Permit CITY OF TIGARD ELECTRICAL PERMIT
1111
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00096
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 4
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 O:' 952 -001 -0090. You ma • • - • - copy o or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �� 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.
FEB -17 -2011 07:19A FROM:D &L ELECTRIC INC 5 6501918 T0: 5035981960 P.
Electrical Permit A plicatioa c: tt S i,
City of Tia l i Z Received " Permit No.: :41.4 � t
I P/
c eR,, _ gate' : •
• 13125 SW Hall g Blvd. , Tigard, OR 97223 `•` v1r )plan Review
Phone: 503.718.2439 Fax: 503.598.1960 c :: �� w�CJ� Da : Other Permit:
I I r ,41.'11 Inspection Line: 503.639.4175 , , . o Q` Date Ready/By: try See Page 2 for
Internet: www.tigard or.gov tv \� :� ∎� Notified/Method: Supplemental Information
TYPE OF WORK �).y PLAN REVIEW
❑ New construction ® Addition /alteration /repl4ment 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:
y where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCT ON 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 1 (r] Accessory building amps for all other installations buildings.
® Multi- family ❑ Master builder Q Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND L ATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "0", "1 -2 ", "1 -3 ",
Job no.: Job site address: 9850 SW Mck !' zie 100HP or more. occupancy.
r ❑ Six or more residential units. 0 Recreational vehicle parks.
City/State /ZIP: Tigard Oregon 97223 i ' 1 ❑ Health -care facilities. ❑ Supply voltage for more than
1 ;'
l i'i ❑ Hazardous locations. 600 volts nominal.
&lite/bldg. /apt. no.: 1 ' Project name: I ' ❑ Service or feeder 600 amps or more.
H FEE SCHEDULE
Cross street/directions to job site: j i Description I Qty. I Fee
I Total I •
Hn New residential single- or multi - family dwelling unit.
i : Includes attached garage.
is g g.
(?' 1,000 ft. or less 168.54
Subdivision: 11.1 Lotno.: sq. , 4
f; , Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: ; _ Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft)
rti Limited energy, multi - family
up grade electrical panel unit 111 residential (with above sq. ft.) 75.00 2
ti 4 unit 111 Services or feeders installation, alteration, and/or relocation
J 200 amps or less — 1 100.70 100.70 2
® PROPERTY OWNER I� I ❑ TENANT
201 amps to 400 amps 133.56 2
{ 401 amps to 600 amps 200.34 2
Name: Eric Rabosky Town House Propertties I !
t , 601 amps to 1,000 amps 301.04 2
Address: 13325 SW Clear View Way i I f Over 1,000 amps or volts 552.26 2
i Temporary services or feeders installation, alteration, and /or
City/State/ZIP: Tigard Oregon 97223 relocation
r ______f Phone: (503)314 -3163 Fax: ( 200 amps or less 59.36 I
201 amps to 400 amps 125,08 2
Owner installation: This installation is being made on pr that 1 own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to OR 447, 449, 670, and 701. Branch circuits - new, alteration, or extension, per panel
I
Owner signature: f Date: A. Fee for branch circuits with
above service or feeder fee, 7 42 2
❑ APPLICANT ❑ (CONTACT PERSON each branch circuit
13. Fee for branch circuits without
Business name: i I service or feeder fee, first
1 brunch circuit 56.18 2
Contact name: I1•
it; Each add'I branch circuit 7.42 2
Address: 11 Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State /ZIP: 11 dwelling, service and/or feeder 67,84 2
it Reconnect only 67.84 2
Phone: ( ) Fes' ( 11 ,)
I I„ ' Pump or irrigation circle 67.84 2
E - mail: j I, Sign or outline lighting 67.84 2
CONTRACTOR f1 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
r Additional inspection (1 hr min) 66.25/ hr
Address: PO BOX 367
Investigation (I hr min) 66.25/ hr
City / State/ZIP: WEST LINN OREGON 97068 I I Industrial plant (1 hr min) 78,18/ hr
ii (503) 656 -5623 Fax: ( ) 650 -1918 specifically for which no fee is
Phone: 90.00/ hr
( ) F 503 fically listed ('h hr min) _
CCB Lie.: 88069 Electrical Lie.: 3 - 161C 11 Suprv. Lic.: 2662S ELECTRICAL PERMTI FEES
1 Subtotal: 100.70
Suprv. Electrician signature, required: Plan review (25% of permit fee):
. I State surcharge (12% of permit fee): 12.08
Print name: DONALD H LE'ITENMAIER j, Date: 02 - 14 - 2011 -
1 I TOTAL PERMIT FEE: 112.78
Authorized signature: I This permit application expires if a permit is not obtained within 180
daya after It has been accepted as complete.
Print name: i Date: • Number of inspections allowed per permit.
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