Permit CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT Permit#: ELC2014-00513
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/07/2015
Parcel: 1 S133DA07200
Jurisdiction: Tigard
Site address: 11470 SW 130TH AVE
Project: Summer Lake Park Restroom Subdivision: AMART SUMMER LAKE Lot: A
Project Description: Electrical work associated with new restroom,(1)service and(4)branch circuits.
Contractor: INLAND ELECTRIC INC Owner: TIGARD, CITY OF
360 SE BASELINE 13125 SW HALL
HILLSBORO,OR 97123 TIGARD,OR 97223
PHONE: 503-681-4700 PHONE: 503 639-4171
FAX: 503-681-4738
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 04/01/2015 $100.70
Specifics: amps or less
4 crt Branch Circuits w/Purchase 04/01/2015 $29.68
Type of Use: COM Service or Feeder
Class of Work: NEW 1 ea 12%State Surcharge- 04/01/2015 $15.65
Electrical
Type of Const:
Occupancy Grp:
Total $146.03
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. ATTENT Oregon requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-001 hrough OAR 952-00 -0r••. You..ay obtain a copy of the rules or direct questions to OUNC by calling . 2.1987 or 1.800.332.2344.
Issued Illy: , 1" p Permittee Signatur _ . ' / /
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' f
Date:
J ! '
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.
03/1912015 13:25 5036859136 DAVID ERICKSON PAGE 03/07
,_lectrical Permit ADOlication
^? � 'a POR OIFFif-i•.US t•:n',i.',
City of Tigard s-cilticz .- Reethod
13125 SW dill Blvd_Tigard.OR 9� 1 ,c,\\. Dnre9v 7 7 / Permit No.: � 1 ,,//
Phonc 503.7132439 Pas: 503.59 1 �r Oat : vcw �Y' QS/
)'IC':1Rf:1 tospeetiorl Linc: 503,639.4175 A ) ,� ..� 0+' ° : Other persnl;
Internet: *thy tiRard or FQ • arc Radl:Ay. p r /'4 A.ZAI i( '0C
Rrn !� :-t•tificdiMerhod: / Y /� / �I See Pall,2 for
r e'i "rA
••• ,,', Swvlr.enrgllmf►rmanom
TYPE OF WORN T a�--' �7• �
Now construction iCp.L / :1�
❑Addition/alteration/r P. r r k all th]r NMI? p
❑Demolition Other: ,j 1' tm>f mbmit sees of hoe a item,checked Wow):
❑ °Service or feeder•rC0 imps or more CI 8ulldlnr over three stories.
CATEGORY OF CONSfRtJCT101v 1e1 •the a,),ilable Gust current
exceeds MAIM moos at ISO role or ❑M:ttlnyt and boatyards,
❑ 1-and 2-family dwelling O Flaring snildins3.
g ❑Commercial/industrial ❑Accessory building lets Ira ground.or exceeds 14.000 0 Co;
Uilding amps for]It Mlrcr lanaltntam. tmlercirt-ux aL'rinrinual
❑Multi-family ❑Heeler builder hnildinge.
®Onc�r.RestrrwmFac CI Fire pump. (]Iarbl4fmnpr150KV1or
0 J08 SITE 1NFORAL4T101\ ND LOC 1TION 0 Emergency system
❑Addhinn v yoe moron lead of brier cpantefy deriv d synerr�
•• ob no.:CEP 92048 Job site eddteas:. ❑ 'E°-!•?. l-:
�r 1 loom ncca� v
City/State/ZIP;Tigard,OR 97223 1//�Q btu ) /G D$°or n msRlenr�l unl;s- ❑Recreational vehicle
,4u ❑Nemni.mite'semis,. {mike.
❑Hasardota Ixn,iplll. Q simply voltage for more!hest
Suite/bldg./apt.no.:N/A I project name:Summer Lake Park Restt»nrn 600 volts nominal.
