Permit CITY OF TIGARD ELECTRICAL PERMIT
111 4- _ COMMUNITY DEVELOPMEN Permit #: ELC2011 -00355
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/28/2011
Parcel: 2S102BD00702
Jurisdiction: Tigard
Site address: 9850 SW MCKENZIE ST 1
Project: McKenzie Street Townhomes Subdivision:RTH TIGARDVILLE ADDITION, AMENC Lot: 7
Project Description: Panel replacement.
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:
FAX: 503 -650 -1918
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 06/28/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 06/28/2011 $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. 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 O • • 952 - 001 -0090. You may obtain a co. • - . - or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ' 1i/ _ 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:
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.
JUN - 28-2011 06:16A FROM:DaL ELECTRIC INC 5036501918 TO:5035981960 P.2
I
Electrical Permit Application ' . oCE' I Olt UI 1'1(1 I .SI 0\1 1
Receive. ��
IN City of Tigard p 20 Date/ll ; , iL! l7Ii1s/ I1 , Permit No.., ;„.• ; u
a 13125 SW Nall Blvd., Tigard, OR 97223 1, N M 8 - Other
1 III . Phone: 503.718.2439 Fax: 503.598.1960 i Date/I3 :
IIC,\I.l1 C
Inspection Line: 503.639.4175 OF TIG . I , t�,
'
Internet: www.tigard- ur.gav ' 'l Mt
i Supplemental Information
` I ) ■ 1 l lit.t
TYPE OF WOR
• 9: dillIlliIllMIIII PLAN REVIEW
0 New construction / / . • ment 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 where the available fault current ❑ Marinas and boatyards.
CATEGORY CONSTRUCTI.4 exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 0 Commercial -use agricultural
■ and dwelling ■ • 1 Accessory building amps for all other installations. buildings.
0 ■ Master builder : II Other: ❑Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
MB SITE INFORMATION 1 1 • TION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job 1 Job - address: ' . I •10 NI unit
100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard Oregon 97223 ' ' ❑ Health -care facilities. ❑ Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bIdg./apt ! �, `� i` J / ,, ID Service or feeder 600 amps or more.
FEE SCHEDULE
Cross • • • job Description I Qty. I Fen I Total I •
New residential single- or multi- family dwelling unit.
includes attached garage.
Subdivision: • • 1.000 sq. ft. or less 168.54 4
Ea. add') 500 sq. ft. or portion 33.92 1
Tax Map /parcel ' Limited energy, residential
75,00 2
DESCRIPTION OP WORK . (with above sq. ft.)
up grade electrical panel unit . Limited energy, multi - family 75.00 2
r residential (with above sq. t1)
S ervices or feeders installation alteration, and/or relocation
• 200 amps or less 1 100,70 100,70 2
E PROPERTY OWNER 201 amps to 400 amps 133.56 2
401 amps to . 1 1 11
Name: Eric Rabosