Permit Support Document (3) CITY OF TIGARD ELECTRICAL PERMIT
,1111
COMMUNITY DEVELOPMENT Permit#: ELC2019-00573
TTGAB D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/30/2019
Parcel: 2S112AD00900
Jurisdiction: Tigard
Site address: 14800 SW SEQUOIA PKWY
Project: 2019 Home Depot Door Lock Reset Subdivision: PACIFIC CORPORATE CENTER Lot: 9
Project Description: Install Hera Linear LED Lights and quad outlets in the back of Bay IDs
17-001,17-002,17-003,17-004,17-005,17-007. 10/3/2019: REPRINT permit to add(2)additional branch circuits for
outlet and light fixture for range hood displays.
Contractor: LIN R ROGERS ELECTRICAL CONTRACTORS Owner: HD DEVELOPMENT OF MARYLAND, INC
2050 MARCONI DRIVE SUITE 200 BY HOME DEPOT USA, INC
APHARETTA, GA 30005 PROPERTY TAX DEPT#4002
PO BOX 105842
ATLANTA, GA 30348
PHONE: 770-7723472 PHONE:
FAX: 866-496-7839
FEES
Quantity Description Date Amount
12 crt Branch Circuits wo/Purchase 08/30/2019 $137.80
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/30/2019 $16.54
Type of Use: COM Electrical
Class of Work: ALT 2 crt Branch Circuits w/Purchase 10/04/2019 $14.84
Service or Feeder
Type of Const: 0 ea 12%State Surcharge- 10/04/2019 $1.78
Occupancy Grp: Electrical
Total $170.96
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 throug AR 952- 1..0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B throug
O/V L_
Y Permittee Signature: /C `'717
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.
city of 1:igard S-4/
10 .1_04(nit- Received)..j)/eV/4
Date/By:f"/--" ,
111 ° 13125 SW Hall Blvd.,Tigard,OR 97223 . Plan Review
1 I Phone: 503.718.2439 Fax: 503.598.1960' Date/By: Related Permit#:
Inspection Line: 503.639.4175 azzoici-00613 Ready Date/By: leis: 0 See Page 2 for
TIGARD
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
0 New construction 0 Addition/alteration/replacement Please check all that apply(submit a sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition Og.Other:-T"..Wirl-4-• froVellypn-1- where the available fault current 0 Marinas and boatyards.
' . ' ! . . CATEGORY OF CONSTRUCTION' . ,• ''"',' • , '', I-' exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling I%Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
_0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
• , , . 1 , • JOB SITE'.INFORMATION AND LOCATION ''•. ' ' •'' • 0anergency system' larger separately derived
0 Addition of new motor load of system.
Job#: , „..,
Job site address:iggno ci,4 .swo too P11-6 . l001IP or more.
' • 0 Six or more residential units. occupancy.
City/State/ZIP: ' rd( CC cr72 2 Li a Health-care facilities, 0 Recreational vehicle parks.
Suite/bldg./apt.#: 0 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: ',1., •'.,', , , FEE SCHEDULE",'":',
Description I Qty. I Each I Total I "
New residential single-or multi-family dwelling unit.
Subdivision: /9-2SiS 70 6-wir77A/Cr--- Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: pendy/7--- Et,C.,,A9/ ---er 5 73
Ea.add'1500 sq.ft or portion 33.92 I
DESCRIPTION OF,WORK ' . ' , :•' .. '•' . Limited energy,residential
75.00 2
•t (with above sq.ft.)
a - :. 114 I a-*A 'll 11 "' . , .,4 41.. Limited energy,multi-family
4111, residential(with above sq.ft.) 75.00 2
44.e. r41,e. (good clibitS.01-147e. - es eieAn5 direal. Renewable Energy 0 See Page 2
',Igt ROPERTY.0 . - , ., ' , ' 0'TENANT,,, ','. ',';' Services or feeders installation,alteration,and/or relocation
Name:Ttre fkrna. vi-E 200 amps or less 100.70 2
Address: 20.6 TilireS erdA 1?8,„ ki W 201 amps to 400 amps
401 amps 10 600 amps 133.56 2
200.34
2
City/State/ZIP:A+(a )48 C..113t,44-).,1(:),_23:751 601 amps to 1,000 amps 301.04 2
Phone:(-7701.13. -g. ...31 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,
NJ APPLICANT , , 1,, „ 0,coNTAd, PERsois , ., , A.
Fanchf circuitsbh-neivt,alteration,thor extension,per panel
ee
or
s
Business name:tn R. enjece...1,fleziaat c_LtAfazkiy--3 -ic ,. above service or feeder fee,
7.42 2
each branch circuit
Contact name: 13A A pt. Nouse(i B.Fee for branch circuits without
r-,, service or feeder fee,first
56.18 , 2
Address:2:::F4f\ matTori :Dr. ,--A-e. 00
...., branch circuit
City/State/ZIP: Akjaarek.ti GA 3 :: Each add'l branch circuit (1., 7.42 .t4.• 94 2
1 Miscellaneous(service or feeder not included)
Phone:(-no)77 e...-3103 Fax::(305)3q 7 -2655 Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email:LcersQLIZef-5E-feci-at.Corr) Reconnect only 67.84 2
67.84 2
'110 i ....-•• t
Business name:rd) lgo At 3 Fler4ficili C 'ffa4d
Sign or outline lighting - 67.84 2
Signal circuit(s)or limited-energy
Address:305C) ,, dr ' r 7--) Ste....100
...1 t panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP:Piltaire.-Etel Cott: 3cy-T),5 . Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
I
Phone:('7-?0)-772-3/4-7.3 Fax:GO)301-1 _i_gic5.5 Investigation(1 hr min) 90.00/hr
, _,. Industrial plant(1 hr min) 78.18/hr
Email: 1:i ceme,Q.1„„'?e5qe.,6Elea-1617,0C,crir) Inspections for which no fee is"
90.00/hr
CCB Lic.:11,4g6,3 Etrical7..:727c Suprv.Lie.:9,21 2 S specifically listed CA hr min)
. . , .
at / ' , • ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: - 41, r Subtotal: iy,,v4-1
Print name: 1:60\ 11/4,A 0 Hokrt Date:10/2/ i q 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): I
0
Authorized signature: P' / TOTAL PERMIT FEE: f Log C:,,2-
This permit application expires if a permit is not obtained within 180
Print name: 06o 1 . Oa&\ Date:16 j 2./ foi days after it has been accepted as complete.
* Number of inspections allowed per permit.
1\Building\Permits\ELC_PernetApp_ELR_ERE doe Rev 06/17/2015 440-4615T(11/05/COM/WEB
1