Permit CITY OF TIGARD ELECTRICAL PERMIT
1
1 1 COMMUNITY DEVELOPMENT Permit#: ELC2021-00135
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 3/23/2021
Parcel: 1 S 135DA04600
Jurisdiction: Tigard
Site address: 11159 SW HALL BLVD
Project: Village at Washington Square Subdivision: 1998-038 PARTITION PLAT Lot: 1-2
Project Description: Building B:(10)branch circuits for units 23,24 and 25. Work includes exterior GFCI,lighting replacement,water
heater disconnect/reconnect,and exhaust fan disconnect/reconnect.
Contractor: INDUSTRIAL COMMERCIAL ELECTRIC COMPANY Owner: VILLAGE AT WASHINGTON SQUARE
PO BOX 21282 LIMITED PARTNERSHIP
KEIZER, OR 97307 BY CPAH
PO BOX 23206
TIGARD, OR 97281
PHONE: 503-981-2383 PHONE:
FAX: 503-981-0053
FEES
Quantity Description Date Amount
10 crt Branch Circuits wo/Purchase 03/18/2021 $122.96
Specifics:
Service or Feeder
1 ea 12%State Surcharge- 03/18/2021 $14.76
Type of Use: MF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $137.72
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
952-001-00101hrouah OAR 952-001-0090. You may obtain a copy of the rules or direct Questions to OUNC by callina 503.232.1987 or 1.800.332.2344.
Issued By: k\ Permittee Signature: t:i'\ pVt(—`ittDr.
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'N 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.
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Electrical Permit Applicationmillizzmolimmiiiiiir ,.
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City of Tigard ,DECEIVED DateB�. ',//)9/� Pomait": �-�t ' -4—
' 13125 SW hall Blvd.,Tigard,OR plan Re '
i a' Phone: 503.718.2439 Fax: 503.598.1960 DateBv: Related Permit#. ,c
Inspection Line: 503.639.4175 MAR 1 0 2021 Ready
°8ef R' aria 0 See Page 2 for ``-
TI(;ARI) Internet www.tigard-or.gov Notified/Method: `•6 Supplementallaformaden 1.'.
TYPE OF woW/OF TIGARD PLAN REVIEW " `,
❑New construction 11 Addition/alterYti4tl[rsDlipt¢47pttk,I S IO N Please check all that apply(submit j sets of plane wtaeme checked): ;
1��JI LIJIIVl7 user ❑Service m fader 400 amps or more ❑Building overtluee stories.
❑Demolition ❑Other: where flu available awn current 0 Marinas and boatyards. n
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. y
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building ices to ground,or exceeds 14,000 0 Commercial-use agrkultunt .,
pamps for all other installations. buiktiap. •
1:yi Multi-family 0 Master builder 0 Other: Orin pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑ f o Addition sew motor load of system ir
Job#: ICE-5176 Job site address: 11159 SW Hall Blvd 100xon . 0"A","E","1-2","1-3-, 1''.
0 Six or more residential unite
City/State/ZTP: ❑Recreational vehicle parka.
Tigard. n 97223 ❑xe.>tti-um�e;lidm.
Suite/bldg./apt.#: Project name:Villa a at Washington S uar3 ❑rlarnrdntakntions ❑Supply voltage for MOM then 11
Bldg B g q ❑Serer ce or feeder 600 amps m more. 600 volts nominal gi
Cross street/directions to job site: FEE SCHEDULE
oaarrotka 1 Otv. I EsO i Total I
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage. :.
1,000 sq.ft or less 168.54 4
Tax map/parcel#: Ea.add')500 sq.ft.or portion 33.92 1 I.
DESCRIPTION OF`:WORK fimited energy,residential 75.00 2
BldgB-UNITS 23,24, 25-exterior GFCI+ lighting replacement water (with above )
iT' 9 Limited energy,maai-family 75.00 2
heater, disconnect/reconnect, selective exhaust fan disconnect/reconnect reaidrntiai(with above a9•It)
PROPERTY OWNER 0 TENANT Renewable Ellerin, ❑ See Page 2
Services or feeders Installatlonolteratton,and/or relocation ii.
Name: Community Partners for Affordable Housing 203 amps or less 100.70 2
201 amps to 400 amps 133.56 2 ,-
6380 SW Capitol Highway 401 amps to 600 amps 200. 2
City/State/ZIP:Portland, OR 97239 601 amps tol,000amps 301.04 2
Phone:(503) 293-4038 Fax:( ) over 000 snips or volts 552.26 2
Temporary services or feeders Installation,alteration,and/or l
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 4%
Owner signature: Date: 401 amps to 599 amps 168.54 2
APPLICANT I 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel ..
WA.Fee far branch circuits with
Business name: Industrial Commercial Electric Company shove service or feeder fee. 7.42 2
each branch circuit
Contact name: Tom Griffith B.Fee for branch circuits without 111
Address:29030 SW Town Center Loop E Suite 202 #159 service or feeder fee.firstbranch 1 56.18 56.18 2
City/Srate/ae:Wilsonville, OR 97070 Each add'l branch circuit 9 7.42 RR7R 2
Miscellaneous(service or feeder not Included)
Phone:(503)981-2383 Fax::(503)981-0053 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
:victoria@ icecoelectric.com Reconnect only 67.84 2 I`
CONTRACTOR;. Pump or irrigation circle 67.84 2 4
Business name: Industrial Commercial Electric Sign or outline lighting 67.84 2
Signal circuits)or limited-energy ❑ See Page.2 2
Address:29030 SW Town Center Loop E Suite 202 #129 panel,alteration,or extension. 3:
Each additional inspection over allowable In any of the above
city/state/ZIP:Wilsonville, OR 97070 Additional inspection(llamin) 66.25/hr
Phone:(503)981-2383 Fax:(503)981-0053 Investigation(1 hrmin) 90.00!Ir i.
Email:tom®icecoelectric.com Inspecionsf fot(1r
whihr ch
7&l8/hr
Inspections for vdaica no fa is 90.00/hr a-
CCB Lie.: 164304 Electrical Lie.: (;5 Suprv.Lie.: 531$1 specifically listed PA hr mill) `
ELECTRICAL PERMIT FEES 1
Suprv.Electrician signature,required 'F' Subtotal: 122.96 ,I.
Print name: Tom Griffith • ❑Plan Review Required(25%of permit foe):
State surcharge(12%of permit fee): 14 7R
(,1 -- /,% TOTAL PERMIT FEE: 137.72
Authorized signature: N94, ✓W This permit application oaplrp B a permit ie not obtained within 180
Print name: Tom Griffith Date: 2/26/21 days after It has been accepted as complete.
• Number of inspections allowed per permit.
t:tauldiq\paruastECC PmmilAnt_Etx_EREaloc Rev 06/172013 440-46151I1 I/05/COMIWEB