Permit a CITY OF TIGARD ELECTRICAL PERMIT
14 COMMUNITY DEVELOPMENT Permit#: ELC2015-00009
T(c,ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/12/2015
Parcel: 1S 136AD06507
Jurisdiction: Tigard
Site address: 11460 SW PACIFIC HWY
Project: Quality Inn Subdivision: WAY LEE Lot: 3
Project Description: (6)branch circuits for TI
Contractor: AWSEM ELECTRIC LLC Owner: AISLING CREATION LLC
20315 NE SANDY BLVD PO BOX 1120
FAIRVIEW, OR 97024 BEAVERTON, OR 97075
PHONE: 503-830-7854 PHONE:
FAX:
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo/Purchase 01/12/2015 $93.28
Specifics: Service or Feeder
1 ea 12%State Surcharge- 01/12/2015 $11.19
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $104.47
Required Items and Reports(Conditions)
This permit is --• •• . the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and a other applicable law. All work will
be don- accordance with app'•ved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
day- ATTENTION: Oregon law r - you to follow the rules adopted by the Oregon Utility Notification enter. Those rules are set forth in OAR
9 '-001-0010 throug OAR 952-00 ' 90. • y obtain a copy of the rules or direct questions to OUNC by calling 503. . .1987 .r 1.800.332.2344.
Issued 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' lI f Date:
LICENSE NO. 177/ O 5
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 Applical E�EIVE I Ull OI I I( 1 I .I OBI 1
City of Tigard Received /ffJ Permit#: E �Q/6.—.0 00
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan R view
Phone: 503.718.2439 Fax: 503.59A*0 7 2015 DateB : Related Permit#: r p,„ 4, -e09--9
Inspection Line: 503.639.4175 Ready Date/By: Jurir la See Page 2 for
T I,■ \I.:I Internet: WWW.tlgard or.gov Notified/Method: Supplemental Information
�1�Yc 'MAKI►
$ TYP>io a �pl�it'N PLAN REVIEW'
❑New construction Additio a eraho re ace a Please check all that apply(submit ii 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 f 'Commercial/industrial ❑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 INFORMATION AND LOCATIO ❑Emergency system. larger separately derived
Job#: Job site address: ( Q ,y; - /a.. �, /�„J� ❑Addition of new motor load of system.
// W (((/// v"`-�� /r� l, v— 100HP or more. ❑••A„ ••E„ ,•1_z„ „1_3>,
City/State/ZIP: Q ❑Six or more residential units. occupancy.
� riit��t - ❑Recreational vehicle parks.
/ / (l _ ❑Health-care facilities. P
Suite/bldg./apt.#: vvv Project name: L k ❑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.
Tax map/parcel#: 1,000 sq.ft.or less - 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
/��s �/ (with above sq.ft.)
' '" ��� Limited energy,multi-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
❑ APPLICANT I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit -
Contact name: B.Fee for branch circuits without
service or feeder fee,first ( 56.18 2
Address: branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: ,f_ )S�yyl ,�,� Sign or outline lighting 67.84 i 2
�l C £ ` (
Signal ler n or limited-energy ❑ See Page 2 2
Address: �, i panel,alteration,or extension. g
City/State/ZIP: %�vj Lam" 0 n 9702--‘)4 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(5-) ) 2c 3 0 ^-1 54-- Fax:( ) Investigation(1 hr min) 66.25/hr .
Email: ',Q o S( , /v/iy� , f 'y1 /o/f/f U Industrial plant(1 hr min) 78.18/hr
Q�' Inspections for which no fee is 90.00/hr
CCB Lic.:AO,Z9{� Electrical Lic.:3 g2sa Suprv.Lic.: 6/7/ rj specifically listed(V,hr min)
( � ELECTRICAL PERMIT FEES
Suprv.Electrician signatl�i t quired: ,� � - Subtotal: 9-3-',d.s
Print name: 2a,..,3 .e ` I i v Se_.1„` Date: 1 — 7_ / S' ❑Plan Review Required(25%of permit fee):
- State surcharge(12%of permit fee): ft./9
Authorized signature: TOTAL PERMIT FEE: /e)C/1/87
This permit application expires if a permit is not obtained within I
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc 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: L FEE SCHEDULE
Fee for all residential systems combined: $75.00 Renewable I Qty. I Each I Total
�' 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)
El 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(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(Enter on 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
[1 Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I.\Building\Pennits\ELC_PermitApp_ELR_ERE.doe Rev 04/21/2014