Permit CITY OF TIGARD ELECTRICAL PERMIT
° PERMIT #: ELC2007 -00416
COMMUNITY DEVELOPMENT
D ATE ISSUED: 6/18/2007
TFGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S136DC-04400
SITE ADDRESS: 11945 SW 70TH AVE ZONING: C -
SUBDIVISION: DARTMOUTH SQUARE LOT : 030 JURISDICTION: TIG
PROJECT: DARTMOUTH SQUARE LLC
Project Description: Temporary power installation.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: 1 SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
DARTMOUTH SQUARE LLC CAPITOL ELECTRIC CO INC
PO BOX 230698 11401 NE MARX ST
PORTLAND, OR 97281 PORTLAND, OR 97220 -1041
Phone: Contact #: PRI 503 - 255 -9488
FAX 503 - 257 -7121
FEES
Description Date Amount Reg #: ELE 26 -496C
[ELPRMT] ELC Permit 6/18/2007 $100.30 LIC 48748
[TAX] 8% State Surcharge 6/18/2007 $8.02 SUP 2865S
Total $108.32 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
nj
Issued By [/ //, Permittee Si gnature: / 7 ___; fC. r' 1lr'L/
�P
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
It , , 0/$°6 ,.
FOIL OhFICI•: liSl•: O \1.1'
Electrical Permit Application EC ' E® / Received/
DBy: / .0 $ go
C ate
City of Tigard �UN 7
��.;, I Pl Revi: Other Permit: p
13125 SW HALL BLVD., TIGARD, OR 97223 9l � DateBy: • . 92
Fa - "
Phone: (503) 639 -4171 Fax (503) 598 -1960 CITI t i i' f D D Ready/By: Juris/ • See Page 2 for
Inspection Line: 503 - 639 -4175
BUILDING Notified/Method: Supplemental Information
Internet: www.ci.tigard.or.us
K
TYPE OF WORK PLAN REVIEW
New construction
11 Other:on/alteration / replacement Please check all that apply (submit 2 sets of plans w /items checked below):
Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories
CAT GORY OF CONSTRUCTION where the available fault current ❑ Marinas and boatyards
U 1 - and 2 family dwelling Commercial /industrial U Accessory building exceeds 10,000 amps at 150 volts or Floating buildings
❑ Multi family Master Builder ❑ Other less to ground, or exceeds 14,000 Commercial -use agricultural
JOB SITE INFORMATION AND LOCATION amps for all other installations. ❑ buildings
❑ Fire Pump ❑ Installation of 75 KVA or
•Job no.: 270775 Job site address: 11935 SW 70th Ave. ❑ Emergency system larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 - 2 ", "1 - 3 ",
City/State /ZIP: Tigard, OR. 100HP or more. ❑ occupancy
❑ Six or more residential units ❑ Recreational vehicle parks.
Suite/bldg. /apt. no.: Project name: Darthmouth Square ❑ Health -care facilities ❑ Supply voltage for more than
Cross Street/Directions to job site ❑ Hazardous locations ❑ 600 volts nominal.
❑ Service or feeder 600 amps or more
FEE SCHEDULE
Subdivision: Lot no.: . , _
Description I Qty. I Fee. I Total
Tax map /parcel no New residential - single or multi - family dwelling unit.
DESCRIPTION OF WORK Includes attached garage.
Temporary Power Installation 1000 sq. ft. or less $ 145.15 4
Ea. Add'I 500 sq. ft or portion $ 33.40 1
(J PROPERTY OWNER 1 11 TENANT Limited energy residential
(with above sq. ft.) S 75.00 2
Name: Limited energy, multi - family
residential (with above sq. ft.) $ 75.00 _ _ 2
Address: Service or feeders installation, alteration, and /or relocation
200 amps or Tess S 80.30 2
City/State /ZIP: 201 amps to 400 amps $ 106.85 2
401 amps to 600 amps 5 160.60 2
Phone: Fax: 601 amps to 1000 amps $ 240.60 2
Owner installation: This installation is being made on property that I own which is not Over 1000 amps or volts $ 454.65 , . 2
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701 Temporary services or feeders installation, alteration, and /or
Owner signature: Date: relocation
200 amps or Tess $ 66.85 I
[J APPLICANT 1 11 CONTACT PERSON 201 amps to 400 amps 1 S 100.30 100.30 2
401 amps to 600 amps _ 5 133.75 _ 2
Business Name: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
I Contact name: service or feeder fee, each
- .._.....__.. blanch cheuit 6.65 2
Address: B. Fee for branch circuits
without service or feeder fee,
City/State /ZIP: first branch circuit S 46.85 2
Each additional branch circuit: $ 6.65 _ 2
Phone: Fax: Miscellaneous (service or feeder not included)
E -mail: Each manufactured or modular
CONTRACTOR dwelling, service and or feeder $ 90.90 2
Reconnect only 5 66.85 2
Business Name: CAPITOL ELECTRIC CO., INC. Pump or irrigation circle 5 53.40 2
Sign or outline lighting S 53.40 2
Contact name: Richard Martin Signal circuit(s) or limited-
energy panel, alterations, or
Address: 11401 NE MARX ST. .
extension. Describe: Page 2 2
City/State /ZIP: PORTLAND, OR 97220 - 1041 Each additional inspection over allowable in any of the above
Per inspection $ 62.50
Phone: 503 - 255 - 9488 Fax: 503 2 ' 19 Investigation per hour (1 hr min) 5 62.50
CCB Lic.: 48748 Electrical Lic.: 26 -4960 S�uprv. Lic.: -S 10/ 1 107 Industrial plant per hour $ 73.75
` ELECTRICAL PERMIT FEES*
Suprv. Electrician signature, required: Subtotal $ 100.30
Print Name: Richard Martin Date: 05/11/07 Plan review (25% of permit fee) 8% of permit fee $ 8.02
,� State surcharge ( Pe )
Authorized signature: y / TOTAL PERMIT FEE , $ 108.32
Print Name. Richard Martin This permit application expires if a permit is not obtained within 180
days after it has been accepicu .., ..mplete
• Number of inspections per permit allowed.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00416
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/18 /2007
Phone: (503) 639 -4171 will
Inspection Requests (24 Hrs.): (503) 639 -4175 :,1.4-
INSPECTION WORKSHEET FOR DATE: 6/19/2007 TIME: 7:01AM PAGE: 55
SITE ADDRESS: 11945 SW 70TH AVE CLASS OF WORK:
SUBDIVISION: DARTMOUTH SQUARE LOT #: 030 TYPE OF USE:
PROJECT NAME: DARTMOUTH SQUARE LLC
DESCRIPTION: Temporary power installation.
OWNER: DARTMOUTH SQUARE LLC, PHONE #:
CONTRACTOR: CAPITOL ELECTRIC CO INC PHONE #: 503- 255 -9488
Inspection Request Scheduled For: Date: 6/19/2007 Pour Time:
Code # Inspec - ID escription Confirm # Contact # Message
110 Temporary electrical se ' . - 050470-01 971 - 533-9524 Y
Corrections /Comments/ Instructions:
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ii-R—ALA Dater / 6 #: (503) 718-