Permit q CITY OF TIGARD ELECTRICAL PERMIT
_
- Permit#: ELC2014-0
0406 COMMUNITY DEVELOPMENT Date Issued: 07/24/2014
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1S126DC04700
Jurisdiction: Tigard
Site address: 9575 SW LOCUST ST
Project: Phoenix Inn Subdivision: LEHMANN ACRE TRACT Lot: 5
Project Description: (10)branch circuits for remodel. 8/6/14,reprinted to add(30)additional branch circuits.
Contractor: BARNEYS ELECTRIC INC Owner: PIH TIGARD LLC
17057 SW 123RD AVE 111 CONGRESS AVE#2600
TIGARD, OR 97224 AUSTIN,TX 78701
PHONE: 503-747-9067 PHONE:
FAX: 503-512-5140
FEES
Quantity Description Date Amount
40 crt Branch Circuits wo/Purchase 08/06/2014 $345.56
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/06/2014 $41.47
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $387.03
Required Items and Reports(Conditions)
This permit is issued sub.- • the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accord: e with app• ed 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. ATTENT. : Oregon law r:quires •u to follow the rules adopted by the Oregon Utility Notfi - Center. These rules are set forth in OAR
952-001-001•through OAR 952-001-01!r ou m= o•tain a copy of the rules or direct questions to OUNC by = • . . •87 or 1.800.332.2344.
,
/
(� �
Issue. By: / Permittee Signature: . 0
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 ApplicatiaECEIVEI F()R OFHCI. I .1 (,\I \
II City of Tigard Received Date/By: Permit No.:
• 13125 SW Hall Blvd.,Tigard.OR 97•i r Plan Review
S Phone: 503.718.2439 Fax: 503.59.. 'i, 6 2014 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 1,1.7,u Dane Ready,By: Duns- 0 See Page 2 for
Internet: www.tigard-or.gov LIT( OF 1'1 Notified/Method: SuppkmentalInformation
Please check all that apply(submit j sets of plans w.+items ct keel below):
❑New construction El Addition/alterationlreplacemen
❑Service or finder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
' , it „ 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 ®Commercial/industrial ❑Accessory building an 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","1-27.„1 3"
Job no.:PHX INN Job site address:9575 SW LOCUST 10011P or mitts. occupancy.
❑Six or more residential unit,. ❑Recreational vehicle parks.
City/State/ZIP:TIGARD,OR 97224 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: ['Service or feeder 600 amps or more.
`,'V : ?
Cross street/directions to job site:GREENBURG Description 4tr.,( To .
Total
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 16834 4
Ea.add'l 500 sy.ft.or portion 33.92 l
Tax map/parcel no.: Limited energy,residential
t:;:c ,7 1v% DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Limited energy,multi-family
ALTERATION OR EXTENTION OF 30 CIRCUIT-ADDITION TO PERMIT residential(whit above sq.ft)
75'00 2
#ELC2014-00406 ReaewahleEnergy D See Page 2
Services or feeders installationialteration,and/or relocation
200 amps or lean 100.70 2
201 amps to 400 amps 133.56 2
Name:PIH TIGARD LLC 401 amps to 600 amps 200.34 2
Address: II I CONGRESS AVE#2600 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP:AUSTIN,TX 78701 Temporary services or feeders installation,alteration,and/or
relocation
Phone:( ) Fax:( ) 200 amps or less 59.36 I 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 1 168.54 1 2
Owner signature: Date: Branch circuits—new,alteration,or extension, r panel
t A.Fec for branch circuits with
'0A,0" r : . 1 ° ` 4, ,.,f;; above service or feeder fee, 7.42 2
Business name:BARNEYS ELECTRIC,INC. each branch circuit
B.Fee for branch circuits without
Contact name:DAVID LISTER service or feeder fee,first 56.18 2
branch circuit
Address:17057 SW 123RD AVE Each add'I branch circuit 30 7.42 222.60 2
Miscellaneous(service or feeder not included)
City/State/ZIP:TIGARD,OR 97224 Each manufactured or modular
67.84 2
Phone:(503)747-9067 I Fax::(503)512-5140 dwelling,service and'or feeder
Rtromuct only 67.84 2
E-mail:barneyselectricra:gmail.com Pump or irrigation circle 67.84 2
& . t t m:-' Sign or outline lighting 67.84 2
Business name:BARNEYS ELECTRIC,INC. Signal circuit(s)or limited-energy See
panel,alteration.or extension. Page 2 2
Address:17057 SW 123 AVE Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:TIGARD,OR 97224 Investigation(I hr min) 66.25/hr
Phone:(503)747-9067 Fax:( )512-5140 Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 00/hr
CCB Lie.: 192192 Electrical Lic.: C67 Suprv.Lic.: 4754S , specifically listed.i:hr min)
Suprv.Electrician signature,required: Subtotal: 222.60
Print name: David Lister Date: 8/6/2014 Plan review(25%of permit fee):
State surcharge(12%of permit fee): 26.71
Authorized signature: TOTAL PERMIT FEE: 249.31
This permit application expires if a permit is not obtained within 180
Print name: David Lister Date: 8/6/2014 days after it has been accepted as complete.
