Permit CITY OF TIGARD111
ELECTRICAL PERMIT
`' Permit#: ELC2017-00314
a. COMMUNITY DEVELOPMENT
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/02/2017
-I-t a°� Parcel: 2S112ACO2300
Jurisdiction: Tigard
Site address: 14795 SW 72ND AVE
Project: Delta Fire Subdivision: FANNO CREEK ACRE TRACTS Lot: 48
Project Description: (6)branch circuits to reconnect RTU's.
Contractor: STAR ELECTRICAL SERVICE Owner: C&C DEVELOPMENT
PO BOX 1784 BY DELTA FIRE INC
BEAVERTON, OR 97075 14795 SW 72ND AVE
PORTLAND, OR 97224
PHONE: 503-620-4020
PHONE: 503-579-9201
FAX: 503-579-4581
FEES
Quantity Description Date Amount
7 crt Branch Circuits wo/Purchase 05/02/2017 $100.70
Specifics: Service or Feeder
1 ea 12%State Surcharge- 05/02/2017 $12.08
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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. Thos rules are set forth in 0
952-001-0010 through OAR 952-001-0090. Y ain he rules or direct questions to OUNC by calling 503.232.198 r 1.800. 2.2344. 7
Issued By: "%e
Permittee Signature: 6 ! C G� re
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.
Electrical Permit Application 1 0k OI l 1( 1. t SI oil.v
City of Tigard
Ill
• 'is�t Received
Date/B : s i7� ..
13125 SW Hall Blvd.,Tigard,OR 9 nn Plan Revie,'
III Phone: 503.718.2439 Fax: 503.59 .1 0 N ZU1� Date/B : Related Permit#: -a _ ` _.' 9"
1 I C.A fZ D Inspection Line: 503.639.4175 ♦►P� Qc) Ready Date/By: H See Page 2 for
Internet: www.tigard-or.gov �`t t�I (ft
-1,10 "� Notified/Method: �` Supplemental Information
TYPE OF WOO y yv G up .'"® PLAN REVIEW
❑New construction X Addition/alter.,t i,I •I.b ment Please check all that apply(submit 2 sets of plans w/items checked):
r 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.
O 1-and 2-family dwelling Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amp0 Multi-family 0 Master builder ❑Other: Fire form all other installations. Installation
buildings.0 Fire pump. ❑Inllatioof 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: I Job site address:f j/795 •••;,,, ' 7 ,fid 9/ e.. ❑AdditionHof new motor load of system.
/, 100HP or more. ❑"A","E","1-2","1-3",
occupancy.
City/State/ZIP: �t�� 9 0 *7���¢�.
0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: // Project name: Gry ❑Six or more residential units.
/ ❑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: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ftor portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
/ (0
/�C rfe �l 0/2 e O (with above sq.ft.)
JLimited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER I ,(f TENANT Services or feeders installation,alteration,and/or relocation_
Name: QsL ��� �/�/ 200 amps or less 100.70 2
Address: /[j `� � 7yy)( /����i 401 amps to 400 amps 133.56 2
i Pt(f / 401 amps to 600 amps 200.34 2
City/State/ZIP: /� Q.fI D' 97 0L 601 amps to 1,000 amps 301.04 2
Phone:(i.V ,,,. 70 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 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
/ PPLICANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
1 f�
/..„ Fee for branch circuits with
Business name: 11/�r�e,z 1�/f /1 i/ /'r jr,V�1 �, above service or feeder fee, /,',
b�/ / �" �G� each branch circuit (I! 7'42 l�(�• 2
Contact name: O,"'� /1/� 6 ace �, B.Fee for branch circuits without
" / Ifs service or feeder fee,first , 56.18 5 yr V 2
Address: s - Y 0 ! t branch circuit
City/Stat IP:(:), / Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone: ) r 1 Fax: :( ) Each manufactured or modular
�f F,
/ ! 67.84 2
3dwelling,service and/or feeder
Email: Reconnect only 67.84 2
L „�/ CONTRACTOR_ ) #. Pump or irrigation circle 67.84 2
Business name: O ...0/ee' f / e�/t)J Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: 6 / � panel,alteration,or extension. ❑ See Page 2 2
City/State/AP: 0" G �
00 g 9 2®7s ' Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone: 79„-----?;%0£ I Fax:( ) Investigation(1 hr min) 90.00/hr
Email: C. Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: Electrical Lic.: 1� Suprv.Lic.: - e a;- ificall listed(%hr min) 90.00/hr
'' ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: .0 Subtotal: //(V 70
r
Print name: -4/ ,�,/ 1 O -p ,P ate: -�I� 0 Plan Review Required(25%of permit fee)_
�{ l 1 State surcharge(12%of permit fee): /,,Z,U
TOTAL PERMIT FEE: /1�, 7 sr
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.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 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:
RESIDENTIAL WORK ONLY: FEE sCIEDULi
Fee for all residential systems combined: $75.00 Renewable
Description Qty. Each Total
�' electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ 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
El Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
El Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
El Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
El Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(''A hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES:
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
y • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
El Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
El Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PennitApp_ELR_ERE.doe Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14795 SW 72ND AVE, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Electrical ELC2017-00314
Inspection Type: Inspector:
199 Electrical final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor