Permit Support Document (2) �, CITY OF TIGARD ELECTRICAL PERMIT
=' COMMUNITY DEVELOPMENTPermit#: ELC2019 00647
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 i ,$` Date Issued: 09/26/2019
Parcel: 2S 101 CA00200
Wet
6 ,,,.' Jurisdiction: Tigard
Site address: 13110 SW WALL ST
Project: Terrafirma Subdivision: None Lot: None
Project Description: Move conduit. 10/9/19: REPRINTED permit to add(1)service for modular building.
Contractor: BEAR ELECTRIC Owner: WALL STREET INDUSTRIAL LLC
PO BOX 389 13170 SW WALL ST
DONALD, OR 97020 TIGARD, OR 97223
PHONE: 503-678-1355 PHONE:
FAX: 503-678-1108
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 09/26/2019 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 09/26/2019 $12.08
Type of Use: COM Electrical
Class of Work: ALT 1 ea Services or Feeders-200 10/09/2019 $100.70
amps or less
Type of Const: 0 ea 12%State Surcharge- 10/09/2019 $12.09
Occupancy Grp: Electrical
Total $225.57
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 952-001-0090. You may obtain a co e rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
'
Issued By: permittee Signature:
v -411....6‘.
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
City of Tigard RECEIVED Received
, 9 1 125 SW hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 0 c T 8 2.019 ate/liv:
71 3 ' Duaterny: /(,)/q/i4e, erjy--. Perm"4:
Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: Ed See Page 2 for
TIGARD
...,, Internet: WWW.tigard-or.gov
.'. OF T GARD Notified/Method: Supplemental Information
TYPE OF VItytt) 'OMISION: I PLAN REVIEW'"V=1":"-7;""AVV:,:',1'*,',..,:,,50,
0 New construction i1 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/iteins checked):
0 Demolition El Other: ^VI' 0 Service or feeder 400 amps or more 0 Building over three stories.
r`4 . where the available fault current 0 Marinas and boatyards.
CATEGORY.OF CONSTRUCTION ' zi)4317,:-., exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
0 I-and 2-family dwelling E Commercial/industrial 0 Ac'esso I V ;i i,i4f,14
amps for all other installations. buildings.
0 Multi-fami Iy E3 Master builder E 011 t, : 0 Fire pump. 0 Installation or 150 KVA or
JOB SIM INFORMATION AND LOCATION El Emergency system. larger separately derived
....
0 Addition of new motor load or system.
Job ti: Job site address: 13110 SW Wall St. 1001-1P or more.
City/State/ZIP:Tigard/OR/97223 0 Six or more residential units, occupancy.
0 Health-care facilities. ID Recreational vehicle parks,
Suite/bldg./apt.#: Project name: - 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: '''- 'Allir00-::' '''' *#040.00ttetEgglaafiv,
Description I Qty. I Each I Total I .
New residential single-or multi-family dwelling unit.
Subdivision: Lot 4: Includes attached garage.
' - 1.000 sq.ft.or less 168.54 4
Tax map/parcel 4:
. Ea.addi 500 sq.II.or portion 33.92 1
ntscatrrioN OF woRK : !.-,.. .. ,,,, Limited energy,residential
75.00 2
Add I service for modular building to existing permit#: ELC2019-00647 (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.) ..
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 TENANTVrikv-w- '
' , ''''',1,'- - Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 1 100.70 100,70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200,34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) 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,
Branch circuits-new,alteration,or extension pr panel
APPLI6***1"44-"HINMA°Iri***14: 1: A.Fee for branch circuits ' 'with
Business name:Bear Electric, Inc. above service or feeder fee,
7.42 2
- each branch circuit
Contact name:Angie Wainwright 13.Fee for branch circuits without
service or feeder fee,first
Address:PO Box 389 branch circuit 56.18 2
City/State/ZIP:Donald/011/97020 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)678-1355 Fax::(503-)678-1108 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:Perm its@beareletric.com Reconnect only 67.84 2
CONTRAC1'OR 11"I'l Pump or irrigation circle 67.84 2
Business name: Bear Electric Sign or outline lighting 67.84 2
_
Signal circuids)or limited-energy
Address:PO Box 389 panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Donald/0R197020Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr ,
Phone:(503)678-1355 Fax:(503)678-1108 Investigation(1 hr min) 90,00/hr
Email:Permits@beareletric.com _industrial plant(1 hr min) 78,18/hr
$.--?,5"," .., Inspections for which no fee is 90,00/hr
CCB Lie.: 20919 Electrical Lie,: 24-107c Suprv.Lic.: m4_s_ speciticalls listed(V,hr mini
required: irp:eRA
4 ELECTRICAL PERMIT,FEESW0P!'
Suprv.Electrician signature,
Subtotal: 100.70
Print name: 66,4e_ 6-2-9149 di-te: %/8/19 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): ,..41 iok-6(1
. , .
Authorized signature:,, D, —
TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name:/4"ele 0,4.,/ ) ,,e i 4f,..4,47.- Date: I0/8/19 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I Anuilding1Pennits1ELC_PermitApp ELkERE.doc Rev 06/17/2015 44G-1615111 I/0,5/COMIWER