Permit CITY OF TIGARD ELECTRICAL PERMIT
Ip
t C COMMUNITY DEVELOPMENT Permit #: ELC2010 00429
TIGARD! 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/19/2010
Parcel: 2S 101 DA01200
Jurisdiction: Tigard
Site address: 7165 SW FIR LP 100
Subdivision: Lot: 0
Project: Alternative Services
Project Description: (6) branch circuits for TI
Owner: FEES
AMERICAN PROPERTY MANAGEMENT Quantity Description Date Amount
2154 NE BROADWAY, STE 200 6 crt Branch Circuits 08/19/2010 $93.28
PORTLAND, OR 97232 wo /Purchase Service or
PHONE: 503 - 284 - 2147 Feeder
1 ea 12% State Surcharge - 08/19/2010 $11.19
Electrical
Contractor:
MILESTONE ELECTRIC
1281 NE 25TH AVE, STE. T
HILLSBORO, OR 97124
PHONE: 503 - 645 -5323
FAX: 503 - 690 -4843
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $104.47
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 04 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503 .246.6699or
Issued By: 4if Permittee Signature: £� `/ or1. Z. " / ey, 77 0"/
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.
CaII 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.
RECEIVED
Electrical Permit Application ' ' . FOR ut rlt L is OM \
City of Tigard A U G 1 9 C 10 R oai � «G . w .
III 13 125 SW Hall Blvd., Tigard, OR 97 T Dat t7, / 9/0 p it No& L.C'a� /Q — DO .0q 9
`:. Phone: 503.639.4171 Fax: 503.5980 �? TIGNRD Plan Review outer P WJ'&O /0 — ii'
;l lr,nxir. lnsp
_ 6 $ar S Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/Hy: 1urS la See Page 2for
Internet: www. d-or, ov Notified/Method: / /.6
Supplemental Information
•
. ' TYPE OF WORIX . - PLAN REVIEW • •
❑ New construction Addition/altcration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
El Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑Other:
where the available fault current ❑ Marinas and boatyards.
' CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
.. less to ground. or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling [ Cornmercial/iadustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION CI Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E" "1 -2 ", "1 -3 ",
lob no.: 10358 Job site address: 165 r. 1 rLoOp rmore, a tion p
❑ Six Six o orr m m Rec,e
ore residential units. ❑ Recreational vehicle arks.
City/State /ZIP: 1 ` 17 '5 1:1 Health-care fatalities. ❑ Supply voltage for more than
/ ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: /0 0 Project name: A. 4,e r406 ve.clxv itES ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: 7 , rel neacrtpaon 1 Qty. j Fee T Tom 1
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
DESCRIPTION OF WORK • (with above sq. ft.) 75.00 2
f i
Limited energy, m ulti - family I 75. 2
('h e ri- C5 ?p &-(e _enf, residential (with above sq. R)
r Services or feeders installation, alteration, and/or relocation
‘ Cs 1 , I C-61:4-€ (' 200 amps or less 100.70 2
O. PROPERTY OWNER -. . . • ❑ TENANT.: . ° 201 amps to 400 amps 133.56 2
Name:
401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City / State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation _
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits— new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
":?`i ; %` ; '','`: APPLI above service or feeder fee,
❑ CANT ```' " :. '!; :^ I' ❑ CONTACT' PERSON::`:' : : :: each branch circuit 7.42 2
• Business name: B. Fee for branch circuits without
service or feeder fee, first p
Contact name: branch circuit ! 56.18 5400 2
Each add'l branch circuit .c. 7.42 3 7, j O 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: dwelling, service and/or feeder 67.84 2
-
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
Sign or outline lighting 67.84 2
,i °: wn04 :/.:`' -` . 3:4. e 1 •. CONTRACTO :.' , : .a•' .
Signal circuit(s) or limited energy
Business name: Ni t , �,,� E (��, ,I.,ti panel, alteration or extension. Pag 2 2
Each additional inspection over allowa in any of the abov
Address: In Ae �-5i-� A Je t t Additional inspection (1 hr min) 6625/ hr
e� lnvesti�rion (1 hr min) 66.25/ hr
City /State /ZIP:
�41 �51azT 1 C 1 R c7 c Industrial plant (1 hr min) 78.18 / hr
Phone: ( tY3) ' - Fax: (13) . ' q(t t{ ? � Inspections for which no fee is
/ � � j specifically listed ('h hr lain) 90.O0I hr
a V CCB Lic.: 15330 Electrical Lie.: 3L % SC„ Suprv. Lic.: DA 3 ELECTRICAL PERMIT FEES ••)'
/y� '
Suprv. Electrician signature, required: �. Subtotal:
Plan review (25% of permit fee): 934:
Print name: W ■ 11 i G'1 ell, A , � y bate: ' / + g / V State surcharge (12% of permit fee): I i , 1 t
►'t [ TOTAL PERMIT FEE; i or.i.y7
Authorized signatut Thls permit application expires if a permit is not obtained ttithin 180
Print name: Date: • days after it has been accepted as complete.
• Number of inspections allowed per permit.
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