Permit CITY OF TIGARD ELECTRICAL PERMIT
11111 s COMMUNITY DEVELOPMENT Permit#: ELC2015-00355
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/13/2015
Parcel: 1 S133DA07200
Jurisdiction: Tigard
Site address: 11470 SW 130TH AVE
Project: Summer Lake Park Restroom Subdivision: AMART SUMMER LAKE Lot: A
Project Description: Interior lighting for a restroom facility.
Contractor: JUNCTION CITY ELECTRIC&PLUMBING Owner: TIGARD,CITY OF
5480 SW PHILOMATH BLVD 13125 SW HALL
CORVALLIS, OR 97333 TIGARD,OR 97223
PHONE: 541-754-0880 PHONE: 503-639-4171
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 05/13/2015 $100.70
Specifics: amps or less
10 crt Branch Circuits w/Purchase 05/13/2015 $74.20
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 05/13/2015 $20.99
Electrical
Type of Const:
Occupancy Grp:
Total $195.89
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 forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy• ect questions to OUNC by calling 503.232.1987 or 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' 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.
I
Electrical Permit Application 1 OR MI It 1' 1 •I 0\1.1
City of Tigard r`v e0 � 5
13125 SW Hall Blvd.,Tigard,P�'rY .: G Plan Review
= Phone: 503.718.2439 Fax: 51•. ! r'1 ^ DateB : Other Permit: i►L� rp.ej r* — 4 i� �)
%T c :�1t a Inspection Line: 503.639.4175 1 - L01� Date Ready/By: HI See OPage 2 for
Internet: www.tigard-or.gov MPS 1 Notified/Method: liM Suppksrertallrforradsn
TYPE OF W�OF�[(,.sA 1 PLAN REVIEW
KNew construction ❑ �IIIetlt Please check ail that apply(submit 2 sets of plans w/items checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
El Demolition ❑Other:Addition/alit where the available fault current ❑Marinas and boatyards
CATS mps
RY OF CONSTRUCTION exceeds 10,000 a at 150 volts or ❑Floating buildings.
less to ground,«exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling CommerciaUindustrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family El 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","1-2","1-3",
Job no.7J 4)2:110 I Job site address: i p../7 0 � j 100HP or more. occupancy.
�jf�� ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: Tv ` (JR_ ❑Health-care facilities. ❑Supply voltage for more than
L�.1� L Res Q Hazardous e dei 600 600 volts nominal.
Suite/bldg./apt.no.: Project name: r D ❑service or feeder 60o amps or more.Q� FEE SCHEDULE
Cross street/directions to job site: Dearriatim I Qty. I Fee. I Teat I
New residential single-or multi-family dwelling unit.
Includes attached garage.
-
Subdivision: Lot no.: 1,000 so.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 ' 1
Tax map/parcel no.: LS t-55 DO , Do Limited energy, `-
rgy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Al G- Limited energy,multi-family
75.00 2
�R Tt�' .-I(7� Li 6,1+-7-?IN C / r-t���IC�_ residential(with above sq.It.)
l /X7n r 7^A AC+ Se
rvices rEnders ❑ SecPage2
�-l..J "`-c/�.�' _` � t:C Services or feeders installation,alteration,and/or relocation
gPROPERTY'OWNER I ❑ TENANT 200 amps or less ( 100.70 l 00.7D 2
201 amps to 400 amps 133.56 2
Name: CITY O F -11 6,4-eLn 401 amps to 600 amps 200.34 2
' Address: I N S Z. s SW 1-11v14-913 I V el 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: �T l � p, O� 2 2_ Temporary services or feeders installation,alteration,and/or
Phone:(S05) 1 18 • _*b l° I 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, .id, 7 42 -74:2D 2
Business name:Junction City Electric&Plumbing each branch circuit
B.Fee for branch circuits without
Contact name:Tracy Hughes service or feeder fee,first 56.18 2
branch circuit
Address:PO Box 201 Each add'I branch circuit 7.42 2
City/State/ZIP:Junction City OR 97448 Miscellaneous(service or feeder not included)
Each manufactured or modular
Phone:(541)998-6466 l Fax::(541)998-3047 dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2-
E-mail:secretary @junctioncityelectric.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:Junction City Electric&Plumbing Signal circuit(s)or limited-energy See
panel,alteration,or extension. _ Page 2 2
Address:PO Box 201 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 6625/hr
City/State/ZIP:Junction City OR 97448
Investigation(1 hr min) 66.25/hr
Phone:(541)998-6466 I Fax:(541)998-3047 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 16699 I Electrical Lic.: 2r� Suprv. ic.: 511 specifically listed(A hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: /r Subtotal: 1 1 4 SO
Print name: T.R.Hamblin Date: 5. 13 .2_05 Z Plan review(25%of permit fee):
State surcharge(12%of permit fee): ' 5j 4
Authorized signature: TOTAL PERMIT FEE: 44/lj7�`l
Print name: Date: This permit application expires if a permit is not obta witbin 190
days after it has been accepted as complete.
• Number of inspections allowed per permit.
l:1Baildia&enntslELC_PermitApp_ELR_ERE.doe Rev 05/212013 440.46151(11/o5/COM/w5i3
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
11470 SW 130TH AVE, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00355
Jeff Grove
Violation Summary:
Inspector Contractor