Permit (169) CITY OF TIGARD ELECTRICAL PERMIT
& I: . COMMUNITY DEVELOPMENT Permit#: ELC2018 00151
T tGAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/05/2018
Parcel: 1 S 135C D00900
Jurisdiction: Tigard
Site address: 11487 SW 98TH AVE
Project: Glacier Lilly Apartments Subdivision: None Lot: None
Project Description: (1)service and(4)branch circuits for garage wiring.
Contractor: DICKINSONS ELECTRIC Owner: SHARON DEVELOPMENT CO LLC
8449 SW BARBUR BLVD 5795 SW CRANBERRY CT
PORTLAND, OR 97217 BEAVERTON, OR 97007
PHONE: 503-246-3550 PHONE:
FAX: 503-213-6049
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 03/05/2018 $100.70
Specifics: amps or less
4 crt Branch Circuits w/Purchase 03/05/2018 $29.68
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 03/05/2018 $15.65
Electrical
Type of Const:
Occupancy Grp:
Total $146.03
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 --adopted by the Oregon Utility Notification Center. Those rule set forth>in- OAR
952-001-0010 throug e.R 952-001-0090. You may obtain a of the rules or dire questions to OUNC by calling 503.232.1987 or 1,88 33 4
... syr
Issued By: �/ ate,- Signature':
X.
Permittee 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 503.639.4175 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 Ap licatio ,ki � ` _ 14)R oii i i t;sl.ON I.1
ipiCity of Tigard vic
Received
13125 SW Hall Blvd.,Tigard,OR 97223 Date/B :. j� Y
= Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 A 6) �� Date/B : Related Permit#:
Inspection Line: 503.639.4175 MAR ReadyDate/By:y SeePage2for
Internet: www.tigard-or.gov T IC ,'IT Notified/Method: lifrSupplemental Information
TYPE OF W tg"�j I VISA)0( PLAN REVIEW
❑New construction tddition/altet�� t'tfentt N Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ther: 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 ❑Other: ❑Fireum .
P p 0 Installation of 150 KVA or
JOB SITE INFORMATION ANDLOCATION 0 Emergency system, larger separately derived
/ '-7 ❑Addition of new motor load of system.
Job#: Job site address:
/6 t1 r / S� 100HP or more. ❑«A» «E» «1 2» «1 3»
City/State/ZIP: Or „ ; /j �� 0 Six or more residential units. occupancy.
0 Health-care facilities.
0 Recreational vehicle parks.
Suite/bldg./apt. Project name: 61,,, 1,,..r0 Hazardous locations. 0 Supply voltage for more than
g pt.#: I , i -i y /Ptd'd'� ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#:
1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
( ay f . A-4-e-� _ (with above sq.ft.) 75.00 2
w „C,Jit/_ Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
0 Renewable Energy 0 See Page 2
PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less tof 100.70 ix.7E) 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) I 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 less59.36 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
Branch circuits—new,alteration,or extension,per panel
0 APPLICANT w I 0 CONT e CT PERSON
A.Fee for branch circuits with y 2
Business name: f"G�%� 41� above service or feeder fee, 7.42 �( lam►
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first
to v,
Address: � � , branch circuit 56.18 2
City/State/ZIP:10a - °1 /� *72-/ 7
J 72/ 7 Each add'l branch circuit 7.42 2
✓ ✓ ICl! /'` 7 6 Each manufacstured
ed or(service r feeder not included)
Phone: 2e./&,2 C� Fax: :( ) Each manufactured or modular
/� / dwelling,service and/or feeder 67.84 2
Email: �f f1 Gk-,�y�f,S , �Veconnect only 67.84 2
CC,,jj CONTRACTORI�I Pump or irrigation circle 67.84 2
Business name: (� Sign or outline lighting 67.84 2
t?Cyro. i S 1.441,,e
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
I 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 I Electrical '/�/7 Suprv,I z`.'41::2--e:::::2 specifically listed('/z hr min)
'7 J
-01
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: A .--
Subtotal: O
Print name: Date: ❑Plan Review Required(25%of permit fee)
State surcharge(12%of permit fee): i 5:65-
Authorized signature: TOTAL PERMIT FEE: i"% 03
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:
RESIDENTIALWORK ONLY, -4 FEE SCHEDULE'
• '
Description I Qty. I Each I Totals
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:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
n 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
n Vacuum Systems* >100kva-noadditional charge 0.0 3
Each additional inspection over allowable in any of the above:
n 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('Vs hr min)
. 2, CIAL WORK ONLY: k.;
ELECTRICAL PERMITFEES '''
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
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
n 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
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11487 SW 98TH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical ELC2018-00151
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor