Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC201500094
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/25/2015
T[(;,�It O 9 Parcel: 2S112AD00500
Jurisdiction: Tigard
Site address: 14650 SW 72ND AVE
Project: Rogers Machinery Subdivision: BONITA GARDENS Lot: 4
Project Description: Electrical for#3 warehouse and paint building.
Contractor: OREGON ELECTRIC GROUP Owner: UNION CENTRAL LIFE
1709 SE 3RD AVE TREASURY SERVICES
PORTLAND,OR 97124 ATTN: DIANE THOMAS
PO BOX 888
CINCINNATI, OH 45240
PHONE: 503-234-9900 PHONE:
FAX: 503-234-1001
FEES
Quantity Description Date Amount
2 ea Services or Feeders-601 to 02/25/2015 $602.08
Specifics: 1000 amps
1 ea Services or Feeders-Over 02/25/2015 $552.26
Type of Use: COM 1000 amps or volts
Class of Work: ALT 20 crt Branch Circuits w/Purchase 02/25/2015 $148.40
Service or Feeder
Type of Const: 1 ea Signal circuit or Limited 02/25/2015 $75.00
Occupancy Grp: Energy Panel
1 ea Plan Review Electricial 02/25/2015 $394.79
1 ea 12%State Surcharge- 02/25/2015 $189.50
Electrical
2 ea Services or Feeders-200 02/25/2015 $201.40
amps or less
5 Misc Administration Fee 02/25/2015 $5.00
Total $2,168.43
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. .• ENTION: -'on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-0r 1-0010 through OAR •-2-0' '090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issu- By: I ' ' Permittee SignatuYe.:__ /�-
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: c9/6r5--//Lj
LICENSE NO. / 0
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
City of Tigard RECEIVE , RReec ed l� ` - 'per- Permil No.: �l
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review - a.
Phone: 503.718.2439 Fax: 503.598.1960 FEB 12 2015 DateB : ■ Other Permit:
T 1 G A R D Inspection Line: 503.639.4175 Date Ready/By: 65 See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGAR I Notified/Method: FM Supplemental Information
TYPE OF WELDING DIVISION PLAN REVIEW
❑ NCti construction 2 Addition;alteration/replacement Please check all that apply(submit/,sets of plans -items checked below):
Mervice 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 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
❑Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of
❑.,A., ..E,...1_2....1.3..
Job no.: Job site address: 1001-IP or more. occupancy.
C /�G,�'D1 ,2�14ue ❑Six or more residential units. ❑Recreational vehicle parks.
Clty/State/ZIP: L} '7 ❑Health-care facilities. ❑Supply voltage for more than
����l G O / /�� ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: ,i,1,i 4e *3 t. rw� ❑Service or feeder 600 amps or more.
° FEE SCHEDULE
Cross street/directions to job site: s� &„un;A Ipeld / Description I Qty I Fee. I Total I
"`� New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
_ --- Limited energy,multi-family
1�lp(f Lt) J) .+,1 4 v it-�I//L4 residential(with above sq.ft.) 75.00 2
i / /" r I Renewable Energy ❑ See Page 2
/o�c 9,J,.) ' 3(mac ,r ✓[t't,s,.( /��.J yet t`„ ,/el,'', Services or feeders installation,,alteration,and/or relocation
0 PROPERTY OWNER I I ❑ TENANT 200 amps or less z 100.70 20i.c% 2
201 amps to 400 amps 133.56 2
Name: `�1 r 401 amps to 600 amps 200.34 2
Address: t ( ,\O ; 601 amps to 1,000 amps 301.04 602,06 2
V' �'� ( U Over 1,000 amps or volts 1 552.26 SS.,L(p 2
City/State/ZIP: ( U V Temporary services or feeders installation,alteration,and/or
S v� `f1ilIaiVr relocation
Phone: ( ) Fax:( ) .(t)
200 amps or less 59.36 l
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 t 68.54 2
Owner signature: _ - _ Date. _ _ Branch circuits-new,alteration,or extension, .erpanel
❑ APPLICANT ti CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee, �'��y
Business name: / each branch circuit 7CD 7'42 /r6'i/0 2
L Lj fie+ ` ? -�(L. B.Fee for branch circuits without
Contact name: i r� / 1c,�� service or feeder fee,first 56.18 2
�/ '_J branch circuit
Address: � 7U S' S 12 . 4�{ Each add'l branch circuit 7.42 2
Ci /State/ZIP: 7/)k ( 72/V Miscellaneous(service or feeder not included)
h Each manufactured or modular
Phone:( ) Fax::( )
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
E-mail: ,�j-� r� G C.Jv'» Pump or irrigation cycle 67.84 2
Sign or outline lighting 67.84 2
Business name: `\,,a �/ 1 /� �,� / Signal circuits)or limited energy See
V/L'4►�,n �i� /4 L-O'►�!S_/' t` I-�t.. /1 panel,alteration,or extension. / _ Page 2 7.r 2
Address: J'" Each additional inspection over allowable in any of the above
/7a S S� 3 ,4vc
I n Additional inspection(i hr min) � bb.25/to
City/State/ZIP:�r. /rt�e) Q 7 )./(7 Investigation(1 hr min) 66.25/hr
Phone:(ses ) S3 r- ��3 Fax:( ) Industrial plant(1 hr min) 78.18/lir
�p-9 S / Q� Inspections for which no fee is 90.00/hr
CCB Lie.: 2 0 3 Electrical Lic.: uprv.Lic.: 'I V J specifically listed(Y:hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: /�7 f,/V
Print name: ��I , Date: ��((}f I�' Plan review(25%of permit fee): 3 q4/.-7g yC
/ i State surcharge(12%of permit fee): ,
Authorized signa l 1 TOTAL PERMIT FEE: A Al a 79
'L /L . • .- !l This permit application expires if a permit is not obtained within 180
Print name: r-- Date: v days after it has been accepted as complete.
s Number of inspections allowed per permit.
I:\Building\Pamits\E1.C_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(l1/05/COM/WEB
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
14650 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Electrical
115 Electrical service
PASS
ELC2015-00094
Jeff Grove
Violation Summary:
Inspector Contractor