Permit CITY OF TIGARD ELECTRICAL PERMIT
' 2 ' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00206
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/04/2011
Parcel: 2S101 CA00400
Jurisdiction:
Site address: 7940 SW HUNZIKER RD
Project: Charter Mechanical Subdivision: Lot:
Project Description: TI
Contractor: CAPITOL ELECTRIC CO INC Owner: GOULD FAMILY PROPERTIES VI
11401 NE MARX STREET 105 PINE ST
PORTLAND, OR 97220 IMPERIAL, PA 15126
PHONE: 503 - 255 -9488 PHONE: 704- 519 6130
FAX: 503 - 257 -7121
FEES
Quantity Description Date Amount
6 ea Services or Feeders - 200 05/04/2011 $604.20
Specifics: amps or less
1 ea Services or Feeders - 201 to 05/04/2011 $133.56
Type of Use: COM 400 amps
Class of Work: ALT 72 crt Branch Circuits w /Purchase 05/04/2011 $534.24
Service or Feeder
Type of Const: 2 ea Signal circuit or Limited 05/04/2011 $150.00
Occupancy Grp: Energy Panel
1 ea Plan Review Electricial 05/04/2011 $355.50
1 ea 12% State Surcharge - 05/04/2011 $170.64
Electrical
Total $1,948.14
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 rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: •1 �i �lJ�h 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: S 9 1
LICENSE NO. - ' G 5 S
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.
Electrical Permit Application FOR OFFICE USE ONLY
� Received
City of Tigard ) Date /By: /0 / Q,..Permit no. �� i �u _��
't. 13125 SW Hall Blvd., Tigard, OR 972 Plan Review r %�� J Ll
a Phone: 503.639.4171 Fax: 503.59 r� % . Date /By: b • 3* 1 i V L. Other Permit: d� „ _ I,t�oc l
T I G A R D Inspection Line: -503.639.4175 ` O `' Date Ready /By: J �it uris: S ee Page 2 for
Internet: www.tigard- or.gov O ry /��Lr -r' / .e
� ti � 5� Notified /Method */ ii off / f Supplemental Information
TYPE ', }RI ; ? PLAN REVIEW
- Li New construction ❑ Addition /alteration/replacemet6 �\ Please check all that apply (submit 2 sets of plans w /items checked below)
❑ Demolition E] Other: y\ Service or feeder 400 amps or more ❑Building over three stories
CATEGORY OF CONSTRUCTION ,' where the available fault current ❑ Marinas and boatyards
Li I- and 2- family dwelling U Commercial /industrial ❑ Accessory building exceeds 10,000 amps at 150 volts or Floating buildings
❑ Multi - family ❑ Master Builder ❑ Other less to ground, or exceeds 14,000 Commercial -use agricultural
JOB SITEINFORIMIATIONANDLOCATION amps for all other installations. ❑ buildings
Job no.: 110531 Job site address: >4W Hunziker Road
LI Fire Pump Installation of 75 KVA or
❑ Emergency system larger separately derived system.
City/State /ZIP: Tigard, OR El Addition of new motor load of El "A", "E", "1 -2 ", "1 -3 ",
100HP or more ❑occupancy
Suite /bldg. /apt. no.: Project name: Charter Mechanical TI ❑Six or more residential units ❑ Recreational vehicle parks.
❑ Health -care facilities ❑ Supply voltage for more than
Cross Street /Directions to job site: ❑Hazardous locations ❑ 600 volts nominal.
❑ Service or feeder 600 amps or more
s , , _ ., r ' :," ? , ., � �S�DLILE ° ._ .
Subdivision: Lot no.:
Descriptio ., I Qty. I Fee. I Total
Tax map /parcel no.: New residential - single or multi - family dwelling unit.
�I . DES TI.TI(N OFi WORifi v t , , , -.r, ? , .° ' Includes attached garage.
