Permit Support Document ,, CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2019 00821
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 a Date Issued: 11/19/2019
Parcel: 2S 102DA00600
f ' '4 Jurisdiction: Tigard
Site address: 13500 SW HALL BLVD
Project: Volta Tigard Library Subdivision: None Lot: None
Project Description: Demo existing charging stations, replace transformer and install(2) new EV Charging stations. 11/27/19:
REPRINTED permit to include(1)additional feeder.
Contractor: E C COMPANY Owner: TIGARD, CITY OF
PO BOX 10286 13125 SW HALL BLVD
PORTLAND, OR 97296 TIGARD, OR 97223
PHONE: 503-224-3511 PHONE:
FAX: 503-295-3012 __
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 11/19/2019 $100.70
Specifics: amps or less
4 crt Branch Circuits w/Purchase 11/19/2019 $29.68
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 11/19/2019 $15.65
Electrical
Type of Const: 1 ea Services or Feeders-200 11/27/2019 $100.70
Occupancy Grp: amps or less
0 ea 12%State Surcharge- 11/27/2019 $12.08
Electrical
Total $258.81
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 rryav obtain a copy_d_the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: /t _ Permittee Signature: ‘' c Kt+�`-e
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.
DO 52-1
Electrical Permit Application r()It OFFICE USE(,./NI.N'
City of Tigard Received 13125
,,... ii/.2.7/// g7)--- Penn"";
13125 SW Hall Blvd.,Tigard,OR 97223 " 7. !,..4',!',.." "v"-- Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 (.44t1 Date/By: Related Permit 0:
Inspection Line: 503.639.4175 'i I-\\I 2 1,-) 7u 11 Ready Date/By: Juris: Ei See Page 2 for
TIGARD
0 Internet: www.tigard-or.gov Notified/Method: :,,,-- --76., Supplemental Information
°CYPE OF WORK PLAN REVIEW
E]New construction r Addition/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.
0 Demolition 1:1 Other:
litAr'4"' '-' ' where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONS'FRECTIO 1,1,'"" j. ,, i- ., ' exceeds 10,000 stops at ISO volts or 0 Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
0 1-and 2-family dwelling iConamercial/industrial 0 ceetio-i ...i....1ding"'
amps for all other installations. buildings.
El . 0 Fire pump. 0 Installation of 150 KVA or
0 Multi-family CI Master builder
JOB SITE INFORMATION AND LOCATION larger separately derived
El FAIdndeirtoenncoyttsnyesstvemmtuor load of system.
Job 4:--T 7 s--iii Job site address: 100HP or more.
occupancy.
City/State/ZIP: -1”•°1 Kt b on 0 Six or more residential units.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bIdglapt.#: ') j Project name:1 0 ifzi—T,,,jard Lityir,,,,i 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: ---- 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 4: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75,00 2
.
A 64(1 i lig tab -ill i 1 , 1 r- - .(with above sq.ft.)
Limited energy,multi-family 75.00 2
i residential(with above sq.IL)
Mit f ?1( .;io ace rYi 011,411,1 A Renewable Energy 1 D See Page 2
0 PROPERTY owivER 0 TENANT ,,
Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less i 100.70 i 1(>047( 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/Slate/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,per panel
APPLICANT I 0 CONTACT PERSON A.Fee for branch circuits with
Business name: F E , c above service or feeder fee,
7.42 2
each branch circuit
Contact name: (4 .- _ "—
B.Fee for branch circuits without
service or feeder fee,find 56.18 2
Address: 2,17,1 ' ill tA iriiiiiiii Si-, branch circuit
City/State/ZIP: oyiltLitit,/ 0i 61 1 2-10 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(4702)) 1,2_8—(..)-1 3-1 Fax: :( ) Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email: co,ce,k ,C,11.0 )wan 0„)i,i.,, )14rS 1 if--c, ,0,tril _ Reconnect only 67.84 2
CONTRACT°. Pump or irrigation circle 67.84 2
Business namc:_E I iohi id. Sign or outline lighting 67.84 2
_
Signal circuit(s)or limited-energy
Address: 2, (2,1 tit) tileari panel,alteration,or extension. 0 Sec Page 2 2
A , Each additional inspection over allowable in any of the above
City/State/ZIP:1)01,,,t I a 1.1 a oic g 4,1(,) Additional inspection(1 hr min) 66.25/hr
Phone:( ,b3) 2,Z,tr:)) --00-1 t—1 Fax:( ) Lnvestigation(I hr min) 90.00/hr
Industrial plant(I hr min) 78.181 hr
Email: cace , eh ) evoi ti) -1 1,"„: ,'-'ig'... 1'WI Inspections for which no fee is
90.00i hr
CCB Lie.: LI Crr, S pry. 5
111 Lic.. C1=1111MI • specifically listed(V.,hr min)
ELECTRICAL PERMIT FEES
' $111/ 1.111IP
Suprv.Electrician signature,required: --: ,- 1, , 1r _ .._.----- Subtotal:
Print name: / Date: II ..L5 ' 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): it°-2,„,„0 b
TOTAL PERMIT FEE: 1 12, 1 .. _
Authorized signature:
'Ilia permit application expires if a permit is not obtained within 80
Print Wattle it C e 12 on 441 Date: 1 1 Vtdr:9161 days after it has been accepted as complete.
. Number of inspections allowed per permit.
IAN,ildingTertnits1 LC_PermitAp_ELR_ERE.doc Rev Oh/I 7/2015 .4,10-4615T(1 DOS/COM/WEB