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Permit Support Document ( °'DocuSign Envelope ID:9F24350E-3647-41F9-BDBD-A072971E8A93 , .- Electrical Permit Application rrrc��' jam` roll orrlCl•,"UM'.1i�r� E�./'^'VE Rasrwd City of Tigard n 7f Penn t r � y 13125 SW Hall Blvd.,Tigard,OR 9722 p�Rarzew / ! r�,d/-_mad` Phone 503718.2439 Fax 503.596.1%0 AUG 3 20ZI DudBy: �/� t JP Related Permit8: .eif }.] �� jj Inspection Line: 503.639.4175 Date/B hris ige ! I l:.\l'n Internet www.tigard-or.gov �t l F TIGRRLI xai6ed/Miettnd: ��Q.�. s&Pin:for ,a i fi 1 r : Supplemental Information TYPE OF WOI%lit jii.,, iltxl";- I PLAN REVIEW ❑New construction Addition/alteratidn/replacement P check all that apply(submit 2 sets of pleas wfitems checked): 0 Demolition 0 Other: ❑Service orfeeder 400 amps or more ❑Building over three stories. where the available fault current Ci Marinas and boatyards. CATEGORY OF CONSTRU I i , ISE ! exceeds 10,090 amps at 150 volts or I]Floating buildings. ❑1-and 2-family dwelling ❑Commercial/industrial s bu x ,• lees to ground,or exceeds 14,000 ❑commercial-use agricultural Till Multi-family El Master builder �1I9 f ,' amps I'll other installations. buildings. ❑Fire pump. ❑Installation of ISO KVAcc JOB SITE INFORMATION AND LOCATION ❑Eser(sem"lsystem. larger separately derived fob#:2110.HWC lob site address 111050- .4irielar— y ❑Addition of new motor load of system 7•l.]Pi,j«.- 'n L� ipouP m . ❑.A",<,E,."t-2",,.1-g", City/State/ZIP: Tigard,OR 97224 ft., ix or more residential,mite.• occupancy Heakh.care Sscititiea. ❑Recreational vehicle ports. Suitelbldg./apt.#: I Project name:Bonita Ville Apartments — ❑Jda ovs to ae n a. ❑s pply,oltage ro mom than 3arvica or fredx 600 amps or mac. 600 vo na:z. Cross street/directions to job site: FEE SCHEDULE SW 76th Ave.and Bonita Drive Description (Ks. I rare Total i • --- New residential single- _.._...._ or tvWti-family dwelling unit : Lot#- Includes attached garage Tax map/parcel#:251128D00100I. - 1,000 sq.ft or less Ea atW'1500 s4 ft or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 1 ADA UNIT UPGRADES,STANDARD UNIT UPGRADES,REPLACE BUILDING SERVICE,REPLACE twill above se N-' 75.00 2 PULLS FROM METERS,REPLACEMENT OF BUILDING WIRING,UNIT/SITE/AND STAIRWAY Limited energy,multi-family ga 75.00 7.200.00 2 LIGHTING UPGRADES. residential;with above sN.ft) 0TENANT.'.__.,_.... Renewable Errol;_. 0 See Pgte 2 ® PROPERTY OWNERServices or feeders installation,alteration,and/or relocation Name: HAWC AHP4 LIMITED PARNTERSHIP111 zoo amps or less 9 100.70 906.30 2 AddresaNE LINCOLN ST, SUITE 200-L 201 amps to 400 amps 133.56 2 �}f bE4UK U, UK 401 amps to 600 amps 200.34 2 City/Sta t 601 amps to 1,000 amps 301.04 2 • 71 4503-846-4794Will S IgU)washin9 t Phone: — Fu @)7 i Over 1,000 amps or volts 552.26 2 N...- - —CIFrellttlS Temporary services or feeders installation,alteration,and/or Email: _ I relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 —7 intended for sale,lease,rent ORSor exchange,according to S 447,449,670,and 70l• 201 amps to 400 snips 125.08 2 .� Owner signature: ---.- Date: 401 amps to 599 amps I 168.54 2 .• El APPLICANT I El CONTACT PERSON Branch circuits-rant,alterationr or extension,per panel " ,.- -- T..Fce(`m bench circuits with Business name:pINNACLE ARCHITECTURE above service or feeder fee, 90 7.42 712.32 2 each branch circuit ',lit.;. Contact name:RYAN CAIN B.Fee for branch circuits without .�r service or feeder fee,first Address:960SW DISK DRIVE#101 branch circuit 56.18 2 City/StateIZIP:BEND,OR 97702 Bach adrflhmnch circuit 7.42 —1--2— Miscellaneous(service or feeder not included) Phone:(541 )388-9 97 X17 Fax::( ) Each manufactured or modules. dwelling,service and/or feeder 67.64 2 Email: RYAN©PARCH.BIZ Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name,. Jet Industries,Inc. Sign or outline lighting 67,84 ZICILo4 2 Address: 1935 Silverton Rd NE Signal rxrmtit(s)or limited-energy 0 See Paget 2 Panel,ahemation,a extension. _ City/Stare/ZIP: Salem,OR 97301 Each additional inspection over allowable in any of the above Additional inspection(l hx min) 66.25/hr I Phone: 503-363-2334 503-363-2622 Investigation(1 hr min) 90.00/hr Email: bear.k@jetindustries.net Industrial plant(1 hr min) 78.18/hr ,,gi��— Inspections for which no fee is CCB Lic.: 3944 E1ectriCAfIC.9m [ rib . Supev.Lila:: 6546S srecificail_listed 415 hr min I 90.00/hr S Suprv.Electrician signature,regain:di 1M I� ----3. ELECTRICAL PERMIT dal: - — S Ntrtt!:nutter Clint Olhesier `Odataee,00„401... 34.id Date: 1 ®Plan Review Required(25%of permit fee). _ 3t?, s.t 25 State surcharge(12%of pennit fee): i. -,lC. .0 Authorized signature: L_ TOTAL PERMIT FEE , This permit application expires If a permit i,not m wined within 180 Print name: Date„_- �—• . days after it has been accepted as complete. " Number of inspections allowed per permit. I:1Budd'malPrmdtdElk Pamit+Wp PLR ERE.doc Rev owl 7/2015 440-4615T111/05/COM/WEB