Permit CITY OF TIGARD ELECTRICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit#: ELC2021-00136
Date Issued: 3/23/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135DA04600
Jurisdiction: Tigard
Site address: 11161 SW HALL BLVD 19
Project: Village at Washington Square Subdivision: 1998-038 PARTITION PLAT Lot: 1-2
Project Description: Building C: (4)branch circuits for unit 19. 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:
PHONE: 503-981-2383
FAX: 503-981-0053
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo/Purchase 03/18/2021 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge- 03/18/2021 $9.41
Type of Use: MF 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 thro ah OAR 952-001-0090. You may obtain a coov of the rules or direct auestions to OUNC by callino 503.232.1987 or 1.800.332.2344.
Issued By: lvn Permittee Signature: r-ir G0D11 LCI
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.
iii.' %' i
Electrical Permit Application
City of Tigard RECEIVE t)/ri/-/ , Perm"' 1- c
• 13125 SW Hall Blvd,Tigard,OR 97243 Plan Review I
t II Phone: 503.718.2439 Fax: 503.598.1960 qy DaWsv: Related Permit It:
Inspection Line: 503.639A 175 PIAR 1 0 2OC 5 Ready Date/By: hoc ® See Page 2 for '
TIG A R t) rifi
Internet: www.tigard-or.gov Noed/Motod: / -'6 I supplemental lefamatioa
TYPE of womUi fY OF TIGRL
c(1 PI .r REt IEW
❑New construction 2 Addition/alteratit 9**DIV1.7IOn' Please chock all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
El Demolition El Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling 0 Commercial/industrial ElAccessory building less to ground,or exceeds 14,000 ❑Commercial-sae agricultural
amps for all other installations. buildings. ii
!XI Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑emergency system larger separately derived
Job#: Job site addrOss:... ❑Addition of new motor bad of aritear•
ICE-5176 11161 SW Hall Blvd 100HP or more. ❑"A-,"E",'I.2","la
CitylStatelZlP: ❑Six or more residential units. occupancy.
Tigard O 97223 ❑Health-care Smithies. ❑Recreational vehicle pmts.
snite/bldgrapt.#: Bldg c I Project.Patne:Village at Washington Square o or ❑ lvoyyor ,„nolp w for.more than
Cross street/directions to job site: FEE SCHEDULE ':
owc.md.,r I oar. 1 Mk I Taw I •
New residential single-or mull-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 eq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential a
Bldg C-UNIT19-exterior GFCI+ lighting replacement, water (t above sq.ft.) 7s.� 2 r
9 9 p Limited energy,malt;-family 75.00 2 e
r.
heater, disconnect/reconnect, selective exhaust fan disconnect/reconnect residential(with above so.ft.)
RI PROPERTY OWNER El TENANT RenewablrfeeEnergy ❑ SeePage2
Services m feeders insfalladoe„alteratton,and/or relocation
Name: Community Partners for Affordable Housing 200 amp or less 100.70 2
Address:6380 SW Capitol Highway 201ampstoatl0amp 133.56 2+
401 amps to 600 amps 200.34 2
city/state/ZIP:Portland, OR 97239 601 amps to 1,000 amps 301.04 2
Phone:(503) 293-4038 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders Installation,alteration,and/or I`.
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
Owner signature: Date: 401 amp to 599 amps 168.54 2
Branch circuits-new,alteration,or extension,per pane '
i� APPLICANT 0 CONTACT PERSON. A.Fee for branch circuits with E
13usineasname: Industrial Commercial Electric Company above service w feeder he, 7.42 2
each branch circuit
Contact name: Torn Griffith B.Fee for branch circuits without I
Address:29030 SW Town Center Loop E Suite 202#159 service orfeederfee,firstbran 1 56.18 56.18 2 E
city/statelZlP:Wilsonville, OR 97070 Each add 3 7.42 22 9B 2
Miscellaneous(service or feeder not Included) n E
Phase:(503)981-2383 Fax::(503)981-0053 Each manufactured or modem 67.84 2 '.
dwelling,service and/or Seeder
Email:victoria@ icecoelectric.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2 tt
r
Business name: Industrial Commercial Electric Sign or outline lighting 67.84 2 1
Address:29030 SW Town Center Loop E Suite 202#129 Signal on,o exteeai ❑ SOC Page 2 2 :i
Each additional lnspectionover allowable In any of the above
city/State/ZIP:WilsonviIle, OR 97070
Additional inspection(1 hr min) 66.25/hr
P>onm(503)981-2383 Fax:(503)981-0053 Investigation(1 hr min) 90.00/lore
Industrial plant(I hr min) 78.18/hr b
Email tom®icecoelectric.com Inspections for which m fee is 90.Oahr
CCB Lie.: 164304 Electrical Lic.: C5 Suprv.Lic.: 53185 specifically listed(v,hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: QTyyt, Subtotal: 78.44 €
Print name: Tom Griffith ,,r�" Date: 2/26/21 ❑Plan Review Required(25%ofpamit fee): ;:
State surchsrge OTAL of PERMIT FEE:
Authorized signature: C TOTAL PERMIT FEE: 87.85 i"
This permit appikados expires if a permit Is not obtained within 180
Print name: Torn Griffith Date: 2/26/21 day.after I has been accepted a complete. i!,',
• Number of inspections allowed par permit I},1
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