1000 sq. ft. or less $ 168.54 4
i Ea. Add' 500 sq. ft or portion $ 33.92 I
LI , :3PP2(PER.TY OWNER ; ',I t I ;.; t 'i - ❑, TENANT' , 0 Limited energy residential
Name: (with above sq. ft.) $ 75.00 2
Limited energy, multi - family
residential (with above sq. ft.) $ 75.00 2
Address:
Service or feeders installation, alteration, and /or relocation
200 amps or less 6 $ 100.70 604.20 2
City/State /ZIP:
201 amps to 400 amps 1 $ 133.56 133.56
401 amps to 600 amps $ 200.34 2
Phone: Fax:
601 amps to 1000 amps $ 301.04 2
Owner installation: This installation is being made on property that I own which is not Over 1000 amps or volts $ 552.26 2
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701 Temporary services or feeders installation, alteration, and /or
Owner signature: Date: relocation
200 amps or less $ 59.36 I
L `APPLICANT e! �' . 't . ' 11 . : CONTACT PERSON 201 amps to 400 amps $ 125.08 2
Business Name: 401 amps to 599 amps $ 168.54 2
Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
Contact name:
service or feeder fee, each
branch circuit 72 $ 7.42 534.24 2
Address:
B. Fee for branch circuits
City /State /ZIP: without service or feeder fee,
first branch circuit $ 56.18 2
Each additional branch circuit: $ 7.42 2
Phone: Fax:
Miscellaneous (service or feeder not included)
E -mail: Each manufactured or modular
s -CO ITRACTOR dwelling, service and or feeder $ 67.84 2
Business Name: CAPITOL ELECTRIC CO., INC. Reconnect only $ 67.84 2
Pump or irrigation circle $ 67.84 2
Contact name: Sign or outline lighting $ 67.84 2
Signal circuit(s) or limited -
Address: 11401 NE MARX ST. energy panel, alterations, or
extension. Describe: hvac control 2 $ 75.00 150.00 2
City /State /ZIP: PORTLAND, OR 97220 -1041 voice /data Page 2
Each additional inspection over allowable in any of the above
Phone: 503 - 255 -9488 Fax: 503 - 257 -7121 Per inspection $ 66.25
Investigation per hour (1 hr min) $ 66.25
CCB Lie.: 48748 Electrical Lie.: 26-496C . L 2865- Industrial plant per hour $ 78.18
Suprv. Electrician signature, required: ELECTRICAL PERMIT FEES°
Subtotal $ 1,422.00
Print Name: Richard Martin Date: 04/20/11,-- Plan review (25% of permit fee) $ 355.50
Authorized signature: State surcharge ( 12% of permit fee) $ 170.64
TOTAL PERMIT FEE $ 1,948.14
Print Name: Richard Martin This permit application expires if a permit is not obtained within 150
5 days after it has been accepted as complete.
* Number of inspections per permit allowed.
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systesm combined $ 75.00
Check Type of work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial sytem $ 75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
• Data Telecommunication installation
❑ Fire Alarm Installation
• HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 2
*No licenses are required. Licenses are required
for all other installations
CAPITOL 1 r
ELECTRIC CO., INC. RECEIVED
11401 NE MARX ST. APP
PORTLAND, OR 97220 -1041 2011
(503) 255 -9488 FAX 257 -7121 ���� CITY OF � TIGARD
SEE
LETTER OF TRANSMITTAL
DATE: 4/20/2011
TO: City of Tigard
ADDRESS: 13125 SW Hall Blvd.
Tigard, OR. 97223
ATTENTION: Permit Specialist
PROJECT NAME: Charter Mechanical TI
ATTACHED: BID
PROPOSAL
SUBMITTALS
CHANGE ORDER
SPECIFICATIONS
LETTER
x SHOP DRAWINGS
COMPACT DISK
OTHER
NUMBER OF COPIES: DESCRIPTION:
2 -sets Electrical Plans
1 Permit application
1 Fee check
FOR YOUR USE
FOR YOUR REVIEW
x FOR APPROVAL
REMARKS
SIGNED RICHARD MARTIN 971 - 506 -3711 cell
MAILED
x DELIVERED RECEIVED BY:
FAXED DATE:
05/19/2011 09:29 5032577121 CAPITOL ELECTRIC PAGE 02/03
Request to Energize an Electrical Installation
-
1 Jurisdiction address: // 3
64'73
.
