOHNNY Owner: KC TIGARD TERRACE LLC
950 NE 152ND AVE 11030 NW 2ND CT
PORTLAND, OR 97230 PORTLAND, OR 97231
PHONE: 503-267-6540 PHONE:
FAX: 503-735-1167
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 05/24/2016 $100.70
Specifics: amps or less
2 crt Branch Circuits w/Purchase 05/24/2016 $14.84
Type of Use: MF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 05/24/2016 $13.86
Electrical
Type of Const:
Occupancy Grp:
Total $129.40
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 acc. .-• - 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. A TION: Orego law r., -s you to follow the rules adopted by the Oregon Utility Notification Center. T ose rules =re set forth in OAR
952-0r -0010 through OAR 952-6* -0090. oL may obtain a copy of the rules or direct questions to OUNC by calling 50 .232.1987 or 0. .—.
I sued By: A. ,tet Permittee Signature: .1 Pr
.rte
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:
-.• TION ONLY
SIGNATURE OF SUPR.ELEC' ' Date: .(9%/
LICENSE NO. 7
75
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 Applicatio'R EC E I VE D I()1t 0141( I. I SI (l\l.)
City ofTigardReceived SmQ� f1� a6
IN Date/B : Permit#:
13125 SW Hall Blvd.,Tigard,OR 97223 MAY 2 4 2016 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960MAY
: Related Permit#:
I WARD Inspection Line: 503.639.4175 CITY OF TIGARD Ready Date/By: Juris. ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
E OF WORK PLAN REVIEW
0 New construction Addition/alteration/replacement 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.
0 Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATS Y OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-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
Job#: I Job site address: /Z 3 S 4i J 2t f, ❑Addition of new motor load of system.
7
IOOHP or more. ❑"A","E","1-2","I-3",
0 Six or more residential units. occupancy.
City/State/ZIP: Recreational vehicle parks.
❑Health-care facilities. 0
Suite/bldg./apt.#: 024.5" I Project name...-- "Wo o -71.111 . i9--&3 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: I Lot#: Z5 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: •
Ea.add'!500 sq.ft.or portion 33.92 1
4EevSCRIPTIOONI OF WORK Limited energy,residential
75.00 2
- C� / // yi-ernfT (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.) _
Renewable Energy 0 See Page 2
0 PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less / 100.70 /Dd.2O 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
0
APPLICANT IQ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit Z 7'42 ici.g V 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'!branch circuit 7.42 2
Phone:( ) I Miscellaneous(service or feeder not included)
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: fe.Z`-��{c41.4, Z. i/ / �/ Sign or outline lighting'0667.84 - 2
Q ^, "� Y J Signal circuit(s)or limited-energy
Address:
/ /Y E /S�i/iia AI S& panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: /4-(„o g?Z .3,2f Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(5715 2.('7 (05,10 I Fax:((70V13 7 S //Cc>7 Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: ,e.21./O(.f I Electrical Lic.: earns I s S . 'c.: S-%27'5 specifically listed('/Z hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: e _
Subtotal: /l
Print name: �N�7►,��/L. ,vf� Date: S---.4 S!/(o ❑Plan Review Required(25%of permit fee): f
State surcharge(12%of permit fee): /3.' p
TOTALPERMIT FEE:
Authorized signature: 1 AC)
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_PermitAppELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description
Fee for all residential systems combined: $75.00 I Q -I Each Total
S' Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min) _
Inspections for which no fee is 90.00/hr
specifically listed(1/2 hr min)
COMMERCIAL WORK ONLY:
ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
y * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015