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Permit (175) CITY OF TIGARD ELECTRICAL PERMIT III COMMUNITY DEVELOPMENT Permit#: ELC2018-00566 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/23/2018 T t r.;k It.1) g Parcel: 1S134DC03001 Jurisdiction: Tigard Site address: 11130 SW TIGARD ST Project: Dirksen Nature Park Subdivision: CHERRY HILL ACRE TRACTS Lot: 6 Project Description: (1)200 amp service and(4)branch circuits for new 1,465 restroom facility. Contractor: BURRILL ELECTRIC Owner: TIGARD, CITY OF 13553 THREE OAKS DR 13125 SW HALL BLVD WHITE CITY, OR 97503 TIGARD, OR 97223 PHONE: 541-826-3416 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders-200 08/23/2018 $100.70 Specifics: amps or less 4 crt Branch Circuits w/Purchase 08/23/2018 $29.68 Type of Use: COM Service or Feeder Class of Work: NEW 1 ea 12%State Surcharge- 08/23/2018 $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 the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 001- 90..You may obtain a copy of the rules or direct questions to OUNC by calling 503 2.198ycr�.800.332. 44. '\ 1/ b C Issued By: � �' Permittee Signature: ( f1 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 603.639.4175 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 Applicatio ( i: p.o i,, FOR OFFICE t SE ONE) City of Tigard Received d r/ 1:'r 'ennit it -C 1 f ©(!�fP'O' . 0 13125 SW Hall Blvd.,Tigard,OR 97223 AUG 2 $ Plan Review �_�� Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Pe T 4'^� Inspection Line: 503.639.4175 C$ ReadyDate/By: runs. 0 See Page 2 for TIGARD p a+ Y ,l Internet: www.tigard-or.gov j jg & J, 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): ❑Service or feeder 400 amps or more 0 Building over three stories. ❑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 ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. 0 Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived 0 Addition of new motor load of system. Job#:92016-06 Job site address: 11130 SW TIGARD ST 100HP or more. ❑"A","E";"1-2","1-3", City/State/ZIP:TIGARD,OR 97223 0 Six or more residential units. occupancy. 0 Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#:N/A Project name:DIRKSEN RESTROOM/NAT PLAY 0 Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site:TIGARD ST AT SW TWIN PARK PLACE FEE SCHEDULE Description l Qty. l Each I Total I * RESTROOM/NATURE PLAY LOCATED NORTH OF SPORTS FIELD 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#: IS134DD01000 Ea.add'/500 sq.ft or portion 3392 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 INSTALLATION OF 3"CONDUIT AND CRCUIT FROM TRANSFORMER TO (with above sq.ft.) Limited energy,multi-family 75.00 2 METER. INSTALL LIGHTING/ELECTRICAL WITHIN BUILDING residential(with above sq.ft.) Renewable Energy 0 See Page 2 ® PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation Name:CITY OF TIGARD 200 amps or less \ 100.70 100,70 2 Address:13125 SW HALL BLVD 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP:TIGARD,OR 97223 601 amps to 1,000 amps 301.04 2 Phone:(503)718-2466 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 t 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 ® APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name:COLUMBIA CONSTRUCTION above service or feeder fee, . 7.42 'k-'1E' 2 each branch circuit Contact name:JEFF DIRKS B.Fee for branch circuits without servAddress: 10749 OAK STREET#6 branche it feederitfee,first 56.18 2 branch circuit City/State/ZIP:DONALD,OR 97020 Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(503)427-0304 Fax::(503)776-9189 Each manufactured or modular 67,84 2 Email:jeff®columbiaci.com dwelling,service and/or feeder Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name:Burrill Electric Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy See Page 2 2 Address: 13553 Three Oaks Drive panel,alteration,or extension City/State/ZIP:White City,OR 97503 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(541)826-3416 Fax:( 'i( ) Li el(J -. 0‘,1 i Investigation(1 hr min) 90.00/hr Email:dburri1119@gmail.com / Industrial plant(I hr min) 78.18!hr ?/ 2C ie. /4//// Inspections for which no fee is CCB Lie.: 32317 Electrical Lic.: / specifically listed(%hr min) 90.00/hr \�j -�„� Suprv.Lic.: � t'S' Pec Y �/ z ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: '{_ 7-uct.l3 r b Z r1- `--- , Subtotal: \"))(5. ) Print name: Donald M.Burrill Date: 8/21/18 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): /5. 6 5 Authorized signature: TOTAL PERMIT FEE: / %' .02 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. I1Heilding\Permits\ELC_Permi[App_ELR_ERE.doc Rev 06/17/2015 440-4615T(1 1/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE * Fee for all residential systems combined: $75.00 Descriptin I Qty. I Each I Total C 3r Renewable electrical energy systems: Check Type of Work Involved: S kva or less l 00.7o 2 5.01 to 15 kva 133.56 2 n A• udio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ B• urglar Alarm 25.01 to 50 kva 301.04 2 5401 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) LI 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* >l00 kva-no additional charge 0.0 3 Each additional inspection over allowable in any of the above: n O• ther: Each additional inspection is 66.25/hr charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(Y:hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Subtotal(Enter on Page 1): Fee for each commercial system: $75.00 y Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: n Audio and Stereo Systems C Boiler Controls Clock Systems n Data Telecommunication Installation n Fire Alarm Installation n HVAC n Instrumentation n Intercom and Paging Systems n Landscape Irrigation Control* n Medical n Nurse Calls n Outdoor Landscape Lighting* n Protective Signaling n Other: Total number of commercial systems: _ *No licenses are required. Licenses are required for all other installations C\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: 11130 SW TIGARD ST, TIGARD, OR, 97223 Record Type: Record ID: Commercial - Electrical ELC2018-00566 Inspection Type: Inspector: 199 Electrical final Jeff Grove Result: PASS - NoCofO Comments: Sub panel and branch circuits for building only Violation Summary: Inspector Contractor