Permit (39) CITY OF TIGARD ELECTRICAL PERMIT
a . ' COMMUNITY DEVELOPMENT
IN
Per #: ELC2016-00466
T f GAR Ly 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/20/2016
Parcel: 2S102DA00500
Jurisdiction: Tigard
Site address: 13000 SW HALL BLVD
Project: Tigard-Tualatin School District Subdivision: None Lot: None
Project Description: Wire for autogas propane dispenser.
Contractor: DRYDEN ELECTRIC INC Owner: TIGARD-TUALATIN SCHOOL
PO BOX 266 DISTRICT 23J
HUBBARD, OR 97032 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 503-981-3913 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 06/20/2016 $100.70
Specifics:, amps or less
7 crt Branch Circuits w/Purchase 06/20/2016 $51.94
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea Plan Review Electricial 06/20/2016 $38.16
Type of Const: 1 ea 12%State Surcharge- 06/20/2016 $18.32
Electrical
Occupancy Grp:
Total $209.12
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 through 0 R 952-001-0090. You ma obtain a co the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: -�� Permittee Signature: �L.44srr�C�a�
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' Date:
LICENSE NO.
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.
d
Electrical Permit Applicati t tit t l ( 1 l . t, i \
RECECity of Tigard �� ' , , j . Permit#TLC.2O/, 00 y6&
13125 SW Hall Blvd.,Tigard,OR 97223 plan R
Phone: 503.718.2439 Fax: 503.598.19C I Date/B : �' Related Permit#:
Inspection Line: 503.639.4175 J u N 6 2 016 Ready Date/By: /' . tag: ® See Page 2 for
I I( \k I) Internet: www.tigard-or.gov Notified/Method:(Q Supplemental Information
TYPE OP f(OFTIGARD PLAN REVIEW
®New construction 0 Addition/a8464tAiiii9elliAli SION Please check all that apply(submit 1 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.
❑ 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 SITU' INFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address:13000 SW Hall Blvd. rooHP or more. ❑"A","E,"1-2", 1-s",
❑Six or more residential units. occupancy.
City/State/ZIP:Tigard OR 97223Recreational vehicle parks.
El Health-care facilities. 0
Suite/bldg./apt.#: Project name:-Propene-dispenser 1 ®_ Hazardous locations. 0 Supply voltage for more than
/n1 77‘")❑Service or feeder 600 amps or more. 600 volts nominal.
XLa
Cross street/directions to job site: S. -cil Sjrl 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
Wire for autogas propane dispenser (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name:Tigard/Tualatin School District;First Student 200 amps or less 1 100.70 100.70 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
® APPLICANT ® CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Dryden Electric,Inc. above service or feeder fee, 7
7.42 51.94 2
each branch circuit
Contact name:Jon M.Dryden B.Fee for branch circuits without
serAddress:PO Box 266 branch
or feederfee,first 56.18 2
branch circuitst
City/State/ZIP:Hubbard OR 97032 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)490-3638 Fax: :(503)981-3913 Each manufactured or modular 67.84 2
denelectric mail.com dwelling,service and/or feeder
Email:d
rY @g Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Dryden Electric,Inc. Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy El See Page 2 2
Address:PO Box 266 panel,alteration,or extension.
City/State/ZIP:Hubbard OR 97032 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)981-3913 Fax:(503)981-3913 Investigation(1 hr min) 90.00/hr
Email:drydenelectric@gmail.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 98943 Electrical Lic.: 24-322C Suprv.Lic.: 6080S /ON V specifically listed(%2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: .„...46 Subtotal: 152.64
Print name: Jon M.Dryden ` Date: 6-3-16 ®Plan Review Required(25%of permit fee): 38.16
State surcharge(12%of permit fee): 18.32
Authorized signature: �'.-.- — TOTAL PERMIT FEE: 209.12
This permit application expires if a permit is not obtained within 180
Print name: Jon M.Dryden Date: 6-3-16 days after it has been accepted as complete.
* Number of inspections allowed per permit.
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
DeFee for all residential systems combined: $75.00 ° I �• I Each I Tall3' Renewable electrical energy systems:
s kva or less 100.70 2
Check Type of Work Involved:
5.01 to 15 Icva 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
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%i hr min)
ELECTRICAL PERMIT FEES
COMMERCIAL WORK ONLY: Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * 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
I1Building\Permits\ELC_PemtitApp_ELR_ERE.doe Rev 06/17/2015