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Permit CITY OF TIGARD ELECTRICAL PERMIT t � " • I1 ' COMMUNITY DEVELOPMENT Permit#: ELC2015-00609 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503-718.2439 Date Issued: 08/03/2015 Parcel: 2S103DD00800 Jurisdiction: Tigard Site address: 13815 SW PACIFIC HWY 50 Project: Gaarde Pacific Subdivision: MELROSE Lot: 7-8 Project Description: Disconnect existing RTU and reconnect new RTU Contractor: FOX ELECTRIC COMPANY Owner: D W SIVERS CO 9050 SW MONTEREY PL 4730 SW MACADAM AVE#101 PORTLAND, OR 97225 PORTLAND, OR 97239 PHONE: 971-563-7215 PHONE: FAX: FEES Quantity Description Date Amount 2 crt Branch Circuits wo/Purchase 08/03/2015 $63.60 Specifics: Service or Feeder 1 ea 12%State Surcharge- 08/03/2015 $7.63 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $71.23 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 • - applicable law. All work will be done in rdance approved plans. This permit will expire if work is not started within 180 days of issuance, or work is suspended for •e 180 days. A NTION: Oregon .w re•uires you to follow the rules adopted by the Oregon Utility Notification Ce• -r. Thos- rules are s-. forth in OAR 952-00 0010 thr• gh OAR 952-•• -1090. Yo ay obtain a copy of he rules or direct questions to OUNC by calling 503.23 . `:7 or 1.800 . 2.2344. Iss d By: / �/ , 1 ' 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: CONTRAC R INS ALLATION 0A13-- _____Z2c____ SIGNATURE OF SUPR.ELEC' Date: LICENSE NO. 17`“.? Call 503.639.4175 by 7:00.-.m.f• e next available inspection date. This permit card shall be kept in a consp ..us 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 P\1°) , I I , :: ; , \City of Tigard ,;,=. �© : ► Ptr�it#: LC .2-0/5--006,0 .. . 13125 SW Hall Blvd.,Tigard,OR 9 _ ��// Phone: 503.718.2439 Fax: 503.598 1.�,� Ii ,' �• : Related Permit a: M r■Ol S—4D F inspection Line: 503.639.4175 �(a P4 -,„ . Date/By: 0 See Page 2 for 1 1` ''v.I, interne[: www.tigard-or.gov P r�N ,\s r fied/Method: 1 Supplemental Information TYPE OF WORK o G D` PLAN REVIEW ❑New construction �Addition/alteration/� Please m�edr that apply(submit sets of plans w/items chocked): O ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition ❑Other: V where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. ❑ I-and 2-family dwelling Commercial/industrial ❑Accessory building less to tad,or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 K VA or JOB SITE INFORMATION AND LOCATION CI Emergency system. larger separately derived la Addition of new motor load of system. / Job#: I Job site address: / 3 d.15-0 S uJ Pa r(C.' ficutilOOHP or more. ❑"A”,"E" "1-2","1-3", City/State/ZIP: Z Six or more residential units. occupancy. �y q Z ❑Health raze facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: I Project name: 1 AA2�f .1 FI 'L ❑Hazardous locations. ❑Supply voltage for more than 5� ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: Old 4 FEE SCHEDULE oarriii&m I on. I Lath I Total I • New residential single-or multi-family dwelling unit. Subdivision: I Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: • Ea.add'!500 sq.ft.or portion 33.92 1 C / DESCRIPTION OF (WORK Limited energy,residential 75.00 2 J t✓E7/LPt,T �k[S'Fl RTU�/ - f a t7 (with above sq.ft.) t Limited energy,multi-family residential(with above sq.ft.) 75.00 2 n.&,-) Renewable Energy _ ❑ See Page 2 ❑ PROPERTY OWNER ❑ 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:( ) I 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 I 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 12.5.08 1 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 ❑ APPLICANT 1 ❑ CONTACT PERSON Branch circuits—new,alteration,or extension, . panel A.Foe 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 I 2 Address: branch circuit City/State/ZIP: Each add'l branch circuit / 7.42 7.¢ 2 Miscellaneous(service or feeder not included) Phone:( ) I Fax::( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: �K 61/5,Kis1 Sign or outline lighting I 67.84 2 Signal circuit(s)or limited-energy ❑ Page 2 2 Address: L v s t.) �� panel,alteration,or extension. City/State/ZIP: tp LLLiiii�fff��/ �yy —7 , Each additional inspection over allowable in any of the above T/ `-"\ ? 2 9 Additional inspection(1 hr min) 66.25/hr Phone: ( ) 51,3 7h(S.-- i Fax:( ) investigation(1 hr min) 90.0W hr / Email: �� industrial plant(1 hr min) 78.18/hr � inspections for which no fee is 90.0W hr _ 7 3 specifically listed(Y2 hr min) CCB Lic.: I Electrical Lic.: '� Su Lic.: 7 �yS _ ELECTRICAL PERMIT FEES O Suprv.Electrician signature,requi Subtotal: �7j (, Date: r" ❑Plan Review Required(25%of permit fee): <--- Print name: nq �( °�f`Z11 J � 1 State surcharge(12%of permit fee): /t 4,1- Authorized signatude: TOTAL PERMIT FEE: -71,,,2 J Tliis permit appieatioa expires if a permit is not Jabot 180 Print name: ,. / IC I Date: 2i/01/15— days after it has been accepted as complete. ��`� • Number of allowed per permit. 1:\Building\Permits LC_ 'App_ELR_ERE.doe Rev 0617, 4404615T(IIibSM,OhtlgrFB 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 13815 SW PACIFIC HWY 50, TIGARD, OR, 97223 Commercial - Electrical 199 Electrical ﬁnal PASS - No C of O ELC2015-00609 Jeff Grove Violation Summary: Inspector Contractor