Permit (57) CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT Permit#: ELC2019-00468
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/10/2019
Parcel: 2S114AA00200
Jurisdiction: Tigard
Site address: 16285 SW 85TH AVE 108
Project: House Gym Subdivision: None Lot: None
Project Description: Demo and adding(3)branch circuits.
Contractor: KEC ELECTRIC INC Owner: WH SHIPMAN LIMITED
761 SW BAILEY AVE BY NORRIS&STEVENS INC
HILLSBORO, OR 97123 900 SW 5TH AVE STE 1700
PORTLAND, OR 97204
PHONE: 503-439-0904 PHONE:
FAX: 503-640-3838
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 07/10/2019 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 07/10/2019 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 9 2-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
- i
Issued By: ��.A. � Permittee 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.
RECEIVED
Electrical Permit Application FOR orFicE t:sE()Nix
City of Tigard J U L 0 2 019_ ReceivedB : ItC i
114 4 13125 SW Hall Blvd.,Tigard,OR 97 r Plan Review Related Permit#:
I ' Phone: 503.718.2439 Fax: 503. g0�°q n`�f y ����� DateB
Inspection Line: 503.639.4175 �i— J I i V G DIVISION Ready Date/By: Juris: ® See Page 2 for
T I G A R D Internet: www.tigard-or.gov Notified/Method: Supplemental Information
❑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 ❑Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
a:}y
} `.4.,::,:', ..; = I p t z+ ,, N' ID 10,000 amps at 150 volts or Floating buildings.
7 : ' '` ., d,
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or
t t r"4 t . a t ❑Emergency system. larger separately derived
r In � �- . ., ,
❑Addition of new motor load of system.
Job#: Job site address:16285 SW 85th Ave#108 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP:Tigard,Or 97224 ❑Six or more residential units. occupancy.
El Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: 1 Project name:House Gym ❑Hazardous locations. ID Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: ,
Description Qty. Each Total
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'l 500 sq.ft.or portion 33.92 I
'•.44 &4FTf Vit R P..4? °. '' 4 :: t;: ..gym.. Limited energy,gy,residential 75.00 2
Demo,add 3 branch circuits (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
:y> . s ' e , .' ''+� _ -r.'- ' Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address:
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) I 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 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
v , Branch circuits—new,alteration,or extension,per panel
�'.. 31 d v =' ',.•,',-0: o Ii' ACT t 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
service or feeder fee,first 1 56.18 58.16 2
Address: branch circuit
City/State/ZIP: Each add'l branch circuit 2 7.42 14.84 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
.. ,; CONN „r. '. „,.: Pump or irrigation circle 67.84 2
Business name:KEC Electric,Inc Sign or outline lighting 67.84 2
Address:761 SW BaileyAve Hillsboro,Or 97123 Signal circuit(s)or limited-energy 0 See Page 2 2
panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP:
Additional inspection(1 hr min) 66.25/hr
Phone:(971)37103461 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:kenc@kecelectric.com Industrial plant(1 hr ruin) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 99267 Electrical Lie.: 34-426C Suprv.Lie.: 44895 specifically listed(%hr min)
c. ELECTRICM,''SWIT T'FEES
Suprv.Electrician signature,required: )1.... (rt Datrr�s Subtotal:
Print name: Kenneth E.Conway l, e: 07.10.19 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE: 79.54
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.
l9Building\Permits\F.LC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB