Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit#: ELC2015-00876
Date Issued: 10/28/2015
TIGARD 13125 SW Hall Blvd,Tigard OR 97223 503 718 2439 Parcel: 2S102AD03000
a.
Jurisdiction: TIGARD
Site address: 12850 SW ASH AVE
Project: Burnham&Ash Apartments Subdivision BURNHAM TRACT Lot: 5
Project Description: (2)temporary services for Buildings 1 &2 of the Burnham&Ash Apartments
Contractor. BEAR ELECTRIC Owner: TIGARD, CITY OF
PO BOX 389 13125 SW HALL
DONALD, OR 97020 TIGARD, OR 97223
PHONE 503-678-1355 PHONE
FAX 503-678-1108
FEES
Quantity Description Date Amount
1 ea Temp Services or Feeders- 10/28/2015 $59 36
Specifics: 200 amps or less
1 ea Temp Services or Feeders- 10/28/2015 $125 08
Type of Use: COM 201 to 400 amps
Class of Work: ALT 1 ea 12%State Surcharge- 10/28/2015 $22 13
Electrical
Type of Const:
Occupancy Grp:
Total $206 57
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 a rnrrl.nre 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 A NTION Ore•• law requires you to follow the rules adopted by the Oregon Utility Notificati• Center Those rules are set forth in OAR
952-00 -0010 through OAR 9 •-••1-•190 ou may obtain a copy of the rules or direct questions to OUNC • - 3 232 1987 or 1 800 33 344
Iss ed By: a Permittee Signat.ure: 110 =.o�.� /ra
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'
0...•_41 /��_ Date: �� gr �
�
LICENSE NO. S
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.
, V Col a -
Electrical Permit ApplicatiaECE VJ➢ Y FOR OFFICE USE ONLY
City of Tigard Received �/. !S''00�7
rY f Date/By / fcf /S Permit# �j
'r 13125 SW Hall Blvd.,Tigard,OR 972 7 2015 Plan Review
Phoned 503 718 2439 Fax 503 598j60 Date By Related Permit#
Inspection Line: 503.639 4175 ,gg pp p) A • y, �j Ready Date/By tuns ® See Page 2 for
TIGARD Internet: www tigard-or gov CH H U114 $IGA II) ,, Notified/Method Supplemental Information
,,,,TYPE`��.1��,9 , ��1� $O >, , PLAN REVIEW
IW New construction ❑Addition/alteration/replacement
Please check all that apply(submit 2 sets of plans w/items checked)
❑Service or feeder 400 amps or more ❑Building over three stones
❑ Demolition ❑Other: where the available fault current ❑Marinas and boatyards
CATEGORY-sOF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings
❑ I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations buildings
❑ Master builder ❑Other: ❑Fire pump ❑Installation of 150 KVA or
,,„ , .JOB SITE,g1NFORMATION_AND LOCATION :,',4,',.,,,: ;_' ❑Emergency system larger separately deirved
❑Addition of new motor load of system
Job#: Job site address: / fsc' SA} ASP A V IOOHP or more ❑"A","E","I-2","I-3",
City/State/ZIP: i' T*--(-i. el� ( i 7 i, .3 O Six or more residential units ❑occupancy parks
[j. i ; Health-care facilities Recreational vehicle arks
Suite/bldg./apt.#: Project name: i wee) ,1QIt,'1^1 k( t4 )S, ❑Hazardous locations ❑Supply voltage for more than
❑Service of feeder 600 amps or more 600 volts nominal
Cross Street/directions to job site: Asti -.4. t 0--0-.t,) /i A-i,.i :FEE SCHEDULE
31 /� �j 73L f� _, q Description I Qty. 1 Each I rood I
/ U c 'L J\+t L New residential single-or multi-family dwelling unit.
Subdivision: /2:7 1 0 S W tS t. Lot#: Includes attached garage.
1,000 sq R or less 168 54 4
Tax map/parcel#:
Ea add'I 500 sq ft or portion 33 92 1
T- • ' - ="f DESCRiPTION'OF WORK - Limited energy,residential
�,, 75 00 2
(with above sq 0)
`'-e1/1,,i P,I 0 et,N1 C ,r-evi)1< < • Limited energy,multi-family
residential(with above sq R) 75 00 2
Renewable Energy ❑ See Page 2
❑.PROPERTY, OWN -1, .- t ": 'i '' . ,❑'TENANT'`';,,;,- Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100 70 2
201 amps to 400 amps 133 56 2
Address:
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 5,.30, I
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 -,0,,,;y„.2, Branch circuits-new,alteration,or extension,per panel
C� '.;'.a i,: ;-, ❑ CONTACT PERSON <; A Fee for branch circuits rvrrh
Business name: C�(f� �' n I (/�C _ above service or feeder fee. 7 42 2
l� each branch circuit
Contact name: SS 13 Fee for branch circuits ivi hour
y service or feeder fee,first 56 18 2
Address: l q- � branch circuit
City/State/ZIP: N0/7, /i o/ / ?O2 Each add'I branch circuit 7 42 2
�) �, _ , 3((//�t� �-.,�, "7� e e d i . Each manufactured ed or(service or modular
not included)
Phone: Y/��'�1�/6� Fax: : L// Each manufactured or modular 67 84 2
Email: eJ/ml. 10 r&/e -1-74'c-C t Reconnect service and/or feeder
� Reconnect only 67 84 2
`CONTRACTOR Pump or irrigation circle 67 84 2
Business name: g-e J.e0-11,C :2-4) ( ,, Sign or outline lighting 67 84 2
/ JSignal circuit(s)or limited-energy
Address: i� isC/ . zO 9 panel,alteration,or extension ID See Page 2 2
/ r� 9 74) Each additional inspection over allowable in any of the above
City/State/LIP: )�) r�- (�
Additional inspection(I hr mm) 66 25/hr
Phone:(, ,3 ) '-/,S Fax:(S73) ( > - - //0 Investigation(I hr min) 90 00/hr
Industrial plant(I hr min) 78 18/hr
Email: `lS7 eke lie_ J,x J,1,,' - (41Js Inspections for which no fee is
'Xi specifically listed('h hr mm) 9000/hr
CCB Lic.: 9/9 Electrical Lie.:Oil"/0)C Supry Lic.:3 3 7S
' ELECTRICAL,PERMIT`FEES
Suprv. Electrician signature.required: Subtotal- )8-1/, lily
Print name: x' ) _ ( v Date. -}p- 1 0 Plan Review Required(25%of permit fee).
C�� zekc' /U State surcharge(12%of permit fee) 07.9 . /.3
Authorized signature: TOTAL PERMIT FEE- 9060, 5 7
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
1\Budding\Permits\ELC_PermmApp_ELR_LRE doe Rev 06/17/2015 440-46151-(1 I/05/COxt/WEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12850 SW ASH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical ELC2015-00876
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor