Permit 1111 ' 1 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00252
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 4
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 - 656 -5623
PHONE: 503 - 314 -3163
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 $112.78
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in r ance -- w` approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. A ENTION Oregon 'law eqL' - you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 -0010 through OAR 952 '1-00; . Y.0 may obtain a copy of the rules or direct questions to OUNC by call ua 03.232.03.232.1987 or 1.800.332 344.
Issu d By: / ) Permittee Signatur•' ff
��° / "�.� ��V21i
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' �W Date:
1'
LICENSE NO.
Call 503.639.4175 by 7:00 a.m, for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
MAY -13 -2011 10:13A FROM: DEL ELECTRIC INC 5036501918 TO: 5121359919613 P.3
Electrical Permit ApplicationRECOVED 1 I I,l O \1,1
Cl of Tigard 1 Received ' � u Perm
Argi t Nc.: . ��
, M 131 SW Hall lvd., Tigard, OR 97223 1 lg 20 Dateln ' r
Plan Review Other Permit:
• Phone: 503.718.2439 Fax: 503.59$„ - I Date/B :
Inspection Line: 503.639.4175 B l 1 j j' OF TI 4 [ � Date Ready/By: Jura: WI See Page 2 for
1 I t ,,1 tt 1`i
Internet www.tigard-or.gov UI LD[N 11 nn Notified/Method: Supplemental Information
U /[
TYPE OF WORK I PLAN REVIEW
f^i Please check all that apply (submit 2 sets of plans w /items checked below):
• ❑New construction ® Addition /alteration /replac .t I ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCT14 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 [� I Accessory building amps for all other installations. buildings.
® Multi- family ❑ Master builder [,�1 Other: ❑ Fire pump. ❑ Installation of 75 KVA or
, ,-� ❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LO ❑ Addition of new molar load of ❑ "A ", "E","1-2","1-3",
t. • , 100HP or more. occupancy.
Job no.: Job site address: 9870 SW Mcken /le #4 unit
0 Six or more residential unite. 0 Recreational vehicle parks.
❑ Health -care facilities. 0 Supply voltage for more than
City /State /ZIP: Tigard Oregon 97223 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. .
_ FEE SCHEDULE
Cross street/directions to job site: - nprriptloa I Qty. I Fee. I_ Total I
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.:
1 ,000 sq. ft, or less 16 8.54 4
— Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: y Limited energy, residential 75.00 2
DESCRIPTION OF WORK 11 (with above sq. ft.)
1 Limited energy, multi - family 75.00 2
up grade electrical panel unit resi •
(with above sq. ft.)
#4 unit Services or feeders installation, alteration, and /or relocation
1 200 amps or less 1 100.70 100,70 2
201 amps to 400 amps 133.56 2
® PROPERTY OWNER ,;, ❑ TENANT
401 amps to 600 amps 200.34 2
Name: Eric Rabosky Town House Propertties 601 amps to 1,000 amps 301.04 2
Address: 13325 SW Clear View Way Over 1,000 amps or volts 552.26 2
- Temporary services or feeders installation, alteration, and /or
City /State /ZIP: Tigard Oregon 97223 . 1 relocation
_ 1 200 amps or less 59.36 I
Phone: (503)314-3163 Fax: ( ): 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on prt( ihrty that 1 own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to O S, 447, 449, 670, and 701. Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee f or branch circuits w ith
above service or feeder fee, 7 42 2
❑ APPLICANT I 0, - CONTACT PERSON each branch circuit ,
;, B. Fee for branch circuits without
Business name: service or feeder fee, first 55.18 2
branch circuit
Contact name: Each add'I branch circuit 7 2
Address: i Miscellaneous (service or feeder not included)
i.j Each manufactured or modular 67.84 2
City/State/ZII': i
dwelling, service and/or feeder
1 . Reconnect only 67.84 2
Phone: ( ) I Fax: : ( I ) Pump or irrigation circle 67.84 2
E -mail: Sign or ou lighting 6 7.84 2
CONTRACTOR Ii T Signal circuit(s) or limited- energy
panel, alteration, or extension. Page 2 2
Business name: D &L ELECTRIC INC. I i. Each additional Inspection over allowable in any of the above
. 17 __ Additional inspection (1 hr min) 66.25/ fir
Address: PO BOX 367 ' Investigation (1 hr min) 66.25/ hr
City/State/ZIP: WEST LINN OREGON 97068 Industrial plant (l hr min) 78.18 / hr
Inspections for which no fee is 90.00 / hr
Phone: (503) 656-5623 Fax: (503) -1918 specifically listed (% hr min)
;,- ELECTRICAL PERMIT FEES
CCB Lic.: 88069 Electrical Lic.: 3 -161C 1; Suprv. Lic.: 2662S Subtotal: 100.70
Suprv. Electrician signature, required: 11✓ Plan review (25% of permit fee):
1 ! State surcharge (12% of permit fee): 12.08
Print name: DONALD H LETTENMAIER ` Date: 05 -12 -2011
; 1---- TOTAL PERMIT FEE: 112.78
/ This permit application expires if a permit is ant obtained within 180 f',
Authorized signature: fy �� . ! i ∎ / days after it has been accepted as complete. �r
Print name: 7�7�f�'' j ` Date: S'/ / 21/) • Number of inspections allowed per permit
it fff
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