Permit ; CITY OF TIGARD ELECTRICAL PERMIT
. - a ` COMMUNITY DEVELOPMENT Permit #: ELC2010 -00376
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/22/2010
Parcel: 2S110DB00200
Jurisdiction: Tigard
Site address: 15191 SW ROYALTY PKWY K35
Subdivision: Lot: 0
Project: Arbor Heights
Project Description: (2) branch circuits for A/C.
Owner: FEES
HOLLAND HOLDINGS I ARBOR Quantity Description Date Amount
HEIGHTS, LLC, BY CLYDE HOLLAND
PARTNERS LLC, 1111 MAIN ST, STE 710 2 crt Branch Circuits 07/22/2010 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 07/22/2010 $7.63
Electrical
Contractor:
TICE ELECTRIC
5405 N. LAGOON AVE.
PORTLAND, OR 97217
PHONE: 503 - 233 -8801
FAX: 503 - 872 -8290
Type of Use: MF
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 through OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. / /
Issued By: Permittee Signature: .0"/ �PL i eel-1 7c " v
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.
07/21/2010 07:58 503 - 231 -3372 TICE ELECTRIC PAGE 02/02
Electrical Permit Application RECEIVED FOR 01^1 ICE USE 0 ?'L1'
IN City of Tigard R ,e ce iv ��� ri%�-�
PermiiNo.: ----LC
.2-o/0 -0037
q 13125 SW Hall Blvd., Tigard, OR 972733 ,., Plan Review Other Permit:
t ' Phone: 503.639.4171 Fax: 503,598.19603U1 2 1 L to Date/B
Inspection Line: 503.639.4175 Date Beady/By: ® Sc e Page 2 for
i' 1 G t\ R_D
Internet: www. d -or. ov information
� - OF G REVI>Ew. ;
> g pFT1GaR Notified/Method: Supplemental
EO NG.DiV
• ��1 :.� : . . PLAN . .. . .
�' p1 Please check
all that apply (submit 2 sets of plans w /items checked below);
❑ New construction Addition/alt o rcplaeement 0 Service or feeder 400 amps or more in Building over three stories.
❑ Demolition ❑ Other where the available fault current 0 Marinas and boatyards.
CATEGORY : 4F CON5TR7CJCTION.:. exceeds 10
,000 amps at 150 volts or Q Floating buildings.
-. less to ground, or exceeds 14,000 D Commercial -use agricultural
❑f 1- a 2,..fn dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. .
uhi- family ❑ Master builder ❑ Other: ❑ Fue pomp. 0 Installation of 75 11/4 or
CI Emergency system. larger separdely derived system.
' " JOB SITE, INFOIt KATION AND . LOCA it :.: 9
(� gaol
C j ei I' 4 _ Job site address: ✓ � �� �� qq `� oval y 1 J T g. . 13 Addition of new motor load of ❑ °A °, , "1_2". "I-3 ",
Job no.:1O . u) 11 Six or or more. occupancy.
-J 5 !! n ) ai 0 six or more o residential units. ❑ Recreational vohick parks.
City /State/ZIP; 71 D I -L A + K 3 ❑ nth-care facilities. ❑ Supply voltage fbr more thane
i r 0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: i 3.- Project name: i% bpi 1.4c49 t hi O Service or feeder 600 amps or more.
' :.:r :,: : ': :' ':.: FEE :SCHEDULE :-- .
Cross street/directions to job site; Dell.,• " "" " OOM Fee. Total -
,
New residential single- or multi- family dwelling unit.
Includes attached garage. _
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: ,
Limited energy, residential 67.84 2
DESCRIPTION OF WORK : - (withabove�CS .it)
2
Limited energy, multi- family
ae1a (a) CK 2 12 - 0 v f A /'. w ►4 s residential (with above sq.) J 6 7.84 ,
_ Services or feeders installation, alteration, and/or relocation
_ 200 amps or less 100.70 2
) El TEPIAIVT 201 amps m 400 amps 133.56 2
In PROPERTY OWNER, .;'.... . , I ; :'. `
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
'— Temporary services or feeders installation, alteration, and /or
City/State/ZIP: relocation
Phone: ( )
Fax ( ) 200 amps or less 59.36
1.2-1 201 125.08 Owner installation: This installation is being made on property that I own which is not amps to 400 amps 401 amps to 599 amps 165.54
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. Pcc for branch circuits with
. above service or feeder fee,
APPLICANT; 0 CONTACT PERSON = i 7.42 2
each branch circuit -
Busincss name: B. Fee for branch circuits a
without service or feeder fee, I 56.18 r a t 14 2
Contact name: first branch circuit '
Each add'l branch circuit 1 7.42 1.4 -d_ 2
Address: Miscellaneous (service or fader not included)
— City/State /ZIP: _ Each manufactured or modular 67.84 2
— — dwelling. service and f eeder
Fax: : ( ) Reconnect only 67.84 2
Phone: ( )
E-mail: il: Pump _Pam or irrigation circle 67.84 2
' ': CONTRACTOR' Sign or outline lighting
67.8 4 2
Sign circuit(s) or limited-
Business name: Tice Electric Company energy panel, alteration, or
extension. Describe: Page 2 2
Address: 5405 N Lagoon Avenue _
City /State/ZIP: por t land, Oregon 97217 Each additional in Lion overble in , of the above
_ Per inspection 66.25
(503) 233 -8801 Fax: ( 503) 872 -8290 Investigation per hour (1brruin) 1111111 66.25
Electrical L ic : 2 6 - 2 6C ry . Lic, , : 3 6 5 1 S Industrial plant ! r hour 78.18
CB Lic.: 16 f? , ELECTRICAL PERMIT. FEES' :
Suprv_ Electrician signature, required: _ as er ._ r le / / Subtotal: / , 1
Plan review (25% of permit fee):
Print name: Doug Johnson Date: i12-1/I 0 Statc surcharge (12 %of permit fec); 7. (o "
0 644.0 . jiL44,_.-- TOTAL PERMIT FEE: - Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: o S C .?d pJs,a Date' days after it has been accepted as compretc.
Number of inspections allowed per permit /2/ 2`-3 I: 1HuildiaB�armitr� .C�PetmitAQQ.doc ]D/Dl/09
440- 46t5Tt1IIo5/COM/WEB r
V e - g i y /-4,4/2.-E c S et y/'/f>' -/