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Permit (70) CITY OF TIGARD ELECTRICAL PERMIT I2 .' COMMUNITY DEVELOPMENT Permit#: ELC2016 00512 Date Issued: 06/22/2016 T[c: ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S104DA21200 Jurisdiction: Tigard Site address: 12988 SW PRINCETON LN Project: COVESCO INC Subdivision:)UAIL HOLLOW SOUTH TOWNHOME; Lot: 38 Project Description: Reconnect only. Contractor: Owner: COVESCO INC 16630 SW SHAW ST STE J ALOHA,OR 97078 PHONE: 503-642-9399 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Reconnect Only 06/22/2016 $67.84 Specifics: 1 ea 12%State Surcharge- 06/22/2016 $8.14 Electrical Type of Use: SFA Class of Work: OTR Type of Const: Occupancy Grp: Total $75.98 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Cod-- nd 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 issua 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 -nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You ••- ••• -co. . .- - or direct questions to OUNC by calling 503.23. 1987 �0.332.2344. \_Jt/` Issued By: �/_ - �s -- •0'tee 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' Date: LICENSE NO. Call 503.839.4175 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. 1-,,,,:::,1,71, Electrical Permit Application (-1 ` ' ,,'n: '" Received City of Tigard �69 /4., LGA��, 5 i 7 Date/By: al 13125 SW Hall Blvd.,Tigard,OR 97223 �p 2���} Plan Review 1C Phone: 503.718.2439 Fax: 503.598.1960 ,i� N Date/By: Related Permit#: Inspection Line: 503.639.4175 J ' Ready Date/By: J ® See Page 2 for i WARD s k s,1c`� Internet: www.tigard-or.gov ., tified/Method: Supplemental Information 3 ."+'rte . TYPE OF WORK�"� PLAN REVIEW * � � Please check all that apply(submit a sets of plans w/items checked): ❑New construction ❑A tion/alteratioit stent 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. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. 0 Multi-family ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived 0 Addition of new motor load of system. Job#: Job site address: Z a rJ ��//✓�,P�' j t7 100HP or more. �'' ❑" Q ❑Six or more residential units. occupancy. City/State/ZIP: .-1-74,�� / 7 23 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: I Project name: 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: 61 JA A fc-to g' FEE SCHEDULE Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: I 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 ,� (with above sq.ft.) 75.00 2 l„ C C!%�✓i L' ri-t__ ��/v iL' 5� Limited energy,multi-family residential(with above sq.ft.) 75.00 2 Renewable Energy 0 See Page 2 PROPERTY OWNER I t3 TENANT Services or feeders installation,alteration,and/or relocation Name: ('o✓ 6.---SC... q200 amps or less 100.70 2 Address: / & 3 0 Lcc4.9-��-��/ 'TO 5 l 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: iiii / 14 ft )2 97 0 7 t/ 601 amps to 1,000 amps 301.04 2 Phone:(503) 6 - -93 ! 9 Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: C....® V eS Ge G - C p(A .yrs-f 42- -- relocation O '"Ta- '1 1 ion: PIO stallation is being made on r.''--• . own which is not 200 amps or less 59.36 1 intended for sale,leas • 1... :.- t r. to 6'S 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner. •, "111 a ` 2 • ,,, 401 amps to 599 amps 168.54 2 [! APPLICANT 0 Y ACT 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: u es-, B.Fee for branch circuits without service or feeder fee,first 56.18 2 Address: 4/VC ti' / branch circuit City/State/ZIP: 9 J& Each add'l branch circuit 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 i 67.84 (p 7 i�2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy 13 See Page 2 2 Address: panel,alteration,or extension. City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Fax:( ) 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.: Electrical Lic.: Suprv.Lic.: specifically listed('h hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,r=j ed: Subtotal: G ) Ifli Print name: l Date: 0 Plan Review Required(25%of permit fee): �/ q State surcharge(12%of permit fee): y,l�'Authorized signature:r,.-- 1�^^%� TOTAL PERMIT FEE: 7S e. This permit application expires if a permit is not obtained within 180 Print name: �--1 e v yl.. tQ E J'��l 1 tJ U`$t Date: 6p-2 2 ./ce 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 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: $75.00criewableQty. Each electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 n 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 with OAR 918-309-0040) 552.26 2 ❑ 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(Ye hr min) COMMERCIAL WORK ONLY:' ELECTRICAL PERMIT FEES $75.00 Subtotal(Enter on Page 1): Fee for each commercial system: * 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 n Outdoor Landscape Lighting* Fl 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 6i/0-0ff, ClV 99-1 5lw I,WGes 1 �� ga � Mq y 2 E8, Elder-Jones C/71, 320/6 PERMIT SERVICE $Ul`©1VG CARO 1120 East 80th Street,#211 V/S' /ON Bloomington,MN 55420-1498 Phone: (952)854-2854•Fax: (952)854-4909 TRANSMITTAL 5/19/2016 To: DEBBIE 503-718-2439 ANN TAYLOR CITY OF TIGARD BUILDING DIVISION WASHINGTON SQUARE 13125 SW HALL BOULEVARD TIGARD, OR TIGARD, OR 97223 216-352 DEBBIE/BUILDING DIVISION, I HAVE ENCLOSED THE FOLLOWING FOR THE ABOVE REFERNCED PROJECT AND WOULD LIKE TO SUBMIT FOR PLAN REVIEW AND PERMIT. -THREE SETS OF PLANS -THREE SETS OF STRUCTURAL CALCS -PERMIT APPLICATION -COMMERCIAL APPLICATION CHECKLIST -CHECK FOR REVIEW FEES PLEASE DIRECT ANY COMMENTS OR QUESTIONS TO MY ATTENTION. THANK YOU TIM SCHENK ELDER-JONES 952-345-6040 ti m s(geld eriones.com