Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00027
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/11/2011
Parcel: 2S102BD00702
Jurisdiction: Tigard
Site address: 9850 SW MCKENZIE ST 6
Project: McKenzie Street Townhomes Subdivision: Lot: 0
Project Description: Panel replacement.
Contractor: D & L ELECTRIC INC Owner: MCKENZIE STREET TOWNHOMES LLC
PO BOX 367 13325 SW CLEARVIEW WAY
WEST LINN, OR 97068 TIGARD, OR 97223
PHONE: 503 - 656 -5623 PHONE:
FAX: 503 - 650 -1918
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 01/11/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 01/11/2011 $12.08
Type of Use: MF 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, 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 -0090. You may obtain a copy of the ules ordirect questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: _ - a / Permittee Signature:
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 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.
JAN -11 -2011 11:15A FROM :D &L ELECTRIC INC 5036501918 TO:5035981960 P.2
Electrical Permit Applic 1 D
t t l It ( 1 1 - 1 - 1 ( 1 I `I ()NI 1
Receiv
City of Tigard �qN g i Penni'No.: * —
13125 SW Hall Blvd., Tigard, OR 972 23 2 ( 11 D ata/B ; @ = sa t� _ , O(} Q 7
Phone: 503.718.2439 Fax: fl Pl an Renew Other Permit:
Inspection Line: 503.639A175 ' ' GA D Date ReadyBy: El See Pa e 2 for
"`' "`" gMUILDING DIVISION `_ Supplemental g
internal: www.ti d-or. Notified/Method: lnformation
+
TYPE OF WORK is I PLAN REVIEW
❑ New construction ® Addition/alteration /repla8ment Please check all that apply (submit 2 sets of plans w /items checked below):
i :� ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: ' 4 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
El 1- and 2- family dwelling El Commercial /industrial I"T" Accessory building amps for all other installations. buildings.
IS Multi- family ❑ Master builder a] Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LO�pT10N ❑ Emergency system. larger separately derived system.
P'' ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
I I 100HP or more. occupancy.
Job no.: Job site address: 9850 SW Mckep *ie
r ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard Oregon 97223 I I. ❑ Health -care facilities. 0 Supply voltage for more than
f I ❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project mime: i j ❑ Service or feeder 600 amps or more.
r FEE SCHEDULE
Cross street /directions to job site: : j Description 1 otv. I Fee, I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: ! I? Lot no.: 1,000 sq. ft. or less 168.54 4
!' I, Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no,: 1 energy, residential
Limited ener 75.00 2
DESCRIPTION OF WORK T , (with above sq. ft)
Limited energy, multi - family
up grade electrical panel unit ,I, residential (with above sq. ft.) 75.00 2
# 6 ( Services or feeders installation, alteration, and/or relocation
200 amps or less I 100.70 100.70 2
® PROPERTY OWNER ' ❑ TENANT 201 amps to 400 amps 133.56 2
T 'r+ 401 amps to 600 amps 200.34 2
Name: Eric Rabosky Town House Propertties 601 amps to 1,000 amps 301.04 2
Address: 13325 SW Clear View Way (i Over 1,000 amps or volts 552.26 2
f IT I Temporary services or feeders installation, alteration, and /or
City/State /ZIP: Tigard Oregon 97223 11. relocation
(r 200 amps or less 59.36 I
Phone: (503)314 Fax: ( ! , ; 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property rty that 1 own which is not 401 amps to 599 amps 168,54 2 ,
intended for sale, lease, rent, or exchange, according to ORO 447, 449, 670, and 701. Branch circuits - new, alteration, or extension, per panel
Owner signature: Ili Date: A. Fee for brunch circuits with
above service or feeder fee,
7.42 2
❑ APPLICANT , ❑ ONTACI' PERSON each branch circuit
� I , B. Fee for branch circuits without
Business name: service or feeder fee, first
it 56.18 2
r1' branch circuit
Contact name:
F1 Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
-j ri
Each manufactured or modular 67.84 2
City/State /ZIP: dwelling, service and/or feeder
j ' M * Reconnect only 67.84 2
Phone: ( ) Fax: • ( j I Pump or irrigation circle 67.84 2
in
E -mail: 1 , Sign or outline lighting 67.84 2
— CONTRACTOR 1 Signal circuit(s) or limited- energy
panel, alteration, or extension. Page 2 2
Business name: D &L ELECTRIC INC. [I' Each additional inspection over allowable in any of the above
Additional inspection (I hr min) 66.25/ hr
Address: PO BOX 367 , Investigation (I hr min) 66.25/ hr Li
City/ State/ZIP: WEST LINN OREGON 97068 1 1 Industrial plant (I hr min) 78.18/ hr
-1 Inspections for which no fee is 90.00 / hr
Phone: (503) 656 - 5623 Fax: (503) f s$ 0 - 1918 specifically listed (54 hr min)
If ELECTRICAL PERMIT FEES
CCB Lie.: 88069 , mjy Electrical Lic.: 3 - 161C (I Suprv. Li e.: 2662S Subtotal: 100.70
Suprv. Electrician signature, required: �� f f r 1 01t '� Plan review (25% of permit fee):
State surcharge (12% of permit fee): 12.84
Print name: DONALD H LETTENMAIER 1 Date: 01 - 11 - 2011
TOTAL PERMIT FEE: 112.78
Authorized signature: I. This permit application expires If a permit is not obtained within 180
F 1: days after it has been accepted as complete.
Print name: ( Date • Number of inspections allowed per permit.
I I