Permit IICITY OF TIGARD ELECTRICAL PERMIT
- COMMUNITY DEVELOPMENT Permit#: ELC2019-00810
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/20/2019
TIGARD Parcel: 2S112DC01400
Jurisdiction: Tigard
Site address: 15875 SW 74TH AVE
Project: NW Mothers Milk Bank Subdivision: FANNO CREEK ACRE TRACTS Lot: 4
Project Description: (1)branch circuit for reconnecting RTU.
Contractor: WILLAMETTE HVAC LLC Owner: JDS LLC
3075 SW 234TH AVE.#206 CRITERION CREEKVIEW LLC
HILLSBORO, OR 97123 BY SPECTRUM REAL ESTATE ADVISORS
1125 SE DIVISION ST#209
PORTLAND, OR 97202
PHONE: 503-259-3200 PHONE:
FAX: 503-848-2597
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 11/14/2019 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 11/14/2019 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 r 0.332.234/Y` .
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.
Electrical Permit Application FOR OFFICE USE ONLY
g F Received 3 l �' ��Ol,• F!D
Cityof Tigard
INDateBy:
13125 SW Ha11 B1vd.,Tigard,OR 9722 ''""� t� , -, Plan Review
' Phone: 503.718.2439 Fax: 503.598.1960 .. , ;Date/By: 'A' A@. la See 2 for
.aC`e, '—'00.7 _
T I G A R D Inspection Line: 503.639.4175 Juris:Date Ready/By: Page
Internet: www.tigard-or.gov 0 C 1 � ^(?+ Notified/Method: Supplemental Information
fi 0,
TYPE OF WORK PLAN REVIEW
El New construction El Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION El Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","l-2","1-3",
Job no.: Job site address: 15875 SW 74"'Ave lOOHP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard OR 97224 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: 100 Project name: Mother's Milk ❑Service or feeder 600 amps or more.
FEE SCHEDUL :J "
Cross street/directions to job site: Description I Qty. r I Fee. I Total 4 *
New residential single-or multi-family dwelling unit.
Includes attached garage. _ _
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
reconnect 7.5 ton RTU Lnres dential(with labove sq.ft.)
75.00 2
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
0 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 _ 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
City/State/ZIP: relocation
Phone:( ) Fax:( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation:This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701.
Branch circuits—new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name:same as below B.Fee for branch circuits without
service or feeder fee,first 1 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Phone:( ) Fax: :( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s)or limited-energy
Business name:Willamette HVAC LLC panel,alteration,or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address:3075 SE Century Blvd Suite 206 Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Hillsboro,OR 97123 Investigation(1 hr min) 66.25/hr
Industrial plant(1 hr min) 78.18/hr
Phone:(503)259.3200 Fax:(503)848.2597 Inspections for which no fee is 90.00/hr
specifically listed('/z hr min)
CCB Lic.: 56951 Electrical Lic.: 34346CRE Supry ic.: 4025LEB ELECTRICAL PERMIT FEES
I� Subtotal:
Suprv.Electrician signature,required:
Plan review(25%of permit fee):
Print name: mike sicard Date: 10/23/1 State surcharge(12%of permit fee):
Authorized signature: °KS-4 ,,/. TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Michael Malstrom Date: 10/23/11/ * Number of inspections allowed per permit.
I:\Building\Permits\ELC-PermitApp.doc 07/01/10 440-4615T(11/05/COM/WEB
Electrical Permit Application - City of Tigard fI Other
Page 2 - Supplemental Information Total number of commercial systems:
LIMITED ENERGY PERMIT FEES: '''No licenses are required. Licenses are require
for all other installations
RESIDENTIAL WORK ONLY:
Fee for all residential systems $75.00
combined
Check Type of Work Involved:
nA• udio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
n Heating,Ventilation and Air Conditioning
System*
Vacuum Systems""
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
nA• udio and Stereo Systems
❑ Boiler Controls
nC• lock Systems
nD• ata Telecommunication Installation
❑ Fire Alarm Installation
n H• VAC
❑ Instrumentation
❑ Intercom and Paging Systems
nLandscape Irrigation Control*
❑ Medical
nN• urse Calls
❑ Outdoor Landscape Lighting'
n Protective Signaling
C\Building\Permits\ELC-PermitApp.doc 07/O1/10