Name of supervising electrician: l ei 4420 l e i t i } (2.r 0 Date of request: S I 1 2O
Supervising electrician's license number: 2665 --5 Date installation was completed: 5 pet Zell
Electrical permit no.: et 20 it -cb 201a If a temporary permit is posted at the job site, please include a copy of it with this form.
V MP " EbE Rr ►L"AVONTW#CTTR " rl+i�I"
Name of electrical contractor: am - 14..) g(•.Ltf+PC4 Co yn c License no.: 26- 4c1, C
Business address: 1)d 0) Allf ,Q.`f •S7•
Cit p4id lKia1 state:
� 6 , . ZiP: Q2t2a
Phone: 9b3 - Q* ^ Fax: -26'7 71,ZJ &mail: ,['ICyu i
R r r
Customer's name: CJ4 ,Q.7 be. 41-e,A . tf
Customer's address: '7 556 .SCJ /Jun-24A, 4_ Jeri _
City: ,4iz,o State: 4t ZIP:
Address of installation if different than customer's address: j,0/3'1.< --
City: State: ZIP:
i;>�rrr;rrr . ra.ffiarrrr�
Authority having jurisdiction to inspect: 6A O Phone: Sa3 -708 - 24
Address: 1 12S 5 W 14 ALL t! U Q
City: 4,04,,0 State: ( ZIP: 9722,3
_� ; °.:'r'- --, � � r
(! � r ryn.:�1': i y�y�,q� j �p.4 j w 'S�;f %,
y ' JY f ..� �'y�Pr . i ,v ;; i6l 1110, � C T I " L�"�: , �Yfr�' +,. ' Rt'IYIGM�f . 1., V , ; n `'p 1� %
Name of electric utility receiving request: pC E Phone: V3 » $ C!
Address:
City: State: ZiP:
er
A. Restoring electrical service that was interrupted or disconnected because of either a:
VI Service change or E Uncontrollable event, such as fire, flood, or severe weather;
or /
B. Electrical service at a remote location needs to be: @//1Cue7"/ A'f �
` Ijd
❑ Initialized J Restored 47 MOP— $
Supervising electrician Electrical contractor
Please note — After sending this form to the electric Please note — By close of business on the first business
utility named above, you must send a copy of this form to: day, following energizing of a completed installation in
(1) the electrical contractor, (2) the customer, and (3) the response to the above request, you must: (1) notify the
inspecting autho it . authority having jurisdiction that the installation has been
'5�f0 energized, and (2) request that the authority inspect the
completed installation.
Supervising electrician's signature Drate
12 FA"
440 - 0948 -COM (9 /08 /COM
05/19/2011 09:29 5032577121 CAPITOL ELECTRIC PAGE 01/03
FAX COVER SHEET
Capitol
Electric Co., Inc. Date: 5/19/2011
11401 NE Marx St.
Portland, Oregon 97220 -1041 Time: 9 :25 AM
(503) 255-9488 FAX 503 - 257 -7121
www.ca ltt oleleC tf cc corn
Please deliver the following pages to:
Name: City of Tigard
Firm:
From: Richard Martin
Comments:
Re: Permit # ELC -2011 00206 79 SVV Hv Nz I KE t2 'RP
We have request a PFE shutdown at this adderss to install 480v breakers at MDP -1
TOTAL NUMBER OF PAGES, INCLUDING COVER SHEET 3
IF YOU DO NOT RECEIVE ALL PAGES, PLEASE CALL (503) 255-9488