Permit s
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received Permit 11;e 1:.g 2.C2.0-150 014f
Date/By:
11 " 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Pax: 503.5911.1960 oryl ft,11:. Date/By: Related Permit 11:
, ,. V L.4.,y.,A ...11 7:. Ready Date/By: Judie I 61 See Page 2 far
T I G ARR Iflintspernccetti:oxiv‘Liv%nve.1:ig5a0r3d.-6o3r9.g.4ov175
-6 'It Notified/Method: I Supplemental information
';',ergV''':1''';'''':,•7;..L'1-'''':':,6":,;.'''''!',1';''i7':' ,'''.11)/19.1140'11W0--', ,x, . ..-P! .d,4 Y. '1',14,.,,,;0:3g1'.;i01,01; Ainnli-,M011,%10t4MOWAVg,layan,Kg,t:
1:1 New construction pf..,Addition/aitcration/replacement Pkasc check ail dua apply(submit a sets of plans whtems checked):
El Service or furter 400 amps or mote D Building over three stories.
D Demolition El Other: where the available Built current a Marinas and boatyards.
OXii*,..,0:01100PL404040011(iftWafMeiA: SYM exceeds 10.000 amps et 150 113111 er El fleeting buildings-
or
0 1-and 2-family dwelling Ini Commercial/industrial 0 Accessory building less to ground, exceeds 14,000 D Commercial-use agricultural
stops for all other insiallatians buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
zgamosso.,,tE:i5,n,,010:itatoroodjoggoomitixiliglic,,lookiA.;,A4 D Emergency system. larger separately derived
D Addition of new motor load of eYelem.
Job : Job site address: 9,C4) sbi 6izet371-113 cAr2-C-, til0HP or more.
City/State/ZIP: 71 6..6.•24=. CR_ '7Z 23 ix o s or more residential units.
a nealth.care facilities. occupancy.
a Recreational vehicle perks.
Supply voltage for more than
Suite/bldg./apt.II: Z Z 4:1. Project name: Jew is/4 peteg„..-„,ay.., Eii_a-d-s locati--- 0 .
Servirc or feeder 600 amps or omre. ••••.yells lemmell-
Cross street/directions to job site: it;,•;;,],Si;Z:CM1 ;:i',,i'OtO?1:.40i0VitANI:0,ig„Wli,f;,,Q.
Description I 'Oty, L Each I Trial I *
New residential single-or multi-family dwelling unit.
Subdivision: Lela M.10...vkaN. A cae.e- -r _-..v, Lott 5 Includes attached garage.
1,000 sq.ft.DY le95 168.54 4
Tax map/parcel#: . Ea.add'1500 sq.ft.or portion 33.92 1
tegint:nRagg : ift0JOPtitiO4):AnigglictiiMOV3:1K-i'AM Limited oncrig,.frknti al 75.00 2
g..f.-Locia---1--ei I Li SIA-7- IA)tie-f (with above sq.11.)
mited energy,inulti-family
75.00 2
residential(with above sq.ft.)
OZiabga;:x:itP*Atr:PWN.C*464:',. .'ai w...ig:14)64..:Ataiii4iiiiiiin:g4t4 :cervneMbolerEfeneed7,installation,alteration,and/or relocation
Name: 0a4 ep„..b ow s /9Y,p GLC 200 amps or less 100.70 2
Address: .570 6,s. iti e74i50.0.5- go v-t--- /co 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: (..../a-k_E c'.55‘4/6-6.0 6 e 9 763.5- 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
Bitx.:FaenftcrIbrracunIcths-e-inciivt;Ilit;iratIon,or extension,per panel
Business name: 54.r./1.1 6 c_ocA...1 ,2"-.N.it. , above service or feeder fee, 7.42 2
each branch circuit
Contact name: ,,,J r.1.3/1.- „..90e-41"1,i Ce B.Fee for branch circuits without
service or feeder fee,fast
Address: 2 4125 S'e-- zr:L.. -.1 .44.--vt" branch circuit 56.18 2
City/State/ZIP: poe-i-e_e-r1/40 0.e. 9 72J 6- Each addl branch circuit 7.42 2
Miscellaneous(ser vice or feeder not Included)
Phone:6565)2'33 ... Fax: :613) 25--3 ..-26,23 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: C-)QS.HS c:_re..e ftlEI.X.) -- ' C6/11 Reconnect only '
67.84 2
;.1,..i.21.11,1001.11441164g1MinOk!Oli1JAOtatc02MIANNY,4,0,4dligi44. Pump or irrigation circle 0.84 2
Business name: 5ter1{,F er-S__ PrBoVe Sign or cardiac lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteratiot,or extension. 0 See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP: Additional inspection(I hr min) 66.251 hr
Phone:( ) Fax:( ) Investigation(1 lir min) 90.00/hr
Industrial plant(I hr min) 75.18/hr
Email: inspections for which no fee is 90.00/hr
CCB Lie.: Electrical Lie.: Suprv.Liu.://aVil/03 specificallyysted ph lir min) .., . , ,,
‘... DA,Magfi'g:g0-00,07clArWit'agtgftIOMOggi
Suprv,Electrician signature,required: Subtotal.:
Subtotal:
Print nammbit,,,t ty 60,08k...I Date: 31 lot 170 D Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signatdczy---4 , ,„„...,,..,_„„---- TOTAL PERMIT FEE:
This permit application expires if a permit Is not obtained within 180
Print name:jc).„ of ,c9togyve.€...r.iC Date: /5 /9 2-0Z° * Nutnbcr of 1d:11%1:i::iallhloassvehdcpnerapc:2Zd as"1"1"°.
15Building%Permit0ELC_PcnnitApp„ELR_ERE.t100 Etev 06/17/2015 440-161511 1/05/COM/IVE13
Electrical Permit Application—City of Tigard
Page 2--Supplemental Information
Limited� �+ 71 Energy Permitr �F)Fees: Renewable Energy Permit Fees:
AT,llJ`L+ITV $_4SI 14?ai t _ iv' I v. s n via,N r� y ,. Y Each s."' Total rn
yt1ix v� & w �:f�t C{f ;Gq�i�'ri, rtr`Iti,.. , s3�rJ}y� ��f���F�ll fr�'ai'S1'kn✓r,ta t Z,;,'x:.
Fee for all residential systems combined: $75.00 Renew i Qty.m : r I
y Renewable electrical energy systems:
Check Type of Work Involved: s kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ B• urglar Alarm 25.01 to50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ G• arage Door Opener* >100 kva(fee in accordance
552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7A2 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in an_of the above:
❑ Other: Each additional inspection is 66.25/hr
charged at an hourly(1 hr Inia)
Inspections for which no fee is 90.00/hr
specifically listed Q/hr nun?
�,7gJS{ �y�v�a y�t� �y. 'yam v a^ sNtf +et�r.;,;.��C :,i7'.'r,`lt,i`Efl',(<.T,'1,i0PER11T1f�.``ESr'j"1s1kd` w .-�•
,xsY.`. '* 4. YYI,,Q9yAY.F1 .`: �;..::• ..�i c..` ., ,..,.£.,v�s�. -
Fee for each commercial system: $75.00 * allowed
Subtotal cmmii Page 1).
y -Number dfiatpealons atlowcd per Ixrcnilt.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
FIVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
In Other:
Total number of commercial systems: _
*No licenses are required. Licenses are required for all
other Installations
1:1Pnilding\Pemnt,Vil.C_PcrmhApp_ti1.R_ER8.doc Rev Ca/172015
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2020-00041
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/31/2020
Parcel: 1S126DC03300
Jurisdiction: Tigard
Site address: 9900 SW GREENBURG RD 220
Project: Jewish Federation Subdivision: LEHMANN ACRE TRACT Lot: 5
Project Description: HVAC system.
Contractor: SUN GLOW INC Owner: MEADOWS 196 LLC
2428 SE 105TH 5665 MEADOWS RD STE 140
PORTLAND, OR 97216 LAKE OSWEGO,OR 97035
PHONE: 503-253-7789 PHONE:
FAX: 503-253-7693
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/12/2020 $75.00
12%State Surcharge-Electrical 03/12/2020 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 0
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 0
HVAC: 1 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 Total $84.00
Other Desc: 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 copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ermittee 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.
4
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard ECE F :,� 1,
mi 13125 SW Hall Blvd.,Tigard,OR 97223 V " .n Review
rinlE
, i I Phone: 503.718.2439 Fax: 503.598.1960 Date/e : IMINIM ' N
Inspection Line: 503.639.4175 MAR 1 Z021 Ready DateBy: ® See Page 2 for
I I t':\1'.I) Internet: www.tigard-or.gov MAR 2 Notified/Method: EMI Supplemental Information
TYPE OF WORK ";t''s •:71T TiCiARD PLAN REVIEW '..,-. '
❑New constructionAddition/alteration/replacement Please check all that apply(submit 2 secs of plans w,9tems checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑Other: where the available fault current ['Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
E I-and2-family dwelling gc Commercial/industrial El Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE LNFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 06 S:(,)-�i � 1A. J l 100HP or more. ❑"A "E„>"1-2„>"1-3,,,
City/State/ZIP: 71 6 d 4 2 /ZZZ ❑Six or more residential units. occupancy.
1� ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: P I Project nanree-j/�fr� B`(e� e0N t,/o�1 ❑H:nardmis locations_ ❑Supply voltage for more than
❑So virc in fluid fi00 amps cr mire 600 eons nmm.nal_
Cross street/directions to job site: FEE SCHEDULE
,64,E 113{d,tli„
Uacriptinn Qty. I tad, I Total I *
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'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
�
/ r (with above sq.ft.) 75.00 2
g
Q�C_ W f C- S I AT-r _.____ Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER JQ'1 E\A\I Services or feeders installation,alteration,and/or relocation
Name:3e u., 6,4 c_e_Peejs,-'t-r C> - cP— I-. 200 amps or less 100.70 2
rr 201 amps to 400 amps 133.56 2
Address:
98 0 S W P C `t ` • "N'• 401 amps to 600 amps 200.34 2
City/State/ZIP: p y. o . 9'7Zil 601 amps to 1,000 amps 301.04 2
Phone:( $ ) a Liss- (p t9 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 I
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
APPLICANT I ❑ CONTACT PERSON Branch circuits-new,alteration,or extension, 'er panel
it
A.Fee for branch circuits with
Business name: S'e.A-N6(...apti _M uC - above service or feeder fee, 7.42 2
each branch circuit
Contact name: J 5 ps (*la..y r�'TV
� B.Fee for branch circuits without
Address: 2 e_ st /O'er.t 4 yr branch circuit service or feeder fee,fast 56.18 2
_v
City/State/ZIP: O 2_(Co Each add branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone: ) '7�59 I Fax: :( ) Each manufactured or modular
,�r dwelling,service and/or feeder 67.84 2
Email: ` QJ I4-J' `5}tiy7 c,� -4-N Reconnect only 67.84 2
CONTR A " OR "'w ,,, ,I Pump or irrigation circle 67.84 2
Business name: 5! ,10.4-ts" )7/ C- r TT—*(� t Sign or outline lighting 67.84 2
� Signal circuit(s)or limited-energy rp
Address: panel,alteration,or extension. See Page 2 .Z., 2
Each additional inspection over allowable in any of the above
City/State/ZIP: Additional inspection(1 hr min) 66.25/hr
Phone:( ) I Fax:( ) Investigation(1 hr min) 90.00/hr
Email: ]� 7��•CG Industrial plant(1 hr min) 7818/hr
r7(i / Inspections for which no fee is 90 00/hr
CCB Lie.: 4gc3 k Electrical Lic• ,j4 yspecifically listed( hr min)�`j{ ELECTRICArPE:- RMIT FEE ., -: ,,,
Suprv.Electrician signature,required: Wdire Subtotal: -SZ
Print name: �//5 A,/ Date:3 z.D ❑Plan Review Required(25%of permit fee):
l State surcharge(12%of permit fee): 9,�
Authorized si tore: TOTAL PERMIT FEE: '�8't•(,
�y I This permit application expires if a permit is not obtained within l80
Print name: S. J C Date:3Z/'(w^� days after it has been accepted as complete.
" Number of inspections allowed per permit.
1:1BuildingWermas\ELC_PermitApp_ELR_ERE.doc Rev 06/17RI115 615 (11/05/COMM1VEB
i
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00 °Renewable
Eaea Total •_
electrical energy systems:
Check Type of Work Involved: 5 kva or less 00.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
Garage Door Opener* >loo kva(fee inaccordance - —
with OAR 918-309-0040) 552.26 2
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(I hr min)
Inspections for which no fee is
specifically listed(A hr mlo) 90.00/hr
COMMERCIAL WORK ONLYM ELECTRICAL PERMIT FEES
Fee for each commercial system: S75.00 Subtotal(Enter on Yaga l):
y * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
gHVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:)<
( 7` 3/&iv j
*No licenses are required. Licenses are required for all
other installations
t?BuildinsTertMs\ELC_PermitApp_ELR_ERE.dac Rev 06/17/2015