Permit•
0 -
CITY OF TIGARD ELECTRICAL PERMIT
11111 = COMMUNITY DEVELOPMENT Permit#: ELC2022-00148
Date Issued: 3/7/2022
T f C.'A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110AA01700
Jurisdiction: Tigard
Site address: 10830 SW CANTERBURY LN 65
Project: Max Subdivision: CANTERBURY PLACE,AMENDED Lot: 6A
Project Description: FIRE DAMAGE-rewire wall between units(65&66)
Contractor: AWSEM ELECTRIC LLC Owner: 10890 SW CANTERBURY LANE LLC
20315 NE SANDY BLVD 700 N SAN VICENTE BLVD STE G460
FAIRVIEW, OR 97024 WEST HOLLYWOOD, CA 90069
PHONE:
PHONE: 503-830-7854
• FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 03/07/2022 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 03/07/2022 $7.63
Type of Use: MF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 throuoh OAR 952-001-0090. You may obtain a coov of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Edga.rdv Mo.ldavr 4o- Permittee Signature: SPA
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.
• , � c
Electrical Permit Application FOR OFFICE LSI:.ONLY
City of Tigard RECEIVE I Reeereea
Dane/B 03 1 41 Permit#: '7:2f) 1443
III • 13125 SW Hall Blvd.,Tigard,OR 97223 q q Plan Review
Phone: 503.718.2439 Fax 503.598.1960 MAR 0 7 2022 Date/B : Related Permit it:
T I G A R D Inspection Line: 503.639.4175 Ready DateBy: Jr 'is nil See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notilied/Method: Supplemental Information
TYPE OF WOrdUALUING DIVISION PLAN REVIEW
❑New constructionAddition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
Multi-family ❑Master builder ❑Other: 0 amps forall other installations. nstngs.
pump. 0 Installation of 150 KVAw r
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#• Job site addrCBs: �/ CO 0 Addition of new motor load of system.
/DO 3 0 sl'•t4)_ l N. 6%4.1. tom,or rmre. ❑••A","E","1_2",••1_3",
City/State/ZIP:' -TTT _ - J 0 rJ' V Six or more residential units. occupancy.
/ Gtil'"GC ``` ��I 0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: /yr. `JC-., C. yl 0 Hazardous locations. ❑Supply voltage for more than
/, a's' Jv'k `1'l' s ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Deteripaon I Qty. I Eara I Total I •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'1500 sq.R or portion 33.92 1
DESCRIPTION OP WORK Limited energy,residential
�7 / (with above sq.ft.) 75.00 2
Re((, 14 Oce / b �ee44 am 1 q /1 at_ `f'0 Limited energy,multi-family 75.00 2
'-7`7 tkie_ C L..K/7 # 6 5 residential(with above sq.ft.)
❑ PROPERTY OWNER ❑ TENANT Renewable Energy 0 See Page 2
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 stops 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 attars or less 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.0E 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
❑ APPLICANT El CONTACT PERSON Branch circuits-new,alteration,or extension,ter panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or Seeder Lae,first ( 56.18 2
_ branch circuit
City/state/ZIP: Each add'1 branch circuit ( 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) I 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: 7 ` C,.r �•4 4,�C c �_C. Sign or outline lighting 67.84 2
.1^'j'�`�l Signal circuits)or limited-energy CI See Page 2 2
Address:
4�5 ' AI 4w2- S ti i/—X,td eii ed r-j panel,alteration,or extension.
City/State/ZIP: fL - (7J' '?7r e2 f Each additional inspection
inspection n(1 hrmin)
over allowable 2 any of the above
z� Additional inspection(1 hr min) 6625!hr
Phone:(S'A ) R 3 0 WS-Y. Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Si, / , �yh Industrial plant(I hr min) 78.18/hr
' � $ Inspections for which no fee is
CCB Lie.: /�8z44L Electrical Lie.: 37-,zc Suprv.Lie.: /f7..ZSI specifically listed('/hr min) 90.00/hr
Suprv.Electrician signature,required: �n^ '- ^ � ELECTRICAL PERMIT FEES
i'3m Y • C.-?c�- Subtotal:
Print name: �,yyt.e I C"'S..O. G a Date: :j-•2.•y ❑Plan Review Required(25%of permit fee):
�a State surcharge(12%of permit fee):
Authorized signature:
TOTAL PERMIT FEE: 7/.23
nit permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit
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