Permit (65) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2017-00613
T Gt o 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/16/2017
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Parcel: 1 S 136AD04000
Jurisdiction: Tigard
Site address: 11531 SW PACIFIC HWY
Project: Spring Oriental Massage Subdivision: VILLA RIDGE Lot: 7
Project Description: (1)branch circuit to reconnect split system.
Contractor: WILLAMETTE HVAC LLC Owner: MCLELLAN ESTATE CO
3075 SW 234TH AVE.#206 707 OLD COUNTRY RD
HILLSBORO, OR 97123 BELMONT, CA 94002
PHONE: 503-259-3200 PHONE:
FAX: 503-848-2597
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 08/16/2017 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/16/2017 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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. ATTENTI• : • -.on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-00 .throu.h OAR• -00 •190. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.80.332,2�44.
Issued y: � 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' 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 Applicatio IVF , FOR OFFICE I. oNLv
CityIiiof Tigard Received //^ / i _��/
- g Date/By: 6 /tL' /7 Permit No.:
w 13125 SW Hall Blvd.,Tigard,OR 97223 1 6 Plan Review
Phone: 503.718.2439 Fax: 503.598.1964 UG 2017 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris See Page 2 for
Internet: www.tigard-or.gov d 'rIi OF TIGARD Notified/Method: Supplemental Information
TYPE OF MIZINC DIVISION PLAN REVIEW
E l New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/itenis checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
0 Demolition" ❑Other: where the available fault current 0 Marinas arid boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A", E ,"I-2","i-3",
Job no.: Job site address: 11531 SW Pacific Hwy 100HP or more. occupancy;.
0 Six or more residential units. 0 Recreatio4l Vehicle parks.
City/State/ZIP:Tigard OR 0 Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:Spring Oriental Massage 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. 1 Fee. I Total I *
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add']500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
reconnect split system residential(with above sq.ft.)
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
0 PROPERTY OWNER 0 TENANT 201 amps to 400 amps 133.56 2
Name:
401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
City/State/ZIP: relocation
Phone:( ) Fax:( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation:This installation is being made on property that I own which is not
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Branch circuits–new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with
0 APPLICANT 0 CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name:same as below B.Fee for branch circuits without
service or feeder fee,first 1
56.18 0 i 2
Contact name: branch circuit
Each add']branch circuit 7.42 2
Address: Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Phone:( ) Fax: :( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s)or limited-energy
Business name:Willamette HVAC LLC panel,alteration,or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address:3075 SE Century Blvd Suite 206 Additional inspection(1 hr min) 66.25/hr,
City/State/ZIP:Hillsboro,OR 97123 investigation(1 hr min) 66.25/
hr
Industrial plant(1 hr min) 78.18/hr
Phone:(503)259.3200 Fax:(503)848.2597 Inspections for which no fee is 90.00/hr
specifically listed('/2 hr min)
CCB Lie.: 56951 Electrical Lie.: 34346CRE Suprv.Lie.: 4025LEB ELECTRICAL PERMIT FEES
Subtotal: ff I
Suprv. Electrician signature,required: 4d ,"1
y
� Plan review(25%of permit fee): ,—'—
Print name: mike sicard Date: 8/14/17 State surcharge(12%of permit fee): 1,, 7 y
TOTAL PERMIT FEE: �"
Authorized signature: ([� �'
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Michael Malstrom Date: 8/14/17
* Number of inspections allowed per permit.
1:\Building\Permits\ELC-PermitApp.dor 07/01/10 440-461510 1/05/COM/WEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11531 SW PACIFIC HWY, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical ELC2017-00613
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor