Permit CITY OF TIGARD ELECTRICAL PERMIT
- COMMUNITY DEVELOPMENT Permit #: ELC2011 -00095
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/16/2011
Parcel: 2S102BD00702
Jurisdiction: Tigard
Site address: 9850 SW MCKENZIE ST 3
Project: MCKENZIE STREET TOWNHOMES Subdivision: Lot: 0
Project Description: Panel upgrade.
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 02/16/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 02/16/2011 $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 •52-001-0090. . -.0 in a y of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
41 Issued By: - Permittee Signature: I_i�_ — I`i
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.
l .�
Electrical Permit Application iv, atilt t,► ► I I. `I i,�,rl
�'sm " � Rcrxived r Permit No,: �-
City of Tigard II n D : I , ;� • / _ r A M.
• 13125 SW Hall BIVd., Tigard, OR 97229 Plan Review
r B 2011
i i Othe Permit:
t Ili
Phone: 503.718.2439 Fax: 503.598.1960 Date/B
i °t t, t; n Inspection Line: 503.639.4175 Date Ready/By: i l 7uci fa See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGA RD Notified/Method: : re, Supplemental Information
TYPE oa Wbi kI' .` DiVIblUI'4 : . PLAN REVIEW
Please check all that apply (submit 1 sets of plans w /items checked below):
❑ New construction ®Addition alteration /replacement
'
❑ Service or feeder 400 amps or mum ❑ Building over three stories.
❑ Demolition ❑ Other: f where the available fault current ❑ Marinas and boatyards,
CATEGORY OF CONSTRUCTION ` exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
I less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building f amps for all other installations. buildings.
® Multi - family ❑ Master builder ❑ Other: i ❑ Fire pump. ❑ Installation of 75 KVA or
I 0 Emergency Addition of "A", separately system.
JOB SITE INFORMATION AND LOCATION
C ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: Job site address: 9850 SW Mckenzie or more. occupancy.
❑ Six x o or r more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard Ore on 97223 1 k ❑ Health -care facilities. ❑ Supply voltage for more than
y g g I 0 Hazardous locations. 600 volts nominal,
Suite/bldg. /apt. no.: '' Project name: if; ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: r!: Da rrlpu•n I Qtr. I Pee I mow I •
j - New residential single- or multi - family dwelling unit.
',1•,) Includes attached garage.
Subdivision: Lot no.: xi 1,000 sq. ft. or less 168.54 4
.
. r. Ea. add'I 500 sq. It. or portion 33.92 1
Tax map /parcel no.: ,. Limited energy, residential
DESCRIPTION OF WORK i I' (with above sq. 75.00 2
u rade electrica{ a nel unit '� a
Limited energy multi- family 75.00 2
P g P residential (with above sq. ft.)
# 3 and I Services or feeders Installation t terati n al, and/or rel lion
- fi g „_ __ ° iJ j 200 amps or less 100.70 I 2
® PROPERTY OWNER ❑TENANT
I; 2 ps to 400 amps 133.56 2
•.! 401 am to 600 amps 200.34' 2
Name: Eric Rabosky Town House Propertt -" 0, ��p�( iv.Je),I � k 601 tun to 1,000 amps 301.04 2
Address: 13325 SW Clear View Way ( g r u• A(U .4 ,i - ' f� 11 # Over I, amps or volts 552.26 2
/ io
t ( If Te °nary services or feeders installation, alteration, and /or
City /State /ZIP: Tigard Oregon 97223 \, PI 17p , '-1'
I. :1,, °cation
�v 200 amps or less 59.36 I
Phone: (503)314 - 3163 \ Fax: ( ) /------ I � 201 amps to 400 amps 125.08 2
Owner installation: This installation is beinglnadg °`property that 1 0. which is not ` 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 4"47 ` - 449, 670, and 701. Ii Branch circuits— new, alteration, or extension, per panel
Owner signature: Date: i 1 A. Fee for branch circuits with
above service or feeder fee, 7.42 2
❑ APPLICANT ❑ CONTACT PERSON 1 i each branch circuit
'' B. Fee for branch circuits without
Business name: j ` service or feeder tee, first
i, branch circuit 56.18 2
Contact name: i
j ' Each add'I branch circuit 7.42 2
Address: i i Miscellaneous (service or feeder not included)
Each manufactured or modular
City /Stale /ZIP: I dwelling, service and/or feeder 67.84 2
j Reconnect only 67.84 2
Phone: ( ) Fax: ( ) ,, Pump or irrigation circle 67.84 2
E - mail: t ! Sign or outline lighting 67.84 2
CONTRACTOR I j . Signal circuit(a) or limited - energy
Business name: D &L ELECTRIC INC. ' j panel, alteration, or extension. Page 2 2
;: Each additional inspection over allowable in any of the above
Address: PO BOX 367 :I Additional inspection (1 hr min) 66.25/ hr
i. Investigation (I hr min) 6625/ hr
City /State/ZIP: WEST LINN OREGON 97068 I I n d ustrial plant (I hr min) - 78.18/ hr
Phone: (503) 656 - 5623 Fax: (503) 650 - 1918 t; . s" Inspections for which ° m a 90.00 / hr pecifically
CCB Lie.: 88069 Electrical Lie.: 3 -161C Suprv. Lie.: 2662S u
H ELECTRICAL PERMIT FEES
Suprv. Electrician signature, r uired: } a Subtotal: - ;(,00..70 Su
P g e9 f i Plan review (25% /v of permit fee):
Print name: DONALD H LETTENMAIER Date; 02 - - 2011 State surcharge (12% of permit fee): 17 b2 , v e
i TOTAL PERMIT FEE:
Authorized signature: I ! 1 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: I Date: . I • Number of inspections allowed per permit.
1
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