Permit (278) CITY OF TIGARD
ELECTRICAL PERMIT
'> COMMUNITY DEVELOPMENT Permit#: ELC2017-00007
Date Issued: 01/04/2017
-f t GA I?L 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1 S136DB02400
Jurisdiction: Tigard
Site address: 11640 SW PACIFIC HWY
Project: Tacos&More Subdivision: None Lot: None
Project Description: Kitchen area remodel,(5)branch circuits.
Contractor: POLARIS ELECTRIC LLC Owner: CHAMPION, RONALD V&ROBERTA E
22380 NW SELLERS RD 16449 LEXINGTON CT
BANKS, OR 97106 LAKE OSWEGO, OR 97034
PHONE: 503-681-8013 PHONE:
FAX: 503-647-9099
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo/Purchase 01/04/2017 $85.86
Specifics: Service or Feeder
1 ea 12%State Surcharge- 01/04/2017 $10.30
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $96.16
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 ,ith 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. ENTION: Orego law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 1-0010 through OAR 95--I -1,1!: You may obtain a copy of the rules or direct questions to OUNC by calling 503.232 87 or .800.332.2344.
Issued By: , / Permittee Signature: y"
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' 4.9_, Date: gv
LICENSE NO. 5 3/ CO S
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 Applicatkp R z ", Foiz 01 I I( I. I sl.0'I.v
1'
City of Tigard f Date/BReceivea / y /7 .! Permit#: E4LC (90/f 0000 7
14 ii 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1 j�604 Date/B : Related Permit#:
Inspection Line: 503.639.4175 " Ready Date/By: Juris: 0 See Page 2 for
f I G A R D Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE�ION'\dR rix r,* xa PLAN REVIEW
n/alteration/replademenf Please check all that apply(submit 2 sets of plans w/items checked):
El New construction 0 Additid
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.
0 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 ❑Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: /f(; t/0 ni/ •Pcic( -,r)r L y.> 100HP or more. ❑"A">"E","1-2",``1-3",
.-� ❑Six or more residential units. occupancy.
City/State/ZIP: f ' <_ ‘,...,1, d r2l Gj 7.)c2 3 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: �gCos 9`,HO 0 Hazardous locations. ❑Supplyltsy nomoltagi for more than
❑Service or feeder 600 amps or more.
l.
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
t (with above sq.ft.) 75.00 2
,F 7-C' - e de I /., c G t'r L v r �`J C Limited energy,multi-family 75.00 2
Pa ' �C L+ . c)f f fl^e w / residential(with above sq.ft.)
J G r Renewable Energy 0 See Page 2
❑ PROPERTY OWNER C., 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 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 ❑ 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 i 56.18 2
Address: branch circuit
City/State/ZIP: Each add'I branch circuit Li 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
P0
n
Business name: (pt r s S / ' r Sign or outline lighting 67.84 2
2 3e v w- �_ // Signal a circuit(s)or extension.
0 See Page 2 2
Address: /�+J'/ e l C/"� R panel,alteration,or extension.
City/State/ZIP: C.�1 0 R '1 710 1 Each additional inspection over allowable in any of the above
Ct't Additional inspection(1 hr min) 66.25/hr
Phone:( 3') 6'0 ( 5-0( ' Fax:( ) Investigation(I hr min) 90.00/hr
Email: A ( �/ ; f CO i."1'1 Industrial plant(1 hr min) 78.18/hr
G� L' m aInspections for which no fee is
( t 1)'i;'' n p �^3 i 6 5 specifically listed('h hr min) 90.00/hr
CCB Lic.: l Electrical Lic.: Suprv.Lic.: J
SC/ ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: I Subtotal:
❑Plan Review Required(25%of permit fee):
p
Print name: �6,, C Date: (/y 7 State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE: 69� ��
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_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
,..,.:. Description ,_.I Qty. ( Each ]... Total ] *
Fee for all residential systems combined: $75.00 Renewable 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
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 PERMIr FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
Ti Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
Ti Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
11640 SW PACIFIC HWY, TIGARD, OR, 97223
Record Type:
Commercial - Electrical
Inspection Type:
199 Electrical final
Result:
PASS- NoCofO
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
Record ID:
ELC2017-00007
Inspector:
Jeff Grove
Contractor