Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00251
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/12/2011
Parcel: 2S102BD00702
Jurisdiction: Tigard
Site address: 9850 SW MCKENZIE ST 5
Project: McKenzie Street Townhomes Subdivision:RTH TIGARDVILLE ADDITION, AMENC Lot: 7
Project Description: Upgrade electrical panel.
Contractor: D & L ELECTRIC INC Owner: MCKENZIE STREET TOWNHOMES LLC
PO BOX 367 BY ERIC RABOSKY
WEST LINN, OR 97068 13325 SW CLEARVIEW WAY
TIGARD, OR 97223
PHONE: 503 - 314 -3163
HONE: 503 - 656 -5623
FAX: 503 - 650 -1918
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 05/12/2011 $100.70
Specifics:_ amps or less
1 ea 12% State Surcharge - 05/12/2011 $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. ATTENTIO C law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 t ugh OAR 952-001- i9•. ou may obtain a .py of the rules or direct questions to OUNC by callin. . 32.1987 or 1.800.332. 344.
Issued By: _ / • L ? Permittee Signature: P� 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 INST • LATION ONLY
SIGNATURE OF SUPR. ELEC' / - /paw ( Date:
or
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.
MAY -13 -2011 10:12A FROM:D &L ELECTRIC INC 5036501918 TO:5035981960 P.2
I
Electrical Permit Application ; .10R 011 It I 1 SI l.t \t 1
City of Tigard RECEIVED p d �j ��� Permit No.: -J�E- / / i�
O 13125 SW Hall Blvd., Tigard, OR 97223 `1 Plan Review
• I Phone: 503.718.2439 Fax: 503.598.1960MAY i Date/B : Other Permit:
Inspection Line: 503.639.4175 ; 2 2011 Date Ready/By: Atria: ta See Page 2 for
I I t';\ R I� p
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
CITY OIV'D PLAN REVIEW
TYPE OF kie 4._ • .. - It
❑ New construction 0 Addition /altcration/rcplac tTterit Please check all that apply (submit 2 sets of plans w /items checked below):
['Service or feeder 400 amps or more ❑ Building over three stones.
❑ Demolition ❑ Other: „ where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCT{ exceeds 10,000 amps at 150 volts or ❑ Floating buildings,
less to ground, ur 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 I: Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LO 1 • TION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 9850 SW Mckenl e #5 unit 1001W or mare. occupancy.
1; ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard Oregon 97223 ❑ Health -cure facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt no.: Project name: I ['Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: •; nncdptlaa 1 oar. I Fee. I Total I •
f New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: ` k Lot no.: 1,000 sq. ft. or less 168,54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: 1 ' Limited energy, residential
75.00 2
DESCRIPTION OF WORK )? (with above sq. It) ,
Limited energy, multi - family 75.00 2
up grade electrical panel unit residential (with above sq. ft.)
#5 unit 4 Services or feeders Installation, alteration, and/or relocation
200 amps or less I 100.70 100.70 2
• T 201 amps to 400 amps 133.56 2
® PROPERTY OWNER I ❑ TENANT
401 amps to 600 amps 200,34 2
Name: Eric Rabosky Town House Propertties :1 601 amps to 1,000 amps 301.04 2
Address: 13325 SW Clear View Way [1 Over 1,000 amps or volts 552.26 2
�y Temporary services or feeders installation, alteration, and /or
City/State /ZIP: Tigard Oregon 97223 , relocation
+ 200 amps or less 59.36 I
Phone: (503)314 I Fax: ( 201 amps to 400 amps 125,08 2
Owner installation: This installation is being made on pro ., t that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to OR ' j 47, 449, 670, and 701. Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
above service or feeder fee, 7 42 2
❑ APPLICANT ❑ ONTACT PERSON each branch circuit
B. Fee for branch circuits without
Business nitrite: service or feeder fee, first
branch circuit 56.18 2
Contact name: .
add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
-,:.1 Each manufactured or modular 67.84 2
City /State /ZIP: dwelling, service and/or feeder
I' 1 Reconnect only 67.84 2
Phone: ( ) I Fax: : ( Pump or irrigation circle 67.84 2
E -mail: Signor outline lighting 67.84 2
CONTRACTOR " Signal circuit(s) or limited- energy
•. , panel, alteration, or extension. Page 2 2
Business name: D &L ELECTRIC INC. j Each additional inspection over allowable in any of the above
I Additional inspection (I hr min) 66.25/ hr
Address: PO BOX 367 y Investigation (I hr min) 66.25/ hr
City /State/ZIP: WEST LINN OREGON 97068 I • Industrial plant (1 hr min) 78.18 / hr .
F ax: ( 503) 0 -1918 Inspections for which no fee is 90.00 / hr
Phone: (503) b56 5523 specifically listed (%3 hr min)
CCB Lie.: 88069 Electrical Lie.: 3 -16 IC f l Suprv. Lie.: 2662S ELECTRICAL PERMIT FEES
L Subtotal: 100.70
,,
Suprv. Electrician signature, required: , I Plan review (25% of permit fee):
+ Stale surcharge (12% of permit fee): 12.08
Print name: DONALD H LEI"1'ENMAI ER i Date: 05-12-2011 TOTAL PERMIT FEE: 112.78
Authorized signature:� /J/' .6��� T his permit application expires if a permit is not obtained within 180 t
'ti days after it has been accepted as complete.
Print name: Date: S` / Za /l ' Number of inspections allowed per permit.
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