Permit CITY OF TIGARD ELECTRICAL PERMIT
III COMMUNITY DEVELOPMENT Permit#: ELC2018-00754
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/15/2018
TIGARD 9 Parcel: 1 S136AD06200
Jurisdiction: Tigard
Site address: 11420 SW PACIFIC HWY
Project: Tigard and Pacific Subdivision: None Lot: None
Project Description: Reconnect only.
Contractor: OWNER Owner: TIGARD&PACIFIC LLC
TIGARD&PACIFIC C/O DANIEL LYMAN 1245 E BRICKYARD RD STE 70
1245 BRICKYARD ROAD#70 SALT LAKE CITY, UT 84106
SALT LAKE, UT 84106
PHONE: 801-550-6109 PHONE: 801-550-6109
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 11/15/2018 $67.84
Specifics:
1 ea 12%State Surcharge- 11/15/2018 $8.14
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 youfollow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 95 -0090 You ma��btain a co of the rul-.or direct questions to OUNC by calling 503.232.1987 or 1.:,0 .2344.
Issued By: /it A` • Permittee Signatur
OWNER INSTALLATION • 'LY
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 RECEIVED FOR OFFICE 1_SE()NIA
City of Tigard Received ,
11111 'N 13125 SW Hall Blvd.,Tigard,OR 97223 N O V 15 2018 DPlaante/B Rev:iew i a/ �� �
*`: ' Phone: 503.718.2439 Fax: 503.598.1960 Date/13 : Related Permit#:
_. Inspection Line: 503.639.4175 CITY OF TIGARD Ready Date/By: Juris: IN See Page 2 for
i1('ARD Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
Js.:' " "° ' .,6 zs - •"'ss�,`,"' fay /�t 1. t i 1 5ti ir'J`//� k.d,F/
❑New construction a_ 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition ,74 Other: I etz-GDN - d ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current 0 Marinas and boatyards.
„ ,,a ®,"' M ;' E .,,.._z h., t ,s exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling arCommercial/industrial 0 Accessory building less to tiround,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
y Z" ,... J.r.° <' i`1 t t °i l._ `nMe ❑Emergency system. larger separately derived
Job#: Job site address: "LU_.O <61\1 v V ❑100H oo of or.motor load of system.
100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: '\L}( ` Ok 011-1.in Health-care
It more facties. units. Recreational
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: 11 1 4 p(k(�\c� ❑Hazardous locations. 0 Supply voltage for more than
\`1 ❑Service or feeder 600 amps or mare.
ore 600 volts nominal.
Cross street/directions to job site: SW L5ili. A PKt `'1'1NPM x x :, yam. e I 1 ; *»
�j �y \ 1 \ �y a Description Qty. Each -Tota' 1..*.N
51 jA LTA bR] SW ��1 V P\-0 t eT New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add 1500 sq.ft.or portion 33.92 1
,rs B ] !', tl 1 �. H �
._ ,�,� }s��„.a,. :r... .,-�; �;" z. Limited energy,residential
75.00 2
�%� (with above sq.ft.)
�-Lt r C( Clttx� Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
a a Renewable Energy
0 See Page 2
� � `�' Services or feeders installation,alteration,and/or relocation
Name:T\(sc •� e 1 p I c. c_a I t ��- 200 amps or less 100.70 2
Address: \7)...v�54,,,,p41\40Ro�/ *- � 201 amps to 400 amps 133.56 2
I �v 401 amps to 600 amps 200.34 2
City/State/ZIP: S T L CAI 0 q( ap 601 amps to 1,000 amps 301.04 - 2
Phone:O6\ )�p--(01 1 I Fax:( ) Over 1,000 amps or volts 552.26 2
Email: O ei[SpO.c�1/4.(ss1"Y rel� �R services or feeders installation,alteration,and/or
Owner installation:This install 'on is being made on property that I own which is not 200 amps or less 59.36 I
intended for sale, - ent,or lige,accordingQ � to ORS 447,449,670 and 70).. 201 amps to 400 amps 125.08 2
Owner signature: A,�V I V� —Date: (<l p 401 amps to 599 amps 168.54 2
Branch circuits-new,alteration,or extension,per panel
•- A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email
5 �s Reconnect only
67.84 2
,yr r F16 f�y�� r i���
y M ..;.�6, ., �, � ,srF�K;. rz,,= r �,, ., ,� �a,«„�,_ s���f�r�ia Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: s, cifically listed 9z hr min
Suprv.Electrician signature,required:
Subtotal:
Print name: I Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature:,� yVV�----'—)W TOTAL PERMIT FEE:
I This permit application expires if a permit is not obtained within 180
Print name: Df �k m �` Date: tt '3' f( days after it has been accepted as complete.
'1, „Y v * Number of inspections allowed per permit.
I'ABuilding'Permits\ELC_PermitAppELR_ERE.doc Rev 06/17/2015 440-4615T(1 l/05/COMJWEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
$75.00 Description Qty. EachTotal
Fee for all residential systems combined: Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100 70 z
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
El 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
specifically listed(%2 hr min)
,:» .,
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*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
[, Other: l Lc `(1-1 r'.Sc kf
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I.\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015