Permit (34) IIIIICITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2018-00259
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/25/2018
Parcel: 2S 102AD03051
Jurisdiction: Tigard
Site address: 12750 SW ASH AVE
Project: Spec Space Subdivision: BURNHAM TRACT
Project Description: (4)branch circuits for lighting,HVAC,and bathroom wiring. Lot: 5
Contractor: RIGHT NOW HOME SERVICES INC
Owner:
BOX#701 12042 SE SUNNYSIDE RD
CLACKAMAS OR 97015
CLACKAMAS, OR 97015
PHONE: 503-490-9471 PHONE:
FAX: 503-775-6006
FEES
Quantity Description Date Amount
Specifics: 4 crt Branch Circuits wo/Purchase 04/25/2018 $78.44
Service or Feeder
1 ea 12%State Surcharge- 04/25/2018 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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, or2 work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules ado.ted by the Oregon UtilityNoti' • n- Ce
Thse
952-001-0010 through OAR 952-001-0090. Y obtain a copy o I e rules or dir. t questions to OUNC bing 503.232. •:or 1.000332.23144, are set forth in OAR
Issued By: .3.G,- __.--
� _,10•. Permittee SiTeognature: / `� �
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
FOR OFFICE USE ONLN'
City of Tigardtail REew
114 • 13125 S W Hall Blvd.,Tigard,OR 97223 DPermit#: fr tI�+r ) c
71
Phone: 503.718.2439 \( Related Permit#:
Email: TigardBuildingPermits@Tigard-or.gov Date/By: �� As "'
1 I G A K t) R % Ready Date/By: Juris: 10 See Page 2 for
Inspection Line: 503.639.4175 Internet: wwv gsi`d-or.gov k ified/Method: +�
f il� << 'Lo Supplemental Information
TYPE OF WORK U N PLAN REVIEW
❑New construction �Addition/alteration/re Yt IC' ` X�`�� Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition 0 Other: Beat 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.
o 1-and 2-family dwelling [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 0 Emergency system. larger separately derived
Job#: I Job site address: ' '7 5 C.) _c co /1(.,f.� ❑Addition 100HP or of
mmoew motor load of system.
---�, � 4_(/�i /l ore. ❑"A","E","1-2","1-3",
City/State/ZIP: 1 i2 0 Kt__ Six or more residential units. occupancy.
V ❑Health-care facilities.
0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: ❑Hazardous locations. 0 Supply voltage for more than
Cross street/directions to Ob site:
0 Service or feeder 600 amps or more. 600 volts nominal.
FEE SCHEDULE
Description 1 Qty. Each Total
New residential single-or multi-family dwelling unit.
Subdivision: J Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
DESCRIPTION OF WORK Ea.add'l 500 sq.ft.or portion 33.92 1
Limited energy,residential
T�g.-�G 2 /rn�r e/L�Pzr. 6 fes' 2 : (with above sq.ft.)
75.00 2
J /11/14<-
Y` Limited energy,multi-family
C h 1 -s /"�V14-� �g'1 , )"-ic,- (with above sq.ft.) 75.00 2
iyjf PROPERTY bWNER / I ❑ TENANT `�- Renewable Energy ❑ See Page 2
Name: Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
City/State/ZIP: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:( ) Over 1,000 amps or volts 552.26
2
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 1 I 1 59.0625.08 1
8 2
Owner signature: Date: 401 amps to 599 amps I 168.54 2
0 APPLICANT I 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
Business name: A.Fee for branch circuits with
above service or feeder fee,
Contact name: each branch circuit 7.42 2
B.Fee for branch circuits without
Address: service or feeder fee,first
branch circuit 56.18 5-4t 2
City/State/ZIP: Each add'l branch circuit 3 7.42 (��- .
G 2
Phone:( ) Miscellaneous(service or feeder not included)
Email: Each manufactured or modular
�S Pe x j ___"•1 ( v, dwelline,serviceonland/or feeder 67.84 2
CONTRACTOR Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
Business name: 12;c,h d-- o Sign 1 ///)7,f� ./'�/i S g or outline lighting 67.84 2
Address: f.: (-)7,,,: `7 / S/:-....-- ` Signal circuit(s)or limited-energy
/ 0/ a % 2 -- c✓tvi . .,' / panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: C�� S/— ( Each additional inspection over allowable in any of the above
Phone:((jZ� 7' g y� Additional inspection(1 hr min) 66.25/hr
5Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
CCB Lic.: /G1 /76 I Electrical Lic.: Is Lic �/✓ Inspections for which no fee is
V .: specifically listed('Vz hr min) 90.00/hr
Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES
6n Subtotal: `7�f`,4,../
Print name: �j_ 6 i
V0 / - Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 1` y
Authorized signature: TOTAL PERMIT FEE: 1r7 s---
I Print name: I This permit application expires if a permit is not obtained within 180
Date:
* days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\BuildingTermits\ELC_PermitApp_ELR_ERE.doc 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:
RESIDENTIAL WORK ONLY: Description
FEE SCIDTIE
QtY• Each
Total`. I
,...
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
111 Audio
to 25 kva 200.34 2
Audio and Stereo Systems*
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 552.26 2
with OAR 918-309-0040)
n Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
>100 kva-no additional charge 0.0 3
❑ Vacuum Systems* Each additional inspection over allowable in any of the above:
Each additional inspection is 66.25/hr 1
EliOther: charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('h hr min)
ELECTRICAL PERNIIT /TEAS
COIYII!!'I�'RCIAL WO ,° Subtotal(Enter on Page 1): 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
n Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ 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
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12750 SW ASH AVE, TIGARD, OR, 97223 May 22, 2018 at 12:12:02 PM
Record Type: Record ID:
Commercial - Electrical ELC2018-00259
Inspection Type: Inspector:
199 Electrical final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor
CITY OF TIGARD ELECTRICAL PERMIT
11 P.' ' COMMUNITY DEVELOPMENT tia► a Permit#: ELC2018-00259
Date Issued: 04/25/2018
T I(3A It E 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Igi7), Parcel: 2S102AD03051
Jurisdiction: Tigard
Site address: 12750 SW ASH AVE
Project: Model Institution Development LLC Subdivision: BURNHAM TRACT Lot: 5
Project Description: (4)branch circuits for lighting, HVAC,and bathroom wiring.
Contractor: RIGHT NOW HOME SERVICES INC Owner:
BOX#701 12042 SE SUNNYSIDE RD
CLACKAMAS OR 97015
CLACKAMAS, OR 97015
PHONE: 503-490-9471 PHONE:
FAX: 503-775-6006
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo/Purchase 04/25/2018 $78.44
Specifics: Service or Feeder
1 ea 12%State Surcharge- 04/25/2018 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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. Those rules are set forth in OAR
952-001-0010 through•'- -I.1-0.•0. You may obtain a copy of the rules or direct questions to OUNC by calling 503. 3 .1987 or 1.800.332.2344.
Issued By. � ' Permittee Signature:
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.