Permit (45) CITY OF TIGARD ELECTRICAL PERMIT
.--
' COMMUNITY DEVELOPMENT Permit#: ELC2016-00275
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/06/2016
Parcel: 2S102AA03301
Jurisdiction: Tigard
Site address: 12345 SW HALL BLVD 29
Project: Tigard Terrace Apartments Subdivision: None Lot: None
Project Description: Panel change
Contractor: ELECTRICAL WIRING BY JOHNNY Owner: KC TIGARD TERRACE LLC
950 NE 152ND AVE 11030 NW 2ND CT
PORTLAND, OR 97230 PORTLAND, OR 97231
PHONE: 503-267-6540 PHONE:
FAX: 503-735-1167
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 04/06/2016 $100.70
Specifics: amps or less
1 crt Branch Circuits w/Purchase 04/06/2016 $7.42
Type of Use: MF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 04/06/2016 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
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 accor ante with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspe.•-• or more the 180
days. ATTE ON: Orego law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rul- are s t forth in OAR
952-001-00 0 through OAR 9 X01-04••. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 0 1 44.
Issued y: _ it _/ /� Permittee Signature: k 4- / w
7
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:
v%NTR• - ONLY
SIGNATURE OF SUPR.ELEC' I1 Date:
LICENSE NO. 569 7 5
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 of i it I. t St. 0N 1
CityofI� Received !
Tigard i C D Date : r , , r /r
;� 13125 SW Hall Blvd.,Tigard,OR 7 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
Inspection Line: 503.639.4175 APR 6 2016 Ready Date/By: tuns: ® See Page 2 for
I I( \I:I Internet: www.tigard-or.gov ^`-� Notified/Method: Supplemental Information
TYPE OF rrGry'�in Of -1lL1HRD PLAN REVIEW
❑New construction ,Q�Addition/�udiltdm ws I o " Please check all that apply(submit 2 sets of plans wiitems checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground.or exceeds 14.000 0 Commercial-use agricultural
amps for all other installations. buildings.
ulti-family ❑Master builder ❑Other: ['Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0Emergency system. larger separately derived
- ❑Addition of new motor load of system.
Job#: Job site address: /z Sys 5w "Ate `4 100HP or snore. ❑"A "E "1 2","I-3 ,
City/State/ZIP: ❑Six or more residential units. occupancy.
Y ❑Recreational vehicle parks.
7 0 Health-care facilities.
Suite/bldg./apt.#: ! Project name: 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'I 500 sq.ft.or portion 33.92 1
/"� DESCRIPTION OF WORK Limited energy,residential 75.00 2
r JA�� / �,a AA���� (with above,sq.m ft.)
/`�J`r' (i /� /'�'C•E% Limited energy,multi-family 75.00 2
J residential(with above sq.ft.)
❑ PROPERTY OWNER TENANT Renewable Energy 0 See Page 2
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 1
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
0 APPLICANT I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee 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 2
Address: branch circuit
City/State/ZiP: Each add'I branch circuit 7.42 2
_Miscellaneous(service or feeder not included)
Phone: ( ) 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: Ver...Yk�L' (�;'44_1t � Sign or outline lighting 67.84 2
T Signal circuits)or limited-energy 0 See Page 2 2
Address: Av /g2A/4 � panel,alteration,or extension.
City/State/ZiP: f PrG40 OC,Q 9 72 pf
Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:( -7 tSVO Fax:('>V5, 73 y`#4,7 Investigation(I hr min) 90.00/hr
Email: /U ! 'o iia.toittA0c b s41,44/.e.#7.i
Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
C Li .' Zod,i0 E e tri al Lic.: G/f76 Sur Lic.: rb175 specifically listed(1/2.hr min)
itASf!$ 7/11/`/7 /,� 41/4" ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: .f. dr j•� �� Subtotal:
Print name- 4 Date. d��� 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
TOTAL PERMIT FEE: /A/.°Y
Authorized signature:
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:Building Permits ELC PermitApp ELR_ERE.doe Rei 06 17 2015 440-4615T(11 05 COM WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
ONLY:
Fee for all residential systems
.RES $t i WORKONLY:
electrical
fig se***
Descri tion Qts
terns combined: $75.00 Each *
I Total
rical energy systems.
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to IS kva 133.56 2
n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
n Vacuum Systems* >100kva—noadditional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is
66.25/hr
charged at an hourly(I hr min)
Inspections for which no fee is
specifically listed('/,hr min) 90.00/hr
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
Ti Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:Building Permits t'LC PermiiApp ELR ERE__doc Res 00 I,2015
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
12345 SW HALL BLVD 29, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00275
Jeff Grove
Violation Summary:
Inspector Contractor