Permit ipl �
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CITY OF TIGARD ELECTRICAL PERMIT
g ` COMMUNITY DEVELOPMENT Permit #: ELC2010 -00651
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/17/2010
TIGARD . Parcel: 2S101 DB00100
Jurisdiction: Tigard
Site address: 7320 SW HUNZIKER RD 320
Project: Golsan Scruggs Subdivision: Lot: 0
Project Description: Electrical for TI.
Contractor: AC & E ELECTRIC Owner: HILLTOP BUSINESS CENTER LLC &
3535 DEL WEBB AVE #100 HUNZIKER LLC
SALEM, OR 97303 9430 NW KAISER RD
PORTLAND, OR 97231
PHONE: 503 - 363 -2301 PHONE.
FAX: 503 - 363 -2302
FEES
Quantity Description Date Amount
7 crt Branch Circuits wo /Purchase 11/17/2010 $100.70
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/17/2010 $12.08
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, Stale of OR. Specialty Codes an. all oth 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, , if work 6 suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Ce .. ' Thos rules are set forth in OAR
952- 001 -0010 t h r o u g h OAR 952 -001 -0090. You m_ obt... _ -.. • . •- - r. - s or dir- t questions to OUNC by calling 503.232.1= : 0 / / .800. 2344.
Issued By: / '/ ��— '/ Permittee Signature: 7 - 4 -
''• WNER INSTALLATION ONLY IV
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 the next available inspection date.
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.
Electrical Permit Application ` FOR.oFr tCE usE oNLy '
':- City and R `. m it No \
✓ Of Tigard Date /Bv: / /�i;l1J / Per
� }^ (
1. `c1 l,!)' U CYPS
13 125 SW Ha Blv d., Tigard, OR 972 11
(
III ? Pl an Review
4,f - - Phone: 503.718 2439 Fax: 503.598.10. Other Permit
0 ` r
10 D /Bl': e Jlb rr) -5T
i Inspection Line. 503.639.4175 Date Ready /By: tuns: RI See Page 2 for
TIGA,RB' Ins
, �� r _''"a Internet: www.tigard- or.,ov \10v ' Notified /Method: j I Supplemental Information
G P R
TYPE GIE WORK C i e Q��t �l\ r.. . - PLAN `REVIEW
III New construction ® Addition /alteration /ret71F 1J �f Pl ease cheek all that apply (submit 2 sets of plans whtems checked below):
�� ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault cun ❑ 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 ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or • JOB SITE�INFORMQ`CION - AND LOCATION ❑ Emergency system. larger separately derived system.
,-
0 of new motor load of ❑ "n "E" ''I _�.... I_l -
Job no.: ,lob site address: 7320 SW Hunzicker 10011P or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard, OR ❑ Health-care facilities. ❑ Supply voltage for more than
El locations. \ 600 volts nominal.
Suite /bldg. /apt. no.: 320 Project name: Golsan Scruggs ❑ Service or feeder 600 amps or more.
FEE ,S
Cross street /directions t0 job site: Description 1 Qty. 1 Fee. I Total 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' 1 500 sq. ft. or portion 33.92 1
Tax map /parcel no.:
Limited energy, residential
DESCRIPTION OF - :WORK (with above sq. ft -) 75.00 2
Limited energy. multi - family 75.00 2
TI Remodel residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ 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
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that t 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. Fee for branch circuits wish
❑. APPLICANT - ❑ : CONTACT PERSON above service or seeder fee, 7.42 2
- each branch circuit
Business name:
B. Fee for branch circuits without
service or feeder tee, first 1 56 18 56.18
Contact name:
branch circuit
Each add'I branch circuit 6 7.42 44.52 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or nodular 67 -84 2
City /State /ZIP: dwelling.. service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
. CONTRACTOR .. Signal circuit(s) or limited - energy
Business name: AC &E Electric panel. alteration. or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 3535 Del Webb Ave Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: Salem OR Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 363 - 2301 Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed ( hr min)
CCB Lic.: 591 Electrical Lic.: 24 -IC Suprv. Lic.: 5387S ELECTRICAL 'PERMIT_FEES, ;w,, _,
Subtotal: 100.70
' Suprv. Electrician signature, required:
� Plan review (25% of permit fee):
Print name: Carl Duncan Date: 11/16/2010 State surcharge (12 %ofpermit fee): 12.08
TOTAL PERMIT FEE: 112.78
Authorized signature:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit.
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