Permit (23) CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENTIN
Permit#: ELC2019-00310
Date Issued: 05/29/2019
T I c;A k.f) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S101AA09800
Jurisdiction: Tigard
Site address: 12570 SW 69TH AVE
Project: George Fox Subdivision: 1996-024 PARTITION PLAT Lot: 2
Project Description: Replacing(1)4-ton 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 05/21/2019 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 05/21/2019 $6.74
Type of Use: COM 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 work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Th se rules are set forth in OAR
952-001-0010 through OAR 9 01-009 You obtain a co y of the r s or direct questions to OUNC by calling 503.232.19 or 1.8 .332.2344.
ft
Issued By: Permittee Signature: 0 0
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 ONLY
CityReceived
of Tigard Date/B : A i/� Permit No.: --
13125 SW Hall Blvd.,Tigard,OR 97223
11 Phone: 503.718.2439 Fax: 503.598.1960 :< - ; Other Permit:
. '��iay
T I G A R D Inspection Line: 503.639.4175 tat Ready/By: See Page 2 for
EGFVii
Internet: www.tigard-or.gov j = .ified/Method: NM Supplemental Information
� �5 i s f 'E OF WORK t AY t`, 19 PLAN REVIEW .
>, ,,,,-;.- Please check all that apply(submit 2 sets , � . ,.;, .� ,... ..,G
❑New construction ®Addition/alteration/replacementof plans w/items checked below):
CITY OF -jt3p�t 0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: ( /^� DIVISION
t�l !. p where the available fault current 0 Marinas and boatyards.
ARY OF CX31tISTR � IG 14F ItixU exceeds 10,000 amps at 150 volts or 0 Floating buildings.
�` less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
J03i SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived system.
0 Addition of new motor load of ❑"A" "E" "1-2""1-3„
Job no.: Job site address: 12570 SW 69th Ave IOOHP or more. occupancy.
0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP:Tigard OR 97223 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.
FEE'SCHEDULE
Cross street/directions to job site: Description I Qty I Fee. I Total I
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'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential 75.00 2
D SCRIPTION M ' (with above sq.ft.)
Limited energy,multi-family 75.00 2
reconnect RTU residential(with above sq.ft.)
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
0 PROPERTY OWNER ❑ TEN ' 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
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
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
0above service or feeder fee,
;APPLICANT CONTACT PERSONabove
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 -5-- 2
Each add'I branch circuit 7.42 2
Address: Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
City/State/ZIP: dwelling,service and/or feeder
Phone:( ) Fax: :( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
67.84 2
¢ �" , 8 '"_� - 1 „ ,„0„ Sign or outline lighting
.. r. x , _. , ,„- ,1. ” .. . 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
City/State/ZIP:Hillsboro,OR 97123 Investigation(1 hr min) 66.25/hr
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 , ,y.,ELECTRICAL.PERMIT FEES. „;
fir/• %� Subtotal: jr(,i
Suprv.Electrician signature,required: `� ��,uo
I
Plan review(25%of permit fee):
Print name: mike sicard _ /- Date: 4/26/19 State surcharge(12%of permit fee): L "�1
/ / TOTAL PERMIT FEE:l t(602.ci),
Authorized signature: This permit application expires if a permit is not o Laine within 180
days after it has been accepted as complete.
_Print name: Michael Malstrom Date: 4/26/19 _ :_Nun.ber of;mpe.,t;ons alluwed per permit.
I:\Building\Permits\ELC-PermitApp.doc 07/01/10 440-4615T(11/05/COM/WEB
A
Electrical Permit Application - City of Tigard ❑ Other
Page 2 - Supplemental Information Total number of commercial systems:
LIMITED ENERGY PERMIT FEES• '"No licenses are required. Licenses are require
for all other installations
Y: v [AL' T i/w, k ATI asSIZtroigialw{;-..
Fee for all residential systems $75.00
combined
Check Type of Work Involved:
❑ Audio and Stereo Systems*
nBurglar Alarm
❑ Garage Door Opener""
n Heating,Ventilation and Air Conditioning
System"
❑ Vacuum Systems""
U Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
• Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control"
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting"
❑ Protective Signaling
1:\Building\Permits\ELC-PermitApp.doc 07/01/10
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
12570 SW 69TH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical ELC2019-00310
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor