Permit CITY OF TIGARD ELECTRICAL PERMIT
`� COMMUNITY DEVELOPMENT ELECTRICAL
ELC2021-00601
T-I G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/10/2021
Parcel: 2S 101 AA08700
Jurisdiction: Tigard
Site address: 12511 SW 68TH AVE 150
Project: Dr Snip Subdivision: WEST PORTLAND HEIGHTS Lot: 34
Project Description: Electrical for TI:
Contractor: CAPITOL ELECTRIC CO INC Owner: TIGARD TRIANGLE PROPERTIES LLC
11401 NE MARX ST 3232 SW FAIRMOUNT BLVD
PORTLAND,OR 97220 PORTLAND,OR 97239
PHONE: 503-255-9488 PHONE.
FAX: 503-257-7121
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 11/10/2021 $100.70
Specifics:
amps or less
20 crt Branch Circuits w/Purchase 11/10/2021 $148.40
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 11/10/2021 $29.89
Type of Const: Electrical
Occupancy Grp: 1 ea Plan Review Electricial 11/10/2021 $62.28
Total $341.27
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 throuah OAR 952-001-0090. You may obtain a cony of the rules or direct auestions to OUNC by callina 503.232.1987 or 1.800.332.2344.
Issued By: Ho�J V De,We9e- Permittee Signature: Ow Atortic-cutio-frt
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.
13- 101 1112 t
Electrical Permit Application FOR OFFICE USE ONI.V
Received _
a 'ertnitno.:
City of Tigard Date/By: it,/1p/�j � /.�zA.� oitto,l
IR • 13125 SW Halt Blvd.,Tigard,OR 97 Plan Review
_` Phone: 503.639.4171 Fax: 503.598 ECEIV'E[ J a •they Permit: /�'• - + (/0(��
Date/By: �(�/p7 , C 1 N �'V P s "V V r lc s
T t G A R D Inspection Line: 503.639.4175 Date Ready/By: uric: ❑ see Page z for
Internet: www.tigard-or.gov /
(ICJ 2021 Notified/Methoda ' X� Supplemental Information
P fl r� ,1 t. It h �tx`i ,
T > Fes. ' t `OF TIGARD, - - '
❑ New construction ❑' Addition/alteration/replacemen 1 { ink, Please check all that apply(submit 2 sets of plans w/items checked below):
❑ Demolition ❑ Other: 81)1LDING DIVIS ❑ Service or feeder 400 amps or more ❑ Building over three stories
,. CATEGORY OF CONSTRUCTION ' ' �� where the available fault current ❑ M• arinas and boatyards
U I-and 2-family dwelling LI Commercial/industrial Li Accessory building exceeds 10,000 amps at 150 volts or ❑ Floating buildings
❑ Multi-family ❑ Master Builder ❑Other less to ground,or exceeds 14,000 ❑ C• ommercial-use agricultural
11,0,09...1,,,K*V*IbTFORMATIONANO LOCATION amps for all other installations. buildings
Job no.: 211553 Job site address: 12511 SW 68th ave Cl Fire Pump ❑ Installation of 75 KVA or
❑ Emergency system larger separately derived system.
City/State/ZIP: Portland ❑ Addition of new motor load of El"A","E","1-2","1-3",
100HP or more. ❑ occupancy
Suite Bldg./apt.no.: Project name: Dr.Snip ❑ Six o ore residential units ❑ R• ecreational vehicle parks.
ealth-care facilities ❑ Supply voltage for more than
Cross Street/Directions to job site: ❑ Hazardous locations 600 volts nominal.
❑ Service or feeder 600 amps or more
Subdivision: Lot no.:
FE> SC}.IEDULE
Description I Qty. I Fee. I Total
Tax map/parcel no.: New residential-single or multi-family dwelling unit.
' 1 J,a t h,'1 I\ 0.W l Pk. ;1 ;)E ' PX1014; 0?1 01tK !:.4 "a1 F'!ii Includes attached garage.
Add(1)I00a panel off existing panel and(20)20a circuits for lighting&receptacles 1000 sq.ft.or less $ 168.54 4
Ea.Add'500 sq.ft or portion $ 33.92 I
''W:TUN i"? TP .74 710k9 ". °ri ''-' ❑ TEN,AI`1"I•'i1.,''''kg'', Limited energy residential
Name: (with above sq.ft.) $ 75.00 2
Limited energy,multi-family
Address: residential(with above sq.ft.) $ 75.00 2
Service or feeders installation,alteration,and/or relocation
City/State/ZIP: 200 amps or less 1 $ 100.70 100.70 2
201 amps to 400 amps $ 133.56 2
Phone: Fax: 401 amps to 600 amps $ 200.34 2
601 amps to 1000 amps $ 301.04 2
Owner installation: This installation is being made on property that I own which is not Over 1000 amps or volts $ 552.26 2
intended for sale,lease,rent or exchange,according to ORS 447,449,670,and 701 Temporary services or feeders installation,alteration,and/or
Owner signature: Date: relocation
200 amps or less $ 59.36 1
, iY' . . , 0 1' 1 a 1'4;1'.~tic art Uw°M, t 'AC' PtI:SI N w;a fi 201 amps to 400 amps 9 $ 125.08 2
Business Name: 401 amps to 599 amps $ 168.54 2
Branch circuits-new,alteration,or extension,per panel
Contact name: A. Fee for branch circuits with
service or feeder fee,each
Address: branch circuit 20 $ 7.42 148.40 2
B. Fee for branch circuits
without service or feeder fee,
City/State/ZIP: first branch circuit $ 56.18 2
Phone: Fax:
Each additional branch circuit: $ 7.42 2
Miscellaneous(service or feeder not included)
E-mail: CEPermitS acepdx.COftl Each manufactured or modular
.r` _ F - CONTRA,I;TOR dwelling,service and or feeder $ 67.84 2
Business Name: CAPITOL ELECTRIC CO.,INC. Reconnect only $ 67.84 2
Pump or irrigation circle $ 67.84 2
Contact name: Sign or outline lighting $ 67.84 2_
Signal circuit(s)or limited-energy See
Address: 11401 NE MARX ST. panel,alterations,or extension. Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP: PORTLAND,OR 97 22 0-1 041 Additional inspection(I hr min) 66.25/hr
Investigation(I hr min) 66.25/hr
Phone: 503-255-9488 Fax: 503-257-7121 Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 48748 !Electrical Lie.: 26-496C ISuprv.Lie.: 3I32-S specifically listed(1/2 hr min)
'"q „t' '''i sEL C' ICAL P,ER1'IE t I't'$S .W, .t h!:, r.+
Suprv.Electrician signature,required. rr Subtotal: $ 249.10
Print Name: Darrell McNee b Date: 10/06/21 Plan review(25%of permit fee): $ 62.28
Authorized signature: / State surcharge(12%of permit fee): $ 29.89
/ i —�� TOTAL PERMIT FEE: $ 341.27
Print Name: Darrell McN �1•�� This permit application expires if a permit is not obtained within IRII
days after it has been accepted as complete.
'Number of inspections per permit allowed.
I:\Building\Permits\ELC-PermitApp.doc 5/21/13 440-4615T(1 t/05/COM/WEB