Permit CITY OF TIGARD ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT Permit#: ELC2013 00550
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/18/2013
Parcel: 1 S 136AD04000
Jurisdiction: Tigard
Site address: 11513 SW PACIFIC HWY
Project: Vine Gogh,LLC Subdivision: VILLA RIDGE Lot: 7
Project Description: (3)branch circuits for TI
Contractor: KEC ELECTRIC INC Owner: PACIFIC TERRACE COMMERCIAL LLC
761 SW BAILEY AVE • BY SMITH, EDITA M
HILLSBORO, OR 97123 833 NW 170TH DR
BEAVERTON, OR 97006
PHONE: 503-439-0904 PHONE:
FAX: 503-640-3838
FEES
Quantity Description Date Amount
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3 crt Branch Circuits wo/Purchase 09/18/2013 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 09/18/2013 $8.52
Type of Use: COM Electrical
Class of Work: ALT
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Type of Const:
Occupancy Grp:
Total $79.54
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• 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 thro s • - 52-001-0090. You may obtain a copy of the rules or direct questions to OUNC.by calling 50 2.1987 or 1.800.332.2344._
r 1
Issued By: /i/��� ` 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
SIGNATUREOF 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.
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Sep 16 13 09:10a p.2
1 Permit A licati `"'1 FOR Wt'l E FSE c ixI,N- .
Electrical pp
City of Tigard SEP 16 2013 Received do a /A I PermitNo.: f/ %/.5-015-50
, 41 13125 SW Hall Blvd.,Tigard,OR 97223 plan Review• Phone: 503.718.2439 Fax: 503.59 Date/13 : t" Other Permit: , 4 11'..60,p(
Inspection Line: 503.639.4175 TIGARD Date Rea .B Jude: 1i See Page 2 for
TIG.\RD BUILDING DIVISION c
Internet: www.tigard-or.gos Notifi xltMethad: Supplemental Information
: TYPE OF WORK PLAN REVIEW
❑New construction ®Addition/alterationireplacement Please check all that apply(submit 2 sets ofplens wine=checked xluw):
❑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.
less to ground,or exceeds 14,1)00 0 Commercial-w a agricultural
❑ i-and 2-family dwelling ®Commerciallindustrial ❑Accessory building turps for an other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fie per. ❑Installation of 75 KVA or
❑Emergency system larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑'A^ "E" "1 °1-;
100HP or more. occupancy.
Job no.: 13-1051 Job site address:11513 5W Pacific Hwy Tigard,
['Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: ❑Health-cart facilities. 0 Supply voltage for mane than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt no.: Project name:Vine Gough ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qrv. I Fee. I Total 1 •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.tl.or less 168.54 4
Ea-add'!500 sq.ft.or portion I 33.92 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) '5.00 2
Limited energy,multi-family
75.00 2
Electrical TI 3 branch circuits residential(with above cu.tl.) 1
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 arnps 133.56 ; 2
Name: 401 amps to 600 amps _ 200.34 , 2
Address: 601 amps to 1,000 amps 301.04 I 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) ' Fax:( ) relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447.449,670.and 701. 401 amps to 599 amps 1611.54 2
Owner signature: Date: Branch circuits-new,alteration,or extension, .er panel
❑ APPLICANT 1 ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit
B.Fee for branch circuits without Ij r'o•ri
Contact name: service or feeder fce,first I 56.18 2
branch circuit
Address: Each add'I branch circuit 2 7.42 14.84 2
City/State/Z[P: Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone: ( ) Fax::( ) dwelling,service and/or feeder
Reconnect only 67.84 2
E-mai I: Pomp or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:KEC Electric,Inc Signal circuit(s)or limited-energy
panel,alteration,or extension. Page 2 2
Address:761 SW Bailey Ave Hillsboro,Or 97123 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.251 hr
City/State/ZIP: Investigation(1 hr min) 66.25/hr
Phone:(503)439-0904 Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
90_00/hr
CCB Lic.: 99267 Electrical Lie.: -426C Suprv.Lic.: 4489S specifically listed(:4 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: h.7 Subtotal: - ;,fir -717.'ry
Print name: Kenneth E Conway Date: 09-16-13 Plan review(257w of permit fee): g y
State surcharge(124' of permit fee): 3'70 ��
Authorized signature: I TOTAL PERMIT FEE: 8
This permit application expires if a permit is not obtained within 120
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
l/BuiAingtPermits/ELC—PermitApp 040913.dee 410-4615Th h,'OSICOM:WEB
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11513 SW PACIFIC HWY, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
2014-01-06 00:00:00
ELC2013-00550
PASS - No C of O
Violation Summary:
Inspector Contractor