Number of inspections allowed per permit.
l uildinenm s'ILC_PenaitAppSlit ERE.duc tier 05,21.2013 441W615rt11b5'COM:Wt:a
CITY OF TIGARD ELECTRICAL PERMIT
11111 1 COMMUNITY DEVELOPMENT Permit#: ELC2014-00406
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/24/2014
Parcel: 1 S 126DC04700
Jurisdiction: Tigard
Site address: 9575 SW LOCUST ST
Project: Phoenix Inn Subdivision: LEHMANN ACRE TRACT Lot: 5
Project Description: (10)branch circuits for remodel
Contractor: BARNEYS ELECTRIC INC Owner: PIH TIGARD LLC
17057 SW 123RD AVE 111 CONGRESS AVE#2600
TIGARD, OR 97224 AUSTIN,TX 78701
PHONE: 503-747-9067 PHONE:
FAX: 503-512-5140
FEES
Quantity Description Date Amount
10 crt Branch Circuits wo/Purchase 07/24/2014 $122.96
Specifics: Service or Feeder
1 ea 12%State Surcharge- 07/24/2014 $14.76
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $137.72
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 ther applicable law. All work will
be done in acco•: = with approved plans. This permit will expire if work is not started within 180 days of issuance, or if rk is suspended for more the 180
days. ATT- • ION: Ore.' law requires you to follow the rules adopted by the Oregon Utility Notification Center. hose rules are set forth in OAR
952-001 6610 through OAR 9 -1. -00404.0 may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 r .332.2344.
/ y
Issue. By: 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: ')._ 2.4
LICENSE NO. L/7 cs S 7
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 Applica FOR OFFICE USE ONLY
City of Tigard Received I Permit t:� e i
Date/By: ?/ /� c,,�!5i_,, (�
IN
- 13125 SW Hall Blvd.,Tigazd,0 RCEIVED
Plan Review
Phone: 503.718.2439 Fax: 503.598.1W.2 4 2014 Date/By: Relates Permit#:
Inspection Line: 503.639.4175 Ready Date/By: .runs: ® See Page 2 for
T I C,.\R I 1 Internet: www.tigard-or.gov
CITYOF CIGAR) Notified/Method: Supplemental Information
TYPE OAIWt +ntif PLAN REVIEW
❑New construction larAddition/a t ra lon/replacement Please check all that apply(submit 2 sets of plans w/items 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.
❑ 1-and 2-family dwelling ,.'Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
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
❑Addition of new motor load of system.
Job#: Job site address: 9 S")' S,.....) L o C lw.%i 100HP or more. ❑"A","E","I-2", 'l-3",
City/State/ZIP: ?'t y,� P1� 9 7 Z Z 3 ❑Six It more residential units. Recreational/t ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: pit()Eitii y /AO ❑Hazardous locations. ❑Supply voltage for more than
❑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#: -
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
AL•11.0-+4•i 0/1, UR fx4fe..s pup`6 / O L+IL'� -S Limited energy, .
gy,muhi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
•
401 amps to 600 amps 200.34 _ 2
City/State/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
Er APPLICANT I ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:-Alth e�rros �iL %//Lz4• .1 G . above service or feeder fee,
7.42 2
each branch circuit
Contact name: )141/4, /.../ .i b/C.— B.Fee for branch circuits without
Address: service or feeder fee,first
7 0,'''") s�� 6Z.L 2� e'er t branch circuit / 56.18 37 .16 2
City/State/ZIP: �'/4/4y0 0 0i 7 2 L Each add'I branch circuit 7 7.42 wit 2
- Miscellaneous(service or feeder not included)
Phone:(rot) i cf 7 g 0 G 7 Fax: :(al 4--,2 s,-,,,,0 Each manufactured or modular 67.84 2
/� dwelling,service and/or feeder
Email: IA ti,j b Y s 4..f....4....1-4,./.4._ a 4,1 )*}• C- , G Veen Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: 4i.!L Ys ,iL,i;Gt�,,= • ,,r , Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy ❑ See Page 2 2
7 0s,7 6"(.,`) / Z 3 ,��� panel,alteration,or extension.
City/State/ZIP: ���,(��� d /� Z Z�, Each additional inspection over allowable in any of the above
t Additional inspection(1 hr min) 66.25/hr
Phone:vJ 3) xe'7 5'o6 7 ` Fax:( p- s7 7 777 440 Investigation(1 hr min) 66.25/hr
( Industrial plant(1 hr min) 78.18/hr
Email: ' 11 I
irgi itt lit t 11 0111� Inspections for which no fee is 90.00/hr
CCB Lie.: j7 Z iq Z f" Electrical Lic.: 6-) c Suprv.Lic.:(,4 7 s(4S specifically listed(14 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 12 'Z.9,6
Print name: -DA✓I7) 1 s-13/c— Date: 7..._ ZA.i ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): ACS( . 74
Authorized signature: TOTAL PERMIT FEE: J 3 7_ 72
This permit application expires if a permit is not obtained within 180
Print name: -3041/, r j t be--- Date:7i 24,. 1 tr(' days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.docx Rev 04/21/2014 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. I Each I Total I •
Fee for all residential systems combined: $75.00 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
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* >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 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
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%3 hr min)
COMMERCIAL WORK ONLY:
ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal l(Enter t Page 1):
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
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1 Building Permit ELCPermitApp_ELR_ERE.dOCX Rev 04/21/2014
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9575 SW LOCUST ST, TIGARD, OR, 97223
Commercial - Electrical
125 Wall cover
PART
ELC2014-00406
Herb Stabenow
2.and 3.floor only email: jake.kasprzyk@gmail.com
Violation Summary:
Inspector Contractor