Permit CITY OF TIGARD ELECTRICAL PERMIT
11111 1111
COMMUNITY DEVELOPMENT Permit#: ELC2017-00100
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/16/2017
Parcel: 2S112DB00500
Jurisdiction: Tigard
Site address: 15065 SW 74TH AVE
Project: Interstate Roofing Subdivision: FANNO CREEK ACRE TRACTS Lot: 15
Project Description: (1)temporary service and(4)branch circuits.
Contractor: TRI STAR ELECTIC INC Owner: INTERSTATE DEVELOPMENT LLC
PO BOX 231175 15065 SW 74TH AVE
TIGARD, OR 97281 PORTLAND, OR 97224
PHONE: 503-860-3838 PHONE:
FAX: 503-590-2302
FEES
Quantity Description Date Amount
1 ea Temp Services or Feeders- 02/16/2017 $59.36
Specifics: 200 amps or less
4 crt Branch Circuits w/Purchase 02/16/2017 $29.68
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 02/16/2017 $10.68
Electrical
Type of Const:
Occupancy Grp:
Total $99.72
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 e: •52-001-0090. You .- •• . -cop - .- ect questions to OUNC by calling 503 32.1987 or 1.800.332.2344.
Issued By: << �� Permittee Signature: Ir�IIIL/) �f\q —h
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.
Electrical Permit Applicationli144 FOR oFFlce 1 SL ON Ll
City of 7 , Pe6,t.N.- rg�,ii 7 Permit PE:
&
n
Date/By: • f :;o 17—'(✓i
13125 SW Hall Blvd.,Tigard,OR 97223rIcAPlan Review
.1 Phone: 503.718.2439 Fax: 503.398.1960. il 1-`" y, Related Permit#:eA tzA.,°'� ,,c�-71y
TIGARD Inspection Line: 503.639.4175 I• :really. naris: � age 2 for
Internet: www.tigard or.gov *Com -`: `�j';X),
,',L ethod Supplemental Information
TYPE OF WORK f �& i�� PLAN REVIEW
❑New construction ❑Addition/alteratiottOrepla �+ 1➢ Please check all that apply(submit 2 sets of plans wliteins checked):
❑Demolition R t Other:TEMP POWER ❑Sen ice or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 MafillaS and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-familydwellingless to or exceeds 14,000 0 Commercial-use
®CommerciaUindustrial 0 Accessory building �°°"d= agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder
❑Other: ❑Fire pump. ❑installation of 150 K VA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. „larger separately derived
Job#: 17001 Job site address:151165 SW 74TH 0 Addition of new motor load of 1 systems.
Iooiip or mote. ❑".,"`E',"t-2","1_3"
City/State/ZIP:TIGARD,OR 97224 0 Six or more residential units. occupy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt#: Project name:INTERSTATE ROOFING ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:BONITA FEE SCHEDULE
Description I Qty. I Each I Total
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
INSTALL TEMPORARY ELECTRICAL SERVICE (with above sq.ft.) 75 00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft)
❑ PROPERTY OWNER 0 TENANT Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name:INTERSTATE ROOFING 200 amps or less 100.70 2
Address: 15065 SW 74T" 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:TIGARD,OR 97224 642 amps ss11,000amps 3111.04 2
Phone:(503)684-5611 Fax:(503)684-3056 Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: re utatiion
Owner installation:This installation is being made on property that I own which is not 200 amps or less 1 59.36 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 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 4 7 42 29.68 2
'each btanch'circuit
Contact name: 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 7,42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular 1
dwelling,service and/or feeder
Email: 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:TRI-STAR ELECTRIC,INC. Sign or outline lighting 67.84 2
Address:PO BOX 231175 Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension.
City/State/ZIP:TIGARD,OR 97281 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)860-3838 Fax:(503)590-2302 Investigation(1 hr min) 90.00/hr
Email: Industrial plant Cl hr min) 78.18/hr
Inspections for which no fee is 90.00P hr
CCB Lie.: 153559 `// ill(
Electrical Lie.: 34-620C Suprv.Lie.: 3832S specifically listed(/S hr min)
ELECTRICAL PERMIT FEES
f
Suprv.Electrician signature,required: - .s..& c_ Subtotal: 89.04
Print name: RICHARD C METZLER D /16/2017 0 Plan Review Required(25%of permit fee):
State surcharge(12.A of permit free): 10.68
TOTAL PERMIT FEE: J
4q
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has bees accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permitt,ELC PerrnitApp Eldt ERE.doc Rev 06/17/2015 110 4615T(11/05/COM/WEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15065 SW 74TH AVE, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Electrical ELC2017-00100
Inspection Type: Inspector:
199 Electrical final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor