Permit Support Document (28) _ CITY OF TIGARD LECTRICAL RESTRICTED ENERGY PERMIT
' a COMMUNITY DEVELOPMENT f01'-','-',, ' „ Permit#: ELC2018-00188
T f c;A R.f7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.24 c. . i `' 1 �� Date Issued: 03/21/2018
v
. Parcel: 1S135BD00300
Site address: 9735 SW SHADY LN 201 Jurisdiction: Tigard
Project: Renew Sleep Solutions Subdivision: None
Project Description: Add new light switches and outlets. 4/4/18:REPRINT to add(2)branch circuits. Lot: None
Contractor: STEELE ELECTRIC LLC
Owner: TIGARD MEDICAL MALL LLC
716 ROXE DR PO BOX 98
FOREST GROVE, OR 97116 POULSBO,WA 98370
PHONE: 503-332-1280 PHONE:
FAX: 503-372-6448
FEES
Description Date Amount
Specifics:
Branch Circuits wo/Purchase Service or 04/04/2018 $71.02
Type of Use: COM Feeder
Class of Work: ALT Plan Review Electricial 04/04/2018 $17.76
12%State Surcharge-Electrical 04/04/2018 $8.52
Total Number of Systems:
Audio&Stereo: Boiler Controls:
CCTV: Clock Systems:
Data&Telecommunications: Fire Alarm:
HVAC: Instrumentation:
Intercom/Paging: Landscape/Irrigation:
Landscape Lighting: Medical:
Nurse Calls: Protective Signal:
Security Alarm: Other:
Other Desc:
Total $97.30
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 001-0,90. Y, may ob,_' a c of the rules or direct questions to OUNC by calling 503 232.1987 or 1.800.332.2344.
Issued By: ! ,
��` Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE:
Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC'
Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OFFICE'. l SF ONLY
x I Y$.y
City of Tigard Received �j
1r t' a d �'Date/By: d', /i Y, �' Pe. it#: E. U 1 g--�50/ET(
;� . 13125 SW Hall Blvd.,Tigard,OR 97223
_ Phone: 503.718.2439 Plan Review `r ,
Date/By: `r Related Permit#:
Email: TigardBuildingPermitsigard or.g st 1` Read D H See Page 2 for
TIGARI) aJ �� Y a Jur s:
Inspection Line: 503.639.4175 Internet: www.ti and or. ov Notified/Method:
p �y�dK, d,g g ��yy �3 /�J�� �� Supplemental Information
TYPE OF W/ i d Of 1I(iARI
El New construction 0 Addition/altel3 t�6i #r 'e� "I1'3` Please applyPLAN REVIEW
: h checkall that (submit 2 sets of planse or400 ams or moreBuilding vs checked):
❑Demolition0Servicfeeder
0 Other: P 0 over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling Q Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑Multi-familyamps for all other installations. buildings.
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#: 1 '3-3( Job Site address: ❑Addition of new motor load of system.
3 S Li }mss.. L n 100HP or more. 0"A","E",`1.2„ "1-3",
City/State/ZIP: 7., p ❑Six or more residential units. occupancy.
}Q V WI Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: �
� Project name: � e 4
14+ S�` \ ❑SeHazarvircedousorfeeder locations.
600 0 Supply voltage for more than
Cross street/directions to job site:
❑ amps
or more. 600 volts nominal.
FEE SCHEDULE
' , Description I Q . 1 Each I Total I *
' °"' .. '`` 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
DESCRIPTION OF WORK, Ea.add00 sq.ft.or portion 33.92 1
/ Limited energy,residential
tG{ C�) C r / (with above sq.ft.) 75.00 2
� �✓) IrK l 7-2) 'yds 12L�C"1 /��l Limited energy,
lN��,// � ) multi-family 75.00 2
(,� / Y t i,�� residential(with above sq.ft.)
PROPERTY OWNER "' I 0 TENANT Renewable Energy 0 See Page 2
0
Name:
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
City/State/ZIP: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:( ) 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
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,
Q c1/4I jrL r
7.42 2
Contact name: each branch circuit
B.Fee for branch circuits without
Address: service or feeder fee,first 56.18
branch circuit 2
City/State/ZIP: Each add'l branch circuit 7.42 2
Phone:( ) Miscellaneous(service or feeder not included)
Each manufactured or modular
Email: dwelling,service and/or feeder
67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: -
ST y-z• E^ / lighting 67.84 2
z c.t Z �i� Sign or outline li tin
Address: Signal circuit(s)or limited-energy
I
b iii c panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Phone:(S17 3) i— f+ i •� rts7 1 1 6 Additional inspection(1 hr min) 66.25/hr
T--t 3 I 1 Investigation(1 hr min) 90.00/hr
Email: ��� 5-k..-c-%(-t-. L<-)
Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: \ (al LA l.- Electrical Lic.: 4 7 5 3 `
Suprv.Lic.: q s specifically listed('/z hr min) 90.00/hr
Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES
Subtotal:
Print name: 00 w,,.\ C 4.� ` Date: 3 l 2 7)) 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
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 10/26/2017 440-4615T(11/05/COM/WEB
Electrical
2— Permit ApplicationSupplemental —Information City of Tigard
Limited Energy Permit Fees: Renewable Energy Per
Fees:
RESIDENTIAL ONLY:
FEE 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:
❑ 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)
n Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
>100 kva—no additional charge 0.0 3
n Vacuum Systems*
Each additional inspection over allowable in any of the above:
Each additional inspection is 66.25/hr 1
ri Other: charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(''A hr mm) F;
y ..4 'ItECTRICAI:" 'F MI[ 'E 'S
C� CIAL WOR { 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*
❑ M• edical
n N• urse Calls
n Outdoor Landscape Lighting*
El 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 10/26/2017
FOR OFFICE USE ONLY-SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
111 I Transmittal Letter
T i G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: 11:' c''';'t
DATES 1i ' I w
DEPT: BUILDING DIVISION
MAR 2 7 2018
FROM: ( c).,., c;-:\--&-eketit) 0 IVALMNx 1 s
COMPANY: 5-4--c.41.z 1j\.e-8,•,, € X11 0;'41
PHONE: Cz=.3 - '332-- ‘1-t-(;) I By:. ,,
RE: 9'7 7 S S l.1 Sl
k� 1- ?-c7
(Site Address) /51C-/51C-hi/' [X� gY
/`�J ,, (Permit Number)
^K.,c,.✓ c c ,A .UnS
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: I Description: Copies: I Description:
Additional set(s) of plans.
Cross section(s) and details. Revisions:
Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS:
cps/ r..,,,- P„1\ 4_,‘ ,,,\,\..t Lt•-4414 %P.v i41
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: V'V/ir
Fees Due: $Yes Due:
Initials:
❑No Fee Description: Amount Due
gai/ .,, -‘r , .� ->,..r,'A:11r /77h
$
$
Special I $
Instructions:
Reprint Permit(per PE): 32jes I ❑No
❑ Done
Applicant Notified: 4t
/Vpr Dat : 4,1,-?/)
9-4-'...- Initials:
I:\Building\Forms\TransmittalLetter-Revisions 061316.doc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9735 SW SHADY LN 201 , TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical ELC2018-00188
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor