Permit IN
44 CITY OF TIGARD ELECTRICAL PERMIT
" COMMUNITY DEVELOPMENT Permit#: ELC2018-00130
T R AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/26/2018
Parcel: 1 S 135D D05000
Jurisdiction: Tigard
Site address: 11975 SW PACIFIC HWY
Project: PACIFIC HIGHWAY HOLDING CO Subdivision: None Lot: None
Project Description: Reconnect only.
Contractor: Owner: PACIFIC HIGHWAY HOLDING CO LLC
201 SE OAK ST
PORTLAND, OR 97214
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 02/26/2018 $67.84
Specifics:
1 ea 12%State Surcharge- 02/26/2018 $8.14
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 • _ :_ -dopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through 52-001-0090. Y• ---. •• -4,.copy of the rules 'r direct questions to OUNC by calling 503.22.1987 dr , 0.332.23 44.
Issued By: .44/111,7,---sr, ---,air, -41111."— Permfftee Signature: � 2l�'`` eiC
4#1Ir Or
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 ApplicationFOR OFFICE USE ONLY
City of Tigard V "' Received Y /��''j— �.�.,��
Date/By: ,+/t D "37/ Permit#: I l3L i �c
Iliii 4 13125 SW Hall Blvd.,Tigard,OR 972 t (I s
Plan Review
C Phone: 503.718.2439lick y� 6" 2"° Date/By: Related Pennit#:
Email: TigardBuildingPermits@Tigard-or.goc w f► . Ready Date/By: auris: ® See Page 2 for
T 1 G A R D Inspection Line: 503.639.4175 Internet: www.ti a cf�� .tified/Method.
��- � # Supplemental Information
:. _" r.:. .,TYPE OF'WO�tl ty1, ®V4I..7 r PLAN REVIEW
0 New construction 0 Addition/alteratl ement Please check all that apply(submit 2 sets of plans w/items checked):
❑ 0 Service or feeder 400 amps or more 0 Building over three stories.
Demolition C Other: where the available fault current
0 Marinas and boatyards.
- CATECORY OF CONSTRUCTION '' exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 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 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
,, JOB SITE INFORMATION AND LOCATION.z` .= 0 Emergency system. larger separately derived
Job#: Job site address: // 9 7..5—:s(.o / r( ' t.-tai,0 ❑Addition of new motor load of system.
yIOOHP or more. ❑"A" "E" "1-2» "1-3"
City/State/ZIP: ( (r-a t 9 7 ��-
0 Six or more residential units. occupancy.
[ ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: R.,(r f'l L ('t�,) c
L 8`617 . 0 Hazardous locations. 0 Supply voltage for more than
❑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.
Tax map/parcel#:
1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
:, v., "f. DESCRIPTION 4)F'WORK ' e'
Limited energy,residential 75.00 2
Vy� (with above sq.ft.)
t C Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
rx , Renewable Energy 0 See Page 2 P PER=[ � R -a ; � ENANT Services or feeders installation,alteration,and/or relocation/2/12._(/`-71/c. i�iy, , C
200 amps or less 100.70 2
Address: ,,k)/'5E 0.-ok Sic ( ,OK' d f 9'7J-/q7- 201 amps to 400 amps 133.56 2
City/State/ZIP: /90-zz tt &"1-- c7 2'--/ 601 amps to
1,000
K 401 amps to 600 amps301.04 2
amps 301.04 2
Phone:(.50-3) 3 V9 s--'-?.?e?"- Over 1,000 amps or volts 552.26 2
�/� �S y Temporary services or feeders installation,alteration,and/or
Email: 16,--A4.,d�'.z=hu C.-_ c rte c..em
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
` : `,; 11 LI ANt`' - Branch circuits new alteration or extension
;�� �;-L��CON''r�.t.I:yPE1;KSOIy� 't > eranel
P P
A.Fee for branch-c circuits with
Business name: Colli e v) above service or feeder fee,
7.42 2
Contact name:�^ / each branch circuit
/ "l- �E"L4L-d""'^ B.Fee for branch circuits without
Address: c service or feeder fee,first
Gt 5 l 5 a� b L•c-c�- -'#`/?f)/ branch circuit 56.18 2
City/State/ZIP: ,..- t/6,-42 Q Z.. '7 2-..,10 (/ Each add'l branch circuit
7/ 7.42 2
(�/�� Miscellaneous(service or feeder not included)
Phone:( S 3 T! s'2c'1 Each manufactured or modular
( / /' dwellin67.84 2
Email: ---yy76 de L!'1 e,K ptQ) C U/(c L"' c.4:0-z, g,service and/or feeder
Reconnect only 1 67.84 6 7 41 2
. £O1(TRACTOR x • ..,;
Pump or irrigation circle 67.84 2
Business name: 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:( ) hr min Investigation(1
g ) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: Electrical Lie.: Suprv.Lic.: specifically listed(%hr min) 90.00/hr
''''''';='-' ' ;; , LE TRICAL:/ERMIT.,;FEF.S tf r
Suprv.Electrician signature,required:
Subtotal: 6 7,.n
Print name: Date: 0 Plan Review Required(25%of permit fee): "-- v
State surcharge(12%of permit fee): . �'l�
Authorized signa -• ! / / TOTAL PERMIT FEE: 7 75;41(
This permit application expires if a permit is not obtained within 180
Print name: 714--4.-L. JGC Cl74fw,ut E Date: . (-)//� days after it has been accepted as complete.
/ * Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR ERE.doe Rev 10/26/2017 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
7�� WORKONLY: .. �- .. FEE`SCHEDULE ;
ICES DENT AIa Description I Qty. I Each 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
❑ 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
n Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ 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
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('h hr min)
m ELECTRIC. !ERNIIT;FEES„co
✓1�� �wow. 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:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
Fl Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
Fl Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:Building/Permits ELC_PermitApp_ELRERE.doc Rev 10/26/2017