Permit (97) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2018-00550
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/16/2018
Parcel: 2S 101 AA09800
Jurisdiction: Tigard
Site address: 12570 SW 69TH AVE
Project: George Fox Subdivision: 1996-024 PARTITION PLAT Lot: 2
Project Description: (1)branch circuit to reconnect RTU.
Contractor: WILLAMETTE HVAC LLC Owner: PLAZA PROPERTIES LLC
3075 SW 234TH AVE.#206 3835 SW KELLY AVE
HILLSBORO, OR 97123 PORTLAND, OR 97239
PHONE: 503-259-3200 PHONE:
FAX: 503-848-2597
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 08/16/2018 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/16/2018 $6.74
Type of Use: SF 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 •rk is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Cen=r. •se rules are set forth in OAR
952-001-0010 through•, •52-001-0090. • ••.. •• -', -cop of the rules or'irect questions to OUNC by calling 503.232.1:Tor 1 i i 3 . 344.
Issued By: - _ ' -e 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 USE ONI.V
City of Tigard ReceivedDate/B : 1) , _may Permit No.: ----- y ,i lips:
13125 SW Hall Blvd.,Tigard,OR 97223„ '4 4.Plan Review
' = Phone: 503.718.2439 Fax: 503.598.1960 7.• '. `"Date/B : Other Permit: i/y)- A I , _‘„ `'41,
T I(,.4 R I) Inspection Line: 503.639.4175 Date Ready/By: ® See Page 2 for
Internet: www.tigard-or.gov 1\; } 2 018 Notified/Method: IMI Supplemental Information
-s .., 14 f t 'A i t. ?ti',,. ♦ °F3L#153 ... , .r'4'1/7''''';:7
Please check all that apply(submit 2 sets of plans w/items checked below):
❑New construction ®Addition/alteratX011/'ep)we[ilent
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
'' exceeds 10,000 amps at 150 volts or 0 Floating buildings.
CATEGORY � I�S'�RITGTIA�1v
. , '" 'el, n - 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 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 75 KVA or
❑Emergency system. larger separately derived system.
JOB SITE INIPORNI+TI LOCATION 0 Addition of new motor load of ❑"A","E","1-2","I-3",
Job no.: Job site address: 12570 SW 69th Ave 100HP or more. occupancy.
❑Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP:Tigard OR 0 Health-care facilities. 0 Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:George Fox 0 Service or feeder 600 amps or more.
y, FEE EDVLE :, , t
Cross street/directions to job site: Description `e �"t�
QtY I Fee.,._ �., Total � *
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'1500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
reconnect RTU Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
r
°' 0 p O-ristit owp,iii ," *mom. y 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
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
„'e. , above service or feeder fee,
0..Al"P1.1CA 1 ' ' NTACT x each •branch circuit 7.42 2
Business name:same as below B.Fee for branch circuits without
service or feeder fee,first 1
Contact name: branch circuit 56.18 3--&ri G 2
Each add'l branch circuit 7.42 0 2
Address: Miscellaneous(service or feeder not included)
Each manufactured or modular
City/State/ZIP: dwelling,service and/or feeder 67.84 2
Phone:( ) Fax: :( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
Sign or outline lighting 67.84 2
CON'J'RACI'O ,. , 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
Investigation(1 hr min) 66.25/hr
City/State/ZIP:Hillsboro,OR 97123
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('h hr min)
CCB Lic.: 56951 Electrical Lic.: 34346CRE Suprv.Lic.: 4025LEB ELECTRICAL PERMIT FEES
N Subtotal: 72. I y
Suprv.Electrician signature,required: Plan review(25%of permit fee):
Print name: mike Sicard Date: 8/15/18 State surcharge(12%of permit fee): Ito- 711
TOTAL PERMIT FEE: } Z
Authorized signature: hel —,_<,- ,, ()%t/ 41C/11
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Michael Malstrom I Date: 8/15/18 * Number of inspections allowed per permit.
I:\Building\Permits\ELC-PermitApp.doc 07/01/10 440-4615T(11/05/COM/WEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12570 SW 69TH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical ELC2018-00550
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor