Permit (20) II ELE:.� ,, CITY OF TIGARD
CTRICAL PERMIT
4 :. COMMUNITY DEVELOPMENT Permit#: ELC2014-00609
TILARD. 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/22/2014
Parcel: 25101 BB00401
Jurisdiction: Tigard
Site address: 11880 SW PACIFIC HWY
Project: Fidelity Fleet Subdivision: TIGARD ROAD GARDENS Lot: 5
Project Description: (3)branch circuits and(1)data telecommunications system for upstairs offices.
Contractor: A+ ELECTRICAL SERVICES INC Owner: GULSONS PACIFIC LLC
PO BOX 446 307 LEWERS ST, STE 600
SCAPPOOSE, OR 97056 HONOLULU, HI 96815
PHONE: 503-284-7300 PHONE:
FAX: 503-813-2087
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 10/22/2014 $71.02
Specifics: Service or Feeder
1 ea Signal circuit or Limited 10/22/2014 $75.00
Type of Use: COM Energy Panel
Class of Work: ALT 1 ea 12%State Surcharge- 10/22/2014 $17.52
Electrical
Type of Const:
Occupancy Grp:
Total $163.54
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 ar- set forth in OAR
952-001-0010 through 0'r :52-001-0090. You may obiai of the rules or direct questions to OUNC by calling 503.23 7 or 1.800. '0.2344.
Issued By: rmittee Signature: 0 ofr'• �/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:
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 ONLY
City of Tigard ' Date/Bed
q 13125 SW Hall Blvd.,Tigard,OR 9722 � ,.*a-" Plan Review ? III =Mr. I- !r
1 m Phone: 503.718.2439 Fax: 503.598.110' Vd•ti*=' ,._ Date/B : Related Permit#:
Inspection Line: 503.639.4175 ';, .. . �l p `ObC Ready Date/By:' ® See Page 2 for
TIGARD Internet: www.tigard-or.gov t1C\ p P •� Notified/Method: Supplemental Information
�A
OF WORK ,1 k,'4 a .ne PLAN REVIEW
❑New construction Aition/alteration/r e n' , ��• i Please check all that apply(submit 2 sets of plans w/items checked):
'/ ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: �I,,t where the available fault current ❑Marinas and boatyards.
CATEG RY OF CONSTRU. ON exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling [Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
t' JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
�'7/o9g I �/ego 5 ,j Pi,/F/c /A ❑Addition H of new motor load of system.
Job#: Job site address: /t 1ooHP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: ❑Six or more residential units. occupancy.
y /r C�Nt41)f 0 2 c 7 Z z 3 ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ;T C��t, _S' �E D s,_' CI Hazardous locations. 0 Supply voltage for more than
`J �C l(t � ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
p Description 1 Qty. I Each I Total 1 *
540 4441.` 0 Lt/D . ri�C4 FLT / t, 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'1 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
_ (with above sq.ft.) 75.00 2
N tMJ U LA TUTS c 110 I Gs= .1)A-TA Ph4.-_ N,=t..) Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
5(Ari 2S O FA e..4----_< Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER 1 ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:' 601 amps to 1,000 amps 301.04 v 2
Phone:( ) 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
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 I 2
Owner signature:_ Date: 401 amps to 599 amps 168.54 2
❑ APPLICANT I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: c I",o__ -C above service or feeder fee,
7 42 2
Q to each branch circuit
Contact name: B.Fee for branch circuits without •
service or feeder fee,first 1 56.18 $6,)$ 2
Address: branch circuit
City/State/ZIP: Each add'I branch circuit Z 7.42 /y,,3j4/ 2
Miscellaneous(service or feeder not included) //
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: f Sign or outline lighting 67.84 2
1 L�LCI`T2-1 -t.� 5EA,.i 4
Signal circuit(s)or limited-energy See Page 2 $7,5;Q 2
Address: 'Q 13�k 9 9 , panel,alteration,or extension.
City/State/ZIP: 7 / Each additional inspection over allowable in any of the above
S e,47O,O o SE i 0,2_ 97i75� Additional inspection(1 hr min) 66.25/hr
Phone:(9)) 243 7—730th Fax:(503) 2,/3- GD 7 Investigation(1 hr min) 66.25/hr
/� Industrial plant(1 hr min) 78.18/hr
Email: psi l� A PL_u 5 GLt=CT/L 1 2...4-4_P b X . e-O' 7 Inspections for which no fee is
� 90.00/hr
CCB Lic.:/6,9,6 0Electrical Lic.: �( Suprv. Lic.: specifically listed CA hr mn)
( f�/J 1/ t ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: /[,� Subtotal: /41„,02-
Print name: 0,44 "1.iy LEI ti Date: /0/2 Z f// / ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): /1, 5-2
Authorized signature: /_ TOTAL PERMIT FEE: 14,3 5sT
� This permit application expires if a permit is not obtained within 180
Print name: /� Date: /0/2_Z// days after it has been accepted as complete.
Al C 17 TH l ( . Number of inspections allowed per permit.
I:\Building\Permi ts\ELC_PermitApp_ELR_ERE.docx Rev 04/21/2014 440-4615T(I I/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 SCHEDULE
Description I Qty. I Each I Total
Fee for all residential systems combined: $75.00 Renewable 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 Ol to 100 kva 552.26 2
❑ 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 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(S4 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 91 8-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
I= Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
n 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.docx Rev 04/21/2014
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
11880 SW PACIFIC HWY, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2014-00609
Jeff Grove
Violation Summary:
Inspector Contractor