Permit (38) CITY OF TIGARD ELECTRICAL PERMIT
'° COMMUNITY DEVELOPMENT Permit#: ELC2016-00562
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/13/2016
Parcel: 2S102AD02200
Jurisdiction: Tigard
Site address: 8900 SW BURNHAM ST
Project: Burnham Business Park Subdivision: None Lot: None
Project Description: Electrical reconnect for Unit E12
Contractor: N/A Owner: BURNHAM BUSINESS&STORAGE LLC
9500 SW BARBUR BLVD STE 300
PORTLAND, OR 97219
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 07/13/2016 $67.84
Specifics:
1 ea 12%State Surcharge- 07/13/2016 $8.14
Type of Use: COM Electrical
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports(Conditions)
A
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Code and f 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 issuan :, or ki7 ork is suspended for more the 180
days. AT ION: Or-=..n law equires you to follow the rules adopted by the Oregon Utility Notification r nter hose rules are set forth in OAR
952-00 010 through OAR 9 .01-0.:0. You may obtain a copy of the rules or direct questions to OUNC by calling 504 .:.0.332.2344.
Iss ed By: I. _ Permittee Signature: 1/0
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:
W7)
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.
Electrical Permit Applicatkm, ° - 4 FOR OFFl(i. tSF OyI.v
City of Tigard Receivedeview'® Permit#: eLC�/4,-QO 5(Q�.
•11111
13125 SW Hall Blvd.,Tigard,OR 97223 PlRDate/Ban
-
0 Phone: 503.718.2439 Fax: 503.598.JZ 60 i<r•'E a Date/B Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: loris: la See Page 2 for
TI G A R l) Internet: www.tigard-or.gov Notified/Method:
' '� Supplemental Information
TYPE 0I i ioIv.tSIii Y PLAN REVIEW
❑New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition 0 Qth 0 Service or feeder 400 amps or more 0 Building over three stories.
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 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other:
0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: "V\y)r)rA \✓W7 //� 0 Addition new motor load of system.
rn ��r'T! �Q11�L- m
100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP:4" A4, v 12--' -3 0 Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 61 U Q �iW ❑Hazardous locations. ❑Supply voltage for more than
�� m600 volts nominal.
0Service or feeder 600 amps or more.
Cross street/directions to job site:
111 fr. E 12. FEE SCHEDULE
Description I Qty. I Each I Total 1
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#:
1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
DES RIPTION OF WORK Limited energy,residential
2/�-tL! Kl C J‘-d (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 TENANT
0 PROPERTY OWNERServices or feeders installation,alteration,and/or relocation
Name: /r\4-4 y'l -nr\` V.1-7 j-y- i 200 amps or less 100.70 2
Address: V G)u U V� vl m yi 0(/lam Gy{- 201 amps to 400 amps 133.56 2
✓ / 1 401 amps to 600 amps 200.34 2
City/State/ZIP: 11 V\ ill 1//L Vg. 01-M-77 601 amps to 1,000 amps 301.04 2
Phone:( p9 ) ( #1 .-O 3--'7 Fax'('(( ) 1 Z Q.S'-j % ' Over 1,000 amps or volts 552.26 2
Email: \'1AY Y\\A 11 WI jtIT \'c1 e Glc 1'.e-,'y yr cV CU , t Temporary services or feeders installation,alteration,and/or
J W 'r 1 l� e f relocation
Owner installation:This installation iPbeing 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: 0 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
Address: branch circuit 56.18 2
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
Email:
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 6 7 Sli 2
C CTOR Pump or irrigation circle 67.84 2
Business name: (fr-
Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(%z hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature required: Subtotal: 7,W
Print name: / Date: 0 Plan Review Required(25%of permit fee): ___.--,---
State surcharge(12%of permit fee): './'f
Authorized signature: TOTAL PERMIT FEE: 7S; ?'
1111.
This permit application expires if a permit is not obtained within 180
Print name: /W-til‘ vi Ili 0 v(7 trill Date:1 1)-7-2 11 ti days after it has been accepted as complete.
* Number of inspections allowed per permit.
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
5.01 to 15 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:
n 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
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other. Each additional inspection is 66.25/hr 1
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
COMMERCIAL WORK ONLY:
ELECTRICAL PERMIT FEES
���� Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
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