Permit (37) CITY OF TIGARD ELECTRICAL PERMIT
IN ' . COMMUNITY DEVELOPMENT Permit#: ELC2019-00044
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/24/2019
T t i;.,`1/4 I<.r', g Parcel: 1S136DB02400
Jurisdiction: Tigard
Site address: 11642 SW PACIFIC HWY 120
Project: Champior Subdivision: None Lot: None
Project Description: Reconnect only.
Contractor: Owner: CBC NORTHWEST LLC
16449 LEXINGTON CT
LAKE OSWEGO, OR 97034
PHONE: PHONE: 503-454-2611
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 01/24/2019 $67.84
Specifics:
1 ea 12%State Surcharge- 01/24/2019 $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: Or-.on 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 952-0 1-009you may ob n a copy oft rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. 4
Ic
Issued By: � '
/� ik / �i! Permittee Signature: (64&*(--(;) /�ne
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 ApplicationFIEr"-"YE! I Received
la FOR o r r l c l: I Si, O y l.1
City of Tigard Date/B :
/�/,z"v l� `ermit#. `�� �� !tel
IN . 13125 SW Hall Blvd.,Tigard,OR 97223 JAN 2 A 2019 Plan Review
CRelated Permit#:
Phone: 503.718.2439 Date/B
Email: TigardBuildingPermits@Tigard-or goc-i-,,,t . ` R D. Ready Date/By: Juris: H See Page 2 for
T I G A R D Inspection Line: 503.639.4175 Internet yv}v rygel-d, p t s*r Notified/Method: Supplemental Information
I L.rWt.x° 0,'vi
TYPE OF WORK PLAN REVIEW
❑New construction ,ddition/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.
❑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 p.Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
4ulti-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION �� ,t/ 0 Emergency system. larger separately derived
Job#: Job site address: /k' }Lo ��1 2 J / �" (�' 0 Addition of new motor load of system.
7 S / ""J" ,y 100HP or more. ❑«A» «E» «1_z» «1.3„
f . 0 Six or more residential units. occupancy.
City/State/ZIP: / a 0 Recreational vehicle parks.
� / ❑Health-care facilities.
Suite/bldg./apt.#: //;;;;4"00 Project name: 0 Hazardous locations. 0 Supply voltage for more than
�� „ed../
�
0 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'I 500 sq.ft.or portion 33.92 1
DESCRI ON OF W RIC Limited energy,residential
� V,-/),/-1>1*-- (with above sq.ft.) 75.00 2
t -` ; . , ., Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
OP TY s/W�
Name: l�.lNER 0 TENANT Services or feeders installation,alteration,and/or relocation
�°7,(_00, .....,1, ( . 200 amps or less 100.70 2
Address: C" ' ) J, f y 201 amps to 400 amps 133.56 2
�' jt /
401 amps to 600 amps 200.34 2
City/State/ZIPt. , �� 601 amps to 1,000 amps 301.04 2
Phone; j7) // L'� Over 1,000 amps or volts 552.26 2
if� ✓ Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is bcafng `ade 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
APPLICANT CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without --
Address: . service or feeder fee,first
!?7/2 branch circuit 56.18 2
' `
� Each add'I branch circuit 7.42 2
City/State/ZIP: _
ty
Miscellaneous(service or feeder not included)
Phone:( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 / 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuits)or limited energy
0 See Pa e 2 2
Address: 7///11 / / ' panel,alteration,or extension. g
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
- _ Inspections for which no fee is
CCB Lic.: Electri al Lic.: Suprv.Lic.: specifically listed('/:hr min) 90.00/hr
ELECTRICAL PERMIT FEES
. - -- ' '.1 : .-1 -, .• -:: Subtotal:
Print nameathh/' j Date: A/�3 ❑Plan Review Required(25%of permit fee):
/ State surcharge(12%of permit fee):
J TOTAL PERMIT FEE:
Authorized signator -'�/� /
n This permit application expires if a permit is not obtained within 180
Print name:r, 2 • �h Ai/7 / Date:7/4.,14-.197
days after it has been accepted as complete.
�IOt `tt * Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 440-4615T(11/05/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
Description Qty. I
Fee for all residential systems Renewable combined: $75.00 Each Total electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
El Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
El Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
El Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
El Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(4 hr min)
c("$,',1 ,l WOK(ONLY: ELECTRiC .`a Y. FEES }
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
El Protective Signaling
El Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\EL.CPermitAppELR_ERE.doc Rev 10/26/2017
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11642 SW PACIFIC HWY 120, TIGARD, January 25, 2019 at
OR, 97223 8:21 :51 AM
Record Type: Record ID:
Commercial - Electrical ELC2019-00044
Inspection Type: Inspector:
199 Electrical final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor