Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00156
;TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 04/07/2010
Parcel: 1S136DC04400
Jurisdiction: Tigard
Site address: 11945 SW 70TH AVE
Subdivision: DARTMOUTH SQUARE Lot: 30
Project: TVF &R
Project Description: Underground conduit sleeves only, (4) 4 ", (9) 2" & (2) 1" for generator, (1) 1" for exercise room
and (2) 1" for conference table.
Owner: FEES
DARTMOUTH SQUARE LLC Quantity Description Date Amount
SUITE 2070, 805 SW BROADWAY
PORTLAND, OR 97205 1 hr Hourly Electrical Rate 04/07/2010 $90.00
1 ea Hourly Electrical 12% 04/07/2010 $10.80
PHONE: Surcharge
Contractor:
PORTLAND ELECTRICAL CONST INC
1019 7TH STREET
OREGON CITY, OR 97045
PHONE: 503 - 655 -2281
FAX: 503- 655 -5033
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $100.80
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 throu R 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 50 •.6699 or 1.800.332.2344.
Issued By: k L (2.44 1 Permittee Signatur: _.� •L' + i��tL
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' - ', �/ Date:
—
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
04/02/2010 15:16 5036555033 p'zttf , 1' �.,- r 'ORTLAND ELECTRICAL PAGE 02/03
Electr Perm Application APR 0 " 2 201 " # .. r �'"' /.'.1..6)1l,'(41+1( a 1 I ti t • .l � r ' '', . • ' r�, y.
Receives c
? lQ Permit No.: /O _ G10/
114 i, City of Tigard T Dalclev & ' 13125 SW Hall Blvd._ Tigard. OR 97223 1 @ I �I' Y+ 131y! "1 clan Review Other Permit: u�C�
'' 17 Phone: 503.639,4171 Fax: 503.598.1960 I -v i 1 n �
Date By: _
lliLQl t� /it,)l )(tateRcnayi:ty, bias 21 See Pnge2for
, +^?? inspection Line: 503639.4175 > IatiScdlMelhod: __Supplemental 'information T ' t t I ' C � CfI'@ �—
- -
iiri , Internet: www.tigard- or,gov
TYPE Or V1'ORiC PLAN RE ;'IEiY • r Please check all that apply (submit ?sit' of plan' w /items checked baiow);
❑ New construction ® Addition /alteration /replacement ❑ Service or *ceder 400 amps or more 0 Building over three stone:
0 Demolition
❑ Other: where the available Bolt current ❑ Marinas and boatyards. •
.. exceeds 10,000 amps at 150 trolls nr Ci Floating b,tildings.
Y:
CATEGOR OF CONSTRUCTION . . ' • less to ground. or exceeds 14,000 0 Commercial• use agricultural •
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. [} ln stalla i r ion of 75 KVA or
❑ Master builder ❑ Other: O Fire pump. ❑ Multi-family 0Emergency system. larger scperntely derived s ystem.
JOB SITE INFOORMATiON AND LOCATION . . • 0 Addition of new motor load of ❑ " �" "E" ' 1 - ` 1 - `'
100HP or more. occupancy.
1 Job no.: 343 . site address: 11945 SW 70 Avenue Six or more residential units. ❑ Recreatlanat vehicle parks.
-- Ill Health -cart facilities. ❑ supply voltage far more than
City /State/ZIP; Tigard, OR 97223 0 Hazardous locations. 600 volts nominal,
Suite/bldg. /apt. no.: Project name: Tualatin Valley Fire & Re ❑ Service or feeder 600 amps or more.
,, • FEE SCHEDULE
Cross street/directions to job site: Damon. - I_9. 1 Fse 1 Tot"I I •
I
New residential single- nr multi - family dwelling unit.
Includes attached garage.
' — 1 sq. ft . or less 1 168.54
Subdivision: 4
division: 1 Lot no.: --
_ Ea. addl 500 sq. ft. or portion 3192 I I
TRx map /parcel no.: Limited energy, residential 67,84 2
' . f1FSCRIP'lON OF WORK • (with above si. ft. •
:-- '— Limited energy, multi - family 67.84 2
Underground conduit sleeves only. 4-4 " , 9-2" & 2 -1 "for generator residential with above s. R. IIII
Services or feeders installation, alteration, and /or relocation
1 -1" for exercise room, 2 -1" for conference table 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
0 PROPERTY OWNER .0 T EN�AN.T . - ,_
401 amps to 600 amps 2no.3n 2
Name! 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
-- ' Temporary Rervices or feeders Installation, alteration, and /or
City/Stale /ZTP: — relocation ,
200 amps or less 59,36 I
Phone: ( ) Fax: ( ) • 201 amps to 400 amps 125 2
_
Owner installation: This installation is being madc on property that i own which is not 401 amps to 599 amps 168.54 2
intended for sale" lease. rent. or exchange, according to ORS 447, 449, 670. and 701 Branch circuits - new, alteration, or extension per panel
Owner signature: Date: A. Fcc for branch circuits with i I
above service nr feeder fee.
ELI APPLICANT RS
❑ CONTACT PERSON 7 I each branch circuit 42 2
' B Fee for branch circuits without
Business name: Portland Electrical Construction, inc. service or feeder fee, first •
56. I P 2
branch circuit
Contact name: Greg Boen Each ndd'I branch circuit 1 7 42 L2_
Address: 1019 7 Street Miscellaneous (service or feeder not Included)
. Each manufactured or modular 67.84 I 2
City /Statc /ZIP: Oregon City, OR 97045 dwellin•, service and/or feeder
Reconnect only 67.84 2
Phone: (503) 655 -2281 I Fax:: (503) 655-5033 Pump or irrigation circle 67.84 2
E -mail: greg(portlandelectrical.com Sign or outline lighting J I 67.84 2
CONTRACTOR Signal circuit(s) m limited energy
,anet, alteration. or extension, Pa ..e 2 2
f3usincss name: Same as above Each additional ins rection over allowable in any of the shove
-` Additional inspection (1 hr min) ... ! 66.25 / hr I
Address: Investigation (1 lir min) 1 66.25/ hr
City /State /ZIP: Industrial plant (1 hr min) 1 78.18/ hr
Phone: ( Fax: ) Inspections for which no tee is
1 I 90.00 / hr k 90
1 specifically listed r hr min) •
1 1 I
C t7 CB Lic,: 51764 $ II Electrical Lic,; 3-246C 1 i t Sup ' • Lic.: 34615 1 ID ELECTRICAL PERMIT FEES
; Suhtot&: 90,
..E.1 Suprv. Electrician signature. required: -' _w- .) � Plan review (25 %of pennir fee):
Print. name: Michael P. Donohue I Date: 4 - -
State surcharge (12% of permit fcc); 10.80
i
TOTAL PERMIT FEE: 100,80
• Authorized signature 1 �.� - This pomnit nppticntion expires ire permit is not nhtnincd within Ian
days otter It has been ncrephri m cnmplet .
J Print name: Michael P. Donohue Date: 4 -02 -10 • Nmnbet of inspections nlInwcrl per permit.
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