Permit Support Document (6) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT f Permit#: ELC2018-00009
TIG A R O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 r,�i? 4111111 Date Issued: 01/04/2018
Parcel: 1 S135DD05100
Jurisdiction: Tigard
Site address: 11970 SW GREENBURG RD
Project: CODA Tigard Recovery Center Subdivision: None Lot: None
Project Description: Reconnect Roof Top Unit,Possible service outlet. 5/10/2018: REPRINT to add(1)additional branch circuit.
Contractor: BEAR ELECTRIC Owner: LANDING SQUARE LIMITED PARTNERSH
PO BOX 389 VIUHKOLA,JENNIFER
DONALD, OR 97020 5250 SW LANDING SQUARE#14
PORTLAND, OR 97209
PHONE: 503-678-1355 PHONE:
FAX: 503-678-1108
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 01/04/2018 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 01/04/2018 $7.63
Type of Use: COM Electrical
Class of Work: ALT 1 crt Branch Circuits w/Purchase 05/11/2018 $7.42
Service or Feeder
Type of Const: 0 ea 12%State Surcharge- 05/11/2018 $0.89
Occupancy Grp: Electrical
Total $79.54
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 Issued By:through OA r±1-OYou ay o a copy of the rules or direct Permittee Sign ture:questions to OUNC by ailing 521987or r-741��3 � �n
Z:W
OWNER INSTALLATION ONLY �i
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 lb..
APPli"tiKECEIVED jvir FOR OFFICE USE ONLY
oi
City of Tiga rd Received "7' Pennit#6-1-CA04
111 . 13123 SW Hall Blvd.,
. ... Tigard,OR 97223
Plan Review
' 5 Phone: 503.718.2439 Fax: 503.598.1 10 2 0 18" 1 D /8 : Related Permit#:
TIGARD Inspection Line: 503.639.4175 " Ready Date/By: kris: Hi See Page 2 for
Internet: www,figard-or.gov .. i., Notified/Method: Supplemental Information
1R-MYVIT:5;C:6ZIFIEragtinrijilfliji'i'l:s.iP-telff177.1tTr:7:472MMli'R: 141,1".7`,44::1,.'.4i.TIA.:Silb.. .iPlai.2..9-6-:14:':644;.A.:'' & ,:.;i *':4'4
0 New construction JZ Additio ‘. ? !Pi -I" 't ' ' ' Please check all that apply(submit a sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
?iirct..:,iiX.,:,fiii17),Leitlilli*Mg !;,.,^134altDiartiellifit?„kilTiliie exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
El 1-and 2-family dwelling 2Commercial/industrial El Accessory building
amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire Pump. 0 Installation of 150 KVA oc
0 Emergency system. larger separately derived
O Addition of new motor load of system-
Job#: Job site address: It olio cko eiyt911 hor9 pd. O
100111'or more.
City/State/ZIPlictosa \i'2_." _'3OSixormoreresidential units. occupancy.
E-Jklealth-care facilities. 0 Recreational vehicle parks.
Suite/bldg/apt.4: ") I Project name: 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: AftWit's.OVAnT;-iritAtiii'lEtif#,M510:414,
Description Qty.IT Each Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot 4: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel 4:
Ea.add'l 500 sq.ft.or portion 33.92 1
1-1-1•3r"VSAIIIA'1,1t..,iiit...1470 S1ti1V6 Y:..471,1111A:1ik4tiktPc‘:54':,es:4 Limitedenergy,residential
75.00 2
2o_oon wt.+ 0-n) (with above sq.ft.)
Limited energy,multi-family
75.00 2
'+ .A.• , .„. 1, ^ residential(with above sq.ft.)
4 ,k4.:‘,0 -e•X. ,,,,,i'.41 or 0,€A-M _, (-A..4.0iii' vOvo 9
,,,,„ Renewable Energy 0 See Page 2
101-"•4-:'!;24.1Fi! ,t2'!'tkt. 4,017:t-7',7::,'1171 Yfgirn,i:s!i,ova',ifr',,,,,',16:13:P?7,---'a: Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less I 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps I 200.34 2
City/State/ZIP:
601 amps to 1,000 amps j 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts j 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that 1 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 10 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
Branch circuits--new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: Bejle .5.ter-4-1ci Inc, above service or feeder fee,
7.42 2
each branch circuit
Contact name: NALUSSOL WI (It Ck,l(vi5 13.Fee for branch circuits without
Address: PO 130y 3S01 service or feeder fee,first 56 18
branch circuit 2
City/State/Z1P:DO na.(.a ()C G1102-0 Each arid'I branch circuit 1 7 42 1.41 2
, Miscellaneous service or feeder not included
Phone:(50`i )co-iq- 1-3es IFax: :(503) (11s/... igulf Each manufactured or modular 1111 67.84 2
dwellin' service and/or feeder
Email: fe„ on ii-s e Bear e-11...c.--i-ri c. co vvi . Reconnect only 67.84 2
1c,Jlt,,,, C074i,s,,ii t,,..,:.;.fr,,T,?`g INr„.214,1%,','S'iia ,Vfit.,:,,-T.', Pump or irrigation circle 67.84 2
Business name: Be -xkr- E, ie.cAl--i c IA)e,.
i Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy r-, see i„8,, 2
Address: Po 80 x 3c/.9 panel,alteration,or extension. ' .6e 2
City/State/ZIP: Dona tai az q 7'c1zd Each additional ins.ection over allowable in an of the above
Additional inspection(1 hr min) II 66.25/hr
Phone:(563 )ta-7?•- / Fax:(503 ) terrg-#01 Investigation(I hr mm ) 90.00/hr
Email:Perm i45 e seet_vdecii-ne. eotkiIndustrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
90.00/hr
C'CB Lic.:za el I 9 1 Electrical Lie.:2[4407 e.. Suprv.Lic.: s;)ecifically listed,....Jo min,
i'-*A;71,2 :143
Suprv.Electrician signature,requiredf---"' , ...-.------"--- ----
A Subtotal': :7.1-12.
Print name<)... /-41, , '\ Date: 5-10-ii- 0 Plan Review Required(25%of permit fee):
't NI:Illko'N. State surcharge(12%of permit fee): ./Sol
Authorized signature: , -------- TOTAL PERMIT FEE: q.3 1
This permit application expires if a permit is not obtained within ISO
I Print name: ;:15.le.x.A.-..,,,e4,..v.fip\s„ ....„\j, Date: 5-1 0- t days after it has been accepted as complete.
BituildinglPertuitstELC femtitApp_ELR_ERE.doe Rev 06/17/2015 It
1 '‘ * Number of inspections allowed per permit.
440-461STO tioS/COmiwEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11970 SW GREENBURG RD, TIGARD,
OR, 97223
Record Type: Record ID:
Commercial - Electrical ELC2018-00009
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor