Permit (10) INCITY OF TIGARD ELECTRICAL PERMIT
' . COMMUNITY DEVELOPMENT Permit#: ELC2017-00044
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/19/2017
TIGARD g Parcel: 2S112AB00300
Jurisdiction: Tigard
Site address: 7350 SW LANDMARK LN 110
Project: Dub Box Subdivision: None Lot: None
Project Description: (3)branch circuits
Contractor: VISION POWER&LIGHT Owner: B-1 LANDMARK LLC
3809 W ST BY PRENTISS C HICKS TR
WASHOUGAL,WA 98671 429 A NW SKYLINE BLVD
PORTLAND, OR 97229
PHONE: 503-951-0415 PHONE:
FAX: 503-926-9384
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 01/19/2017 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 01/19/2017 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
Required Items and Reports(Conditions)
This permit.'- s ubject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be do -'in accordance 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 aw r-:.`-s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 /01-0010 through OAR 952-4/ -0090. u may obtain a copy of the rules or direct questions to OUNC by calling 5/ . -.1987 or 1.800.332.2344. /
Is- ed By: / �� • Permittee Signature g 0-/-
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:
I CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' hi,
Date: //9//
LICENSE NO. '4//0.7 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 Applic..� tr.E a Taiirii ro►z OU(IC CS►:0y1-1
City of Tigard (1#991 i..40 AID Date/Bed / '/9 Permit#: e� j�7-4,6,. 13125 SW Hall Blvd.,Tigard,OR 23
Phone: 503.718.2439 Fax: 503.598.1 Plan Review
T Date/B : Related Permit#:
II -
Inspection Line: 503.639.4175 l R d H See Page 2 for
T I G A R D Ready Date/By: Juris:
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE r r ,off t> PLAN REVIEW
0 New construction (d Addition I 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.
ID 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.
❑ I-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#: Job site address: .5�y,� ❑Addition of new motor load of system.
—� Cl 4030/J 1 (th 411 ft A 100HP or more. ❑<A> <E» l_2» 1.3»
City/State/ZIP: ,�Glr�7 Q r- 47-7 22 0 Six or more residential units. occupancy.
r� 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: 819 Project name: ,j b Boy 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: -7 2 U + h in or- & FEE SCHEDULE
k 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
DESCRIPTION.OF WORK Ea.add'I 500 sq.ft.or portion 33.92 1
Limited energy,residential
d,i-. CA.))0-1.L (with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
0 PROPERTY OWNERIN
TENANT Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name: bu b 13e57. 200 amps or less 100.70 2
Address: .7 g S Ai 1 i p7-� 4A.
201 amps to 400 amps 133.56 2
City/State/ZIP: t / 401 amps to 600 amps 200.34 2
�) rJ c�YJ 7,2_,z_ 601 amps to 1,000 amps 301.04 2
Phone:(,03) 749 etb3 Z Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
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 0 CONTACT PERSON Branch circuits-c new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
Contact name:
each branch circuit 7.42 2
B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit f"?...-' 7.42 2
Phone: Miscellaneous(service or feeder not included)
( ) Fax: :( ) Each manufactured or modular
dwelling, 67.84 2
Email: service and/or feeder
Q Reconnect only 67.84 2
CONTRACTOR Pump Pump or irrigation circle 67.84 2
Business name: Ud 1$�1 10 K i '.;� 1q A ,L
d�>°t�„r :- � Sign or outline lighting 67.84 2
Address: 23 e set f�5� l Signal circuit(s)or limited-energy
/ panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: W�A ou el / t g�J 7 1 Each additional inspection over allowable in any of the above
cp Additional inspection(1 hr min) 66.25/hr
' -7Q 3' ,
Phone:( ) / Fax:( ) Investigation(1 hr min) 90.00/hr
Email: I l(Q(� 7I l I 1d Industrial plant(1 hr min) 78.18/hr
` toll` Inspections for which no fee is
CCB LIC.: lectrical Lie.: U specifically listed '/z hr min) 90.00/hr
f 2 coS /�6 Suprv.Lie.: /z7,S 1e y (
Suprv.Electrician signature, / ELECTRICAL PERMIT FEES
p required: ,
' //71/
Subtotal: 77/,cli -Print name:('j10.Y`-� sj t y�4 ZDo-t&. Date: '7 El Plan Review Required(25%of permit fee): �—_ •
/ State surcharge(12%of permit fee): r.5-a
Authorized signature: TOTAL PERMIT FEE: 7i7.
This permit application expires if a permit is not obtained/with 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PemritApp_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: >EE SCHEDULE
Description I Qty. I Each I Total I *
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved: 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:
n 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:
nOther: 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('Vs 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
n C• lock Systems
n D• ata 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.doe Rev 06/17/2015