Permit f
CITY OF TIGARD ELECTRICAL PERMIT
s a COMMUNITY DEVELOPMENT ELECTRICAL
ELC2022-00149
Date Issued: 3/7/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110AA01700
Jurisdiction: Tigard
Site address: 10830 SW CANTERBURY LN 66
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: ME 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 160 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 coov of the rules or direct questions to OUNC by callino 503.232.1987 or 1.800.332.2344.
Issued By: E°Lgarolo-M�0tO"iCO o-
Permittee Signature: S,-,&•0-10114-i-C4 w"
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.
--
• i Electrical Permit Application I OR to FR l: u' I: 0\1.'t
City ofTigard RECEIVED Received/,? 7 ;fit
p Daffy.U7 0 Pertnir q: ��`LJLy^(�I
v 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
II Phone:Phone: 503.718.2439 Fax: 503.598.1960M AR 0 7 ZOZZ Date/By: Related Permit t:
Inspection Line: 503.639A175 ReadyDate/By: fur
TIGARD
H See Page2for
Internet: www.tigard-or.gov CITY OF TIGARD Notifie l7rethod: Supplemental information
TYPE OF wetilLDING DIVISION PLAN REVIEW
❑New construction Z Addition/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.
El Demolition 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-familydwellingCommercial/industrialless to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ 0Accessory building
amps for all other installations. buildings.
(.0 Multi-family ❑Master builder 0 Other:
❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: �/ r C lV K,,,� //h 0 Addition of new motor load of system.
/o0 .? 0 !` t201.✓t 100HP or more. ❑•A•.,`E..,•.i_2..,_t_3..,
City/State/ZIP: Six or more residential units. occupancy.
q��ct 0 0 Health-care facilities. 0 Recreational vehicle parka.
Suite/bldg./apt.#: . Project name: {it"`, (JSDy, Q t1/Ls 0 Hazardous locations. 0 Supply voltage for more than
f"` ❑Service or feeder 600 amps or more 600 wills nominal.
Cross street/directions to job site: - FEE SCHEDULE
Description I Qty. I Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax trap/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
/ -r� 1 /' ',, (with above sq.fl.) 75.00 2
C e/v i�P !Sal/ be,-Fw eem. a..0 i .i)Gf e Limited energy,multi-family
75.00 2
v/—,e_ (1/(-v!i -# 6, ) residential(with above sq.ft.)
0 ,hENANT, Renewable Energy 0 See Page 2
PROPERTY OWNERServices 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 amps 30104 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 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 amps to 599 amps 168.54 2
0
APPLICANT ❑.CONTACT PERSON Branch circuits-new,alteration,or extension,Per 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
service or feeder fee,first 1 56.18 2
Address:
branch circuit
City/$tate/Z1P: Each add'l branch circuit 1 7.42 2
Miscellaneous(service or feeder not Included)
Phone:( ) Fax: :( ) Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email:
Reconnect only 67.84 2
n CONTRACTOR Pump or irrigation circle 67.84 2
Business name: gyp t)�j a-s �� C L, Sign or outline fighting 67.84 2
/ I "L '�`�'l't Signal circuit(s)or limited-energy 0 See Page 2 2
Address: /QZ;—'?'J A' u,, C/_Wp ,,q r/ / G� panel,alteration,or extension.
City/State/ZIP:�f, ( --i l �fJ�/D�G` �bO 6 Each additional inspection over allowable in any of the above
_ Additional inspection(I hr rain) 66.25/hr
Phone:(cD ) .5_ 0 LE Fax:( ) Investigation(1 hr min) 90.00/hr
Email: �U y S� � G�� / �/yt Industrial fort(1 whichhr no) 78.0w18/hr
g""—` D` Inspections fee is
CCB Lie.: i� Z� Electrical Lie.: 3 Suprv.Lie. i specifically listed eh hr min) 90.00/hr
qZs� p 1f7/�I..
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: t� r4�.
Subtotal:
Print name: ya,ty` Date: 3----7—Z7.- ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE: 71.2,
This 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.
t:d3uilding\Permits\ELC—PennitApp_ELl_hRE.doe Rc%n6/172015 440-06151Q1l05/COM/WP.B