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Permit CITY OF TIGARD ELECTRICAL PERMIT " 8 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00163 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/30/2011 Parcel: 25101 BC00100 Jurisdiction: Tigard Site address: 8185 SW HUNZIKER RD A Project: Knez Subdivision: Lot: 0 Project Description: (2) branch circuits for power supply. Contractor: MILESTONE ELECTRIC Owner: KNEZ, JOHN S SR & JEANNE M 1281 NE 25TH AVE, STE. T 12301 SW HWY 212 HILLSBORO, OR 97124 CLACKAMAS, OR 97015 PHONE: 503 - 645 -5323 PHONE: FAX: 503 - 690 -4843 FEES Quantity Description Date Amount 2 crt Branch Circuits wo /Purchase 03/30/2011 $63.60 Specifics: Service or Feeder 1 ea 12% State Surcharge - 03/30/2011 $7.63 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $71.23 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 it 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 R 952- 001 -0090. Y. - - _ .= py of then s or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. V Issued By: _ t Permittee Signature: t _ 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. Mar. 30. 2011 7:16AM Milestone Electric No. 9428 P. 2 Electrical Permit Application ., .. uYll2 tlFI :I('F. 1'SF f) \\I.v City of Tigard ' 12pcsiveed 'ATM= Pe rmitNo' : a natflB : LG' a //— 13125 SW Hall Blvd., Tigard, OR 97223. Plan Review 111 a Phone: 503.639.4171 Fax; 503,598,19 .. ® e \ DateBy: Other Permit: R Inspection Line: 503.639.4175 r r i.� Date Ready/By: luris: RI Sec Page 2 for T f t rA D Internet; www.tigard- or.gov `A P� ` 7 Notifud tvrethod �7 Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑Other: 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 ❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pomp. ❑ Installation of 75 KVA or J013 SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system, ❑ Addition of new motor load of ❑ "A ", "E ". "1 -2 ", "1 -3 ", Job no.: �) �j lob site address: + ©� //alit 100HP or more. occupancy. ! N /7 f 0 t 7 s I f - ✓ (] Six or more residential units, ❑ Recreational vehicle parks. City /State /ZIP: ---/ ! / ' ❑ Health -care facilities. ❑ Supply voltage for more than 1 / ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: Project name: k w e ,4J7 !};i , 1� ", s. p y ❑ Service or feeder 600 amps or more. Cross street/directions to job site: t^ , FEE SCHEDULE nt9criPtio° I OCT. l Fee, 1 Total rr New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 r 4 Ea, add' 500 sq, ft. or portion 33.92 1 Tax map /parcel no.: . Limited energy, residential 75.00 2 D ESCRIPTION OF WORK ( with above sq. ft.) ( - Limited energy, multi - family 75.00 2 ' "fin "V ` , ,,, , - 1 0,! �(j , residential (with above sq. ft. ) V Services or feeders installation, alteration, and /or relocation 200 amps or less 100,70 2 ❑ PROPERTY OWNER 0 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: ( ) I Fax: ( ) 200 amps or less 59,36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps T 125,08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168,54 2 Branch circuits - new, alteration, or extension, per_panel Owner signature: Date: A. Pee for branch circuits with ;: .. ; , ,. ; '0 ❑APPLICANT above service or feeder fee ❑ CONTACT PERSON each branch circuit 7.42 2 Business name: B. Fee for branch circuits without , - - — service or feeder fee, fast 56 / / $ 2 Contact name: branch circuit f r Each add'/ branch circuit ( , 7.42 '7 r 2.t 2 Address: Miscellaneous (service or feeder not Included) City /State/ZIP: Each manufactured or modular 67,84 2 dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only - 67.84 2 Pump or irrigation circle 67,84 2 E-mail: M-- ' r, A r CONTRACTOR'.;.:. Sign or outline lighting 67,84 2 u"n 3 41:, iw ' ; ,, f r }j7 ai , ;.,'u ,i t, Signal circuit(s) or limited- energy - Business name: / panel, alteration, or extension, Page 2 2 j` � �i E ac h a inspection over allowable in any of the abov Address: '' 8 i Al , c , ' . -. it ; e . ,� Additional inspection (1 hr min) - 66,25/ hr /.,( './45 p Investigation (1 hr min) 66,7.5/ hr City/State /ZIP: /' i t9 Yo O' 2 J 7� Industrial plant (1 hr min) 78,18/ hr Phone: ( %8 ) 64 S " 5'3 4 , Y ,a Fax: i ), 9D ` S71/3 inspections for which no fee 90.00 / hr specifically listed eh hr min) CCB Lie.: / . • U Electrical Lic.: 3(./ -. 4 z Suprv, Lic.; S 5 • ', ELECTRICAL PERMIT FEES Subtotal (,3 , (4, 0 Suprv, Electrician signature, require - Plan review (25% of permit fee): a - Print name: eaz C i ` a tat, Date: 3 U 6 / / State surcharge (12% of permit fee): 7, ( Authorized signature: TOTAL PERMIT FEE: 7/, Z.3 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. i:}BuildinoWrrmitalElt PsrmitAnn,tru: 07101/10 400.401 STY 1/0C /fAIM/w1717