Permit (215) L CTRICAL PERMIT
IIIII_ E
9 CITY OF TIGARD E. COMMUNITY DEVELOPMENT Permit#: ELC2018-00489
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/25/2018
TIGARD g Parcel: 2S112AD00301
Jurisdiction: Tigard
Site address: 14610 SW SEQUOIA PKWY
Project: John Barleycorns Subdivision: BONITA GARDENS Lot: 4
Project Description: Adding(6)branch circuits for equipment.
Contractor: ROBERTS ELECTRIC INC Owner: SMETS FAMILY TRUST I
5759 SW 48TH ST BY SMETS,JOHN E&MARIETTA D TRS
PORTLAND, OR 97221 PO BOX 560
AURORA, OR 97002
PHONE: 503-244-7754 PHONE:
FAX: 503-244-0560
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo/Purchase 07/25/2018 $93.28
Specifics: Service or Feeder
1 ea 12%State Surcharge- 07/25/2018 $11.19
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $104.47
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 R 952-001-009 . in a cop oy he rules or direct questions to OUNC by calling 503.232.19 or 1.800.332.2344
Issued By: ....04....-6e--- 0 iTIIU � 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 _ 3 �' I"OR 014i( I: tSI: Oy1.1
1111 City of Tigard JUL 2 Date/Bed . 7 I " _
• 13125 SW Hall Blvd.,Tigard,OR 97223 2013 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960C, Date/B : Related Permit#:
Inspection Line: 503.639.4175 a1 , - Ready Date/By: Juris: ® See Page 2 for
I I G A R D Internet: www.tigard-or.gov ,.. '?i Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
0 New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
El Demolition ❑Other:
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 IS Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
Other: amps for all other installations. buildings.
0 Multi-family El Master builder
❑ ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: /
❑Addition of new motor load of system.
(�l U 5�( t,,.., �1d1{. Six or or more. ❑occupancy.
cc "1-3»
!;
0 Six or more residential units. occupancy.
(^V r G. ,J
City/State/ZIP: `` �,\ U(2 -L Recreational vehicle parks.
V T� f ❑Health-care facilities. 0
Suite/bldg./apt.#: Project name: ', 0 Hazardous locations. 0 Supply voltage for more than
(Lt �0(��'N S ❑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 I *
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
i (with above sq.ft.) 75.00 2
t. i cc'\-. t a rt.00 S ft,r Limited energy,multi-family
I 11(y`j residential(with above sq.ft.) 75.00 2
E]t PROPERTY OWNER 0 TENANT Renewable Energy El See Page 2
Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 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:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
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
iit
APPLICANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: R b b ._l \--, e ,Q(411 /
above service or feeder fee, 7 42 2
l� each branch circuit
Contact name: V}j C.p.\ (i LI �� B.Fee for branch circuits without
Address: J service or feeder fee,first 56.18 2
t'13`Mj 5c:, `-kk AA - k.4,JI 124branch circuit 1
City/State/ZIP: /Lt t l' L I Ok (i/.c, y Z Each add'I branch circuit 9' 7.42 2
Phone: LI (.:(1).) T Miscellaneous(service or feeder not included)
(� .3 ) 1 1-j L c.'I Fax: :( ) Each manufactured or modular 67.84 2
( dwelling,service and/or feeder
Email: 1 �C l C Oc S t_i `r em Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: �b kr, 1 e('e-c .ir flc.
F Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: 2-Gi 3;3 ,st,yi-.-,\ AA z `i„ R 1' tZL.�, panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: /LA u'i !�A r\n ` Each additional inspection over allowable in any of the above
t / L 9 7 V L12 Additional inspection(1 hr min) 66.25/hr
Phone:(. "a)) (1 7 it L >%f ax:( ) Investigation(1 hr min) 90.00/hr
�(/` Email: -. /� ( /- _) Industrial plant(1 hr min) 78.18/hr
` \•..�L,k�ieA 1' Ger.-`�--. CtCC-I (-0A1 3y'-IC 7hA!/ Inspections for which no fee is
,e CCB Lie.: (3 7)V Electrical Lie.:_ * o Suprv.Lie.:3 5 5 specifically listed(%hr min) 90.00/hr
�/ ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: to i { l Subtotal:
Print name: g C, r-� M r,i t t D /ate: 7_a,/ 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signatur 45/ TOTAL PERMIT FEE:
1f
This permit application expires if a permit is not obtained within 180
Print name: ( it rr Date: 7_/51/ days after it has been accepted as complete.
J * Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitAppELR_ERE.doc Rev 06/17/ 5 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
smEN TI: I.,wo "- Y. : l
� .`-�..., .�', �. �-�j- .;.. FEE �d C l' 1 '2,•7;':',
' Description
Fee for all residential systems combined: $75.00aI Each I Total
y Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
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
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
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ 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
s• ifically listed((''/hrwmin)) +}
gs
Fee for each commercial system: $75.00 Subtotal Enteron Page 1):
3' s Number of inspections allowed peer 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
❑ Nurse Calls
❑ O• utdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELCPermitApp_ELRERE.doc Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14610 SW SEQUOIA PKWY, TIGARD, OR, 97224 August 2, 2018 at 1 :23:46 PM
Record Type: Record ID:
Commercial - Electrical ELC2018-00489
Inspection Type: Inspector:
199 Electrical final Chip Barnett
Result:
PASS - NoCofO
Comments:
Skype/ FaceTime with Jeff Grove
Violation Summary:
Inspector Contractor