Permit •'
II i CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009-00128
T(GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/18/2009
Parcel: 2S115AA00100
Jurisdiction: Tigard
Site address: 16100 SW 108TH AVE 173
Subdivision: DURHAM PARK APARTMENTS Lot: 36
Project: Brightwaters
Project Description: New light pole.
Owner: FEES
DHP TERRACE LLC & Quantity Description Date Amount
DHP ANNEX LLC, BY AKAWIE & LAPIETRA PC, 1 crt Branch Circuits 03/18/2009 $46.85
13 HERON DR wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 03/18/2009 $5.62
Contractor: Electrical
SQUIRES ELECTRIC
PO BOX 16851
PORTLAND, OR 97292
PHONE: 503 - 252 -1609
FAX: 503 - 253 -5831
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $52.47
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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
■ • Ap p By: 1; IRS- IRS-
� � Permittee Signature: �� p ` `"c , e\
OWNER INSTALLATION ONLY r
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'N Date:
LICENSE NO. .
Call 503.639.4175 by 7:00 a.m. for an Inspection that business day.
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.
I
00./17.42009 13:21 5032535831 SQUIRES ELECTRIC #1525 P 002/002
Electrical Permit Application FOR OFFICE IJSb: ()NIA'
City of 'Tigard In
F IV F Received ,
2
I L3125 SW Hall Blvd., 'Tigard, Datc/BY: `) ' ( • �rI •
r
Beard, O 9 Plan Review
Phone: 503.639.4171 Fax: 503.595. }24c 'Z009 B T Other Permit:
T1C, .i.K )
Inspection Line: 503.639.4175 M AK 1 / r 7 Date RcadyBy: Ins: H See Page 2 (or
Internet: www.tigard Notified/Method: C, St pplrmrnwl information
I=1 Ncw construction ! i Addition/ :• ` : R rep *cement Please check all that apply (submit 2 sets of plans w /items checked below):
Demolition O Service or feeder 400 am ps or more Building over three stories.
where a available fault current 0 Marinas and boatyards. • i
•
. :. . , i- exceeds 1 0,000 at 150 vo1Lti or rloatin m i,1 t j "'a, w . s 'Fi.',:; Y .y., c, ;nn 1555 to grcArriti, or exceeds 14,010
❑ Comtteereial -use agricultural
Q 1- and 2- family dwelling 0 Commercial /industrial ❑ Accessory building amps for all other installations. build' op.
QMulti- family ❑Masterbuildcr ❑ Other: D!tire O installation of75KVAor `
, l'y • r' ❑ Emergency sYStcm, larger separately derived system.
+.4 ?..:p: , #. 1 ? :I �_-._"_AT�,' f' wl - . _ . . • •-•,..;,-... :. _ ¢CPtr ... ' .:, El Addition of new motor load o ❑ " " « 1 _ 2 . " - > »
Job no.; Job Bit a ddrss: /pp /� l�Y or more. occupancy.
�
•
� • ❑ Sir or more roicigolial unit*. ❑ Recreational vehicle pinks.
City/State/ZIP: — �`/t/0,�r D ❑ h ealth -care facilities. • ❑ Supply voltage for'morc than
I { �../ (110 volt* nominal,
�� ❑liazardouslocaeo '
-
Suite/bldg./apt. no.: Project name: ,. 4 AOCt�P/Y -g ice or fordci Goo amps to mom. ;
.,i
Cross streeVdirections to job site: o et .. tioti
I ohs I Fee. 1 Total 1
New residential single- or multi - family dwelling unit.
Includes attached garage-
~ Subdivision: Lot no.: 1,000 sq. it or less 145.15 4
Ea. add'! 500 sq. It or portion 33.40 1
Tout map/parcel no.: Limited energy, residential 75.00 2
>. ... • > 44.•.•> 1 tifSCRIP'TitQPI' - 'R'.OIt?Iti:: : ., h .. . °:..,,f (with above sq. R.)
�,;� t Limited energy, multi family 75.00 2
l: Lt /5 t re e.. residential (with above sq. ft.)
Services or feeder` installation, alteration, and/or relocation
200 amps or less 80.30 2
.. •`'<':C iii O M E>t `� 1 - ' '" '' : . ti ...* 4 . , k 201 amps to 400 amps 106.85 2 • Name; 401 amps to 600 amps _ 160.60 , 2
— 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/Stale/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less I 66.85 1
Owner installation: This installatiuo. is being made on property thtrl 1 own which is not 201 amp to 400 amps 100.30 2
intended for sale, leas , .., rent, or exchange, according to ORS 447, 449, 670, and 701, 401 amps to 599 amps I 133.75 2
Owner signature: Date: Branch circuits— new, alteration, or extension, per panel
A. Fox for branch circuits with
- -0. APPiLIC4NT , i' .. ,.4.•,.. ; . a r4CI': above service or feeder fee,
6.65 2
each branch circuit
Business name: Fr. Fee for branch circuits ./
Contact name: �.^ _ x. without service or feeder fee, 1 !a
first branch circuit • 46 2
Address: F.ach add'I branch circuit 6.65 2
— Miscclianeou V(se vice or feeder not included)
City /Statc/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66 :85. 2
E - mail: y
Pump or irrigation circle 53,40 I 2
:'•",•'. , ,.w,a : -' .:.r ° �. z::;;..° ;t ••? .ge.."G" ,a .... ,..... _- ... ., .. Sign or i outline lighlin 53A0 2
1311Sincss name: t f e - e circuit(s)or limited-
-•(.t r Ldp Eklrtr e!.. energy panel, alteration, or
Adart,ss:
7Tb flax k t / extension. Describe: Page 2 2 ..
C:ity /State /ZIP: #• / lt..,'4 p r 97t 9.). Each additional inspection over allowable in any of the above
Per inspection I 62,50
Phone: j` c 5,,l_ -- / 6 4 9 Tax: ( ) - � e / investigation per hour (1 hr min) I 62 :50
CC13 Lic.:1,3 So 0 Electrical Lie.J 1/6/6 Suprv. Lie.: d../4 i p l 73,75 1
Suprv. Electrician signature, requi Subtotal:
Print name Lt./ re.,.. e Dater /7 D 9 Plan review (25% of permit fee):
State surcharge (12'!4, of permit fcc): , ,
Authorized signature: _ TOTAL PERMIT FEE: 5� . -7_
This permit application expires if a permit is not obtained within 180
Print name: Date: days u ner it Itas bean accepted 23 r:ompl 14
I
• Number of inspections allowed per permit. .
I: V3uil, iaa1Pc.rnre1F.1£- PerrnitApp.doc 05/23/05 440.46151'(11/05/cOM/1VEll