❑Ser+•;ce or(Leda tiCO]raps or more
Cross strect'directions to job site:Head westbound on Walnut St from Hwy 99W
FEE SCHEDULE
Rt per 128'" oOeft jlaa
,e� Rt on 3Yintertake Dr.Immediate It on Lakeview TCrr.to cud.
Includes residential single-or multi•-family llEi nl�sa
v Subdivision:N/A
Includes attached. rage.
i.ot no.:N/A 1.000 sq.ft.or less -1112Z1
C. Tex map/parcel no.:15133DA07200 a,add'I sao sq.B.or portion ,
. 33.9_ �d
DESCRIPT7G/ OF WORK
t.imiced energy.residential ■
(with above r .ft.
75.00 ��
nstnllatlon of 3"pvc conduit from transformer to restroom facility. Install Limited energy,multi-amity* idenG61(with above•,.rl.) 75.00 Mil
metertnain on building.Lighting&Electrical within bldg.
- (:i Sec P • 2
® 'Ronan oWWER
❑ TENANT 200 amps or lace
Name:City of Tigard , t� I�•>D 10
01 amps toJ00onp !33.56 �B
Address: 13125 SW Hal/Rlvd. 401 ampsto600amps r 200.34 —
i.) 6f11 amps to I p00 al+tps 301,Oa �B
Ciry'Statel2fP:Tigard,OR 97223 Over I,o00 amps r r volts -�_�
Phone(503)718-246 _ TempoMr,.services Cr feeders installation,alteration,rendfor
1a Fax:(5032J.0742 relocation
TVA Owner installation:This installation is being made on property that I own which is not 200
0!an g la tees -
intended for;stele,lease,tern,or exchange. 4.36 �0
gc according to ORS 447,449.670,and 701- 401 amps to 599 amps ME 125.04 �B
Owner signature; 401 amps to 599 amps i ��
Date:
i:81 A,PPLiCANT ❑ CONTACT PERSON &Fee ibe branch circuhs r•;!h
Business nnrlla:City of Tigard
above satire or reader fee,
each branch circuit
ite 7,J2 �1
Contact name Jeff Peck 8.fcc for branch circuits udrhnrtt
Address:13125 SW Hall Blvd service Cr trade nee,firm
!trench circuit 56.13 �II
vCity/State/Z/P:Tigard,OR 97223 Each add'I*rota*c;rc5t4 7 4^ �e
Phone(503)718-2466
Each mm5ufncnrred or ntorhr)or
' Fax :(503)624-0752 dsacllin_service ndnrfeeder ■ 61.94 MI"
E-mail:jell%r'legend-ar.gov
67.84
CONTRACTOR 67.54 ��
J ' '
6784 �B Si S"] circa*fs)or limited-ono-try �Business numr=w.\c, 1.c G -Y 1t� ? �' d,sltegti, orexensioo.Address: O be.tSC11?.t... 6\.
lamerimIlICEICi III
Cityism vp: A tN\310'to 04/ t
Phonc,
host ;(SOS)ct i': x.10 P :( )(At it l3. 73 i s
G4 C Lid i i,�` /1- EIC[fiCBI L1C.: , s�. inspections far which no fee Is 78.1 R/hr _■
J I r �3 t�J Suprv.Lilt:33].X j J ifictll Rued f 95 In min ■ 90.00/hr IIIIIII
Suprv.Elt:E6ician signature,required: I ., !O 1 k
Print name: S �w D'- Dow 3 )„3l IS l
P170 review i25l6 Of prnn;t fee): ligmmium
Authorized signature: Stets surcharge(12%of permit fee);
Print lame; per TOTAL PERMIT FEE; 146.03
Date; Thk m*npplJcstien erplrm if a permit rr mat ohr■lned within 180
d
ay%alert/kher been erupted as complete-
Number f" peetnMS snowed per mimic Awm rsrenni Permit. EIJtFREdne Rrr 0+2171! 4m-16151(1 I VS•COM Won
Electrical Permit Application FOR OFFICE USE ONI
1
City of Tigard �e�By`d , i pen Ili No.. ekC'�/41- €2 /3
• 13125 SW Hall Blvd. Tigard,OR '
g Plan Review
IN
C Other Permit is P,tpY 4-e Phone: 503.718.2439 Fax: 503.59: Date/By:
�
TI G A R D Inspection Line: 503.639.4175 `Q 1,v Date Ready/By: /1/1/ � Juris: ® See Page 2 for
Internet: www.tigard-or.gov Oj �,tified/Method: / � Supplemental Information
..1 1.1 AWE!
TYPE OF WORK ` ��, 6/ L+'Eg�� PLAN REVIEW
®New construction ❑Addition/alteration/r
• \.a P"'r' a 'I'k all that apply(submit,'sets of plans w/items checked below):
❑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.
r 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:Restroom Fac ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION
El Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","1-2","i-3",
t--lob no.:CIP 92048 I Job site address: -j_ 100HP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97223 i ly 70 Su. /3 ) A4. ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:N/A I Project name:Summer Lake Park Restroom
0 Service or feeder 600 amps or more.
FEE SCHEDULE
• Cross street/directions to job site:Head westbound on Walnut St from Hwy 99W Description I Qn• I Pee. I Total
New residential single-or multi-family dwelling unit.
Rt on 128th. Rt on Winterlake Dr.Immediate Lt on Lakeview Terr.to end. Includes attached garage.
Subdivision:N/A Lot no.:N/A 1,000 sq.ft.or less 168.54 4
p Ea.add'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: 1S133DA07200
Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00
• ' -_ Limited energy,multi-family .,
t
nstallation of 3" pvc conduit from transformer to restroom facility. Install residential(with above sq.ft.) 75.00
Renewable Energy ❑ See Page 2
metermain on building.Lighting&Electrical vi ithin bldg. Services or feeders installation,alteration,and/or relocation
® PROPERTY OWNER I ❑ TENANT 200 amps or less 1 100.70 100.70 2
201 amps to 400 amps 133.56 2
Name:City of Tigard 401 amps to 600 amps 200.34 2
Z Address:13125 SW Hall Blvd. 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
f City/State/ZiP:Tigard,OR 97223 Temporary services or feeders installation,alteration,and/or
r Phone:(503)718-2466 I Fax:(503)624-075 relocation
200 amps or less 59.36 1
2
,$.
Owner installation:This installation is being made on property at I own which is not 201 amps to 400 amps 125.08
intended for sale,lease,rent,or exchange,according to ORS•• ,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 ❑ ONTACT PERSON A.Fee for branch circuits with
above service or feeder fee, 4
7.42 29.68 2
Business name:City of Tigard I each branch circuit
B.Fee for branch circuits without
Contact name:Jeff Peck service or feeder fee,first 56.18 2
branch circuit
Address: 13125 SW Hall Blvd \ ` Each add'l branch circuit 7.42 2
r \ Miscellaneous(service or feeder not Included)
City/State/ZIP:Tigard,OR 97223
4.
Each manufactured or modular 67.84 2
Phone:(503)718-2466 1 : :,(,13)624-0752 dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail:jeffp @tigard-or.gov Pump or irrigation circle 67.84 2
CO R ft R Sign or outline lighting 67.84 2
Business name: Signal circuit(s)or limited-energy See
f panel,alteration,or extension. Page 2 - _
Address: I Each additional inspection over allowable in any of the above
jti k� t Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: ,, Investigation(1 hr min) 66.25/hr
Phone:( ) I Fax:( ) Industrial plant(I hr min) 78.18/hr
I Inspections for which no fee is 90,00/hr
CCB Lie.: r lec ': Suprv.
• Lie.: . Lie.: ('A specifically listed hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,req re t
Subtotal: 130.38
Print name: Date: Plan review(25%of permit fee):
/ _ State surcharge(12%of permit fee): 15.65
I Authorized signature: TOTAL PERMIT FEE: 146.03
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.
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