Permit IIICITY OF TIGARD ELECTRICAL PERMIT
�. COMMUNITY DEVELOPMENT Permit#: ELC2014-00014
Date Issued: 01/13/2014
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Parcel: 2S113AD01700
Jurisdiction: Tigard
Site address: 16940 SW 72ND AVE
Project: Mens Wearhouse Subdivision: ROSEWOOD ACRE TRACTS Lot: 26-34. P
Project Description: Electrical for TI. (4) branch circuits.
Contractor: ADVANCED WIRING SERVICES INC Owner: BRIDGEPORT LAND LLC
PO BOX 644 3939 NW ST HELENS RD
CLACKAMAS, OR 97015 PORTLAND, OR 97210
PHONE: 503-310-3655 PHONE.
FAX: 503-698-6372
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo/Purchase 01/13/2014 S78 44
Specifics: Service or Feeder
1 ea 12%State Surcharge- 01/13/2014 $9 41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87 85
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 h in OAR
952-001-0010 through OAR 952-001-0090 You ma o o of - or direct questions to OUNC by calling 503 232.1987 or 1 80 332 _ .
Issued Bjf�� — — —�� 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
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
Received
City of Tigard Permit No.:
tar g Date/ft : f ,�� EG� '{—CVO 41
IN 13125 SW Hall Blvd.,Tigard,OR 97 Plan Review
g Phone: 503.718.2439 Fax: 0 , Date/By: Other Permit: /317, a /3,-do 17,F1
Inspection Line: 503.639.4175 ( Date Ready/By furls HI See Page 2 for
I Ii.,;\I:I) Notified/Method: Supplemental Information
Internet: www.tigard-or.gov . pP
TYPE OF WOIt'ii (�^�� , PLAN REVIEW
❑New construction . 'Addition/altcratlprl/g-4 ��?? 8` Please check all that apply(submit 2 sets of plans w/items checked below):
t u\ ❑Service or feeder 400 amps or more ❑Building over three stones.
❑ Demolition 111 Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF Cora ,`. TION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling ,aCommercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","I-2","1-3",
Job no.:�O/G//_ . Job site ress:/(99') � ?e t, I x or or more. occupancy.n
b! a� // ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: `? 7 ❑Health-care facilities. ❑Supply voltage for more than
0� ��' ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apL no.: Project name: /y?��s l '4' ❑service or feeder 600 amps or more.
/�/ FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I For. I Total I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
•
Subdivision: Lot no.: 1,000 sq.11.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
2
DESCRIPTION OF WORK (with above sq.ft.) _ 75.00
Limited energy,multi-family 15.00 2
fc r sI\ residential(with above sq.ft.)
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 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 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 168.54 2
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel
❑ APPLICANT I ❑ 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
Contact name: service or feeder fee,first
branch circuit i 56.18p,Og 2
Address: Each add'I branch circuit J 7.42 ?1a.2 S, 2
Miscellaneous(service or feeder not included)
City/State/ZIP: _Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Phone:( ) Fax: :( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
ONTRAQOR Sign or outline lighting 67.84 2
Business name: � 1,./.0./0•5 S��(/,�-,' Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address: 1 (j�/ Each additional inspection over allowable in any of the above
City/State/ZIP: ry `r /'/e e77/.5 Investigation gat inspection(1 hr min) •
66.25/hr
F( (/ Investigation(I hr min) 6b.251 hr
Phone:( ; ) 533 —AVM Fax: i ) ' Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.-.4/6:2917 V.3/15.--Electrical Lic.: 7 rv.Lic.: ij75-S' specifically listed(%x hr min)
ELECTRICAL PERMIT FEES Electrician signature -t f
Suprv.
Subtotal: f 7t./y
Print
Print name: / /// Date:/734i Plan review(25%of permit fee): —
(/// leo,
State surcharge(12%of permit fee): y, 4/
Authorized signature: TOTAL PERMIT FEE: P7 y5'
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
' Number of inspections allowed per permit.
1:1BuiidinglPcrmiu\ELC_PmoitApp_ELR_FRE.doe Rev 0521!2013 440.4615TM/05/CCM,wEB
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 Description I On. I Fee I Tom I •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
ElAlarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
El Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with
El Heating, Ventilation and Air Conditioning
OAR 918-309-0040) 552.26 2
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
ElVacuum Systems* >100 kva—noadditional charge 0.0 3
ElOther: additional inspection over allowable in any of the above:
Other: Each additional inspection is
charged at an hourly(1 hr min) 6625/hr I
Inspections for which no fee is 90.00/hr
specifically listed('/A hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
nA• udio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
❑ Boiler Controls
n C• lock Systems
n Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\Building\Permits\ELC_PermitApp_ELR ERE.doe Rev 05/21/2013
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
16940 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Electrical
199 Electrical final
2014-03-11 00:00:00
ELC2014-00014
PASS - No C of O
Aws@
Violation Summary:
Inspector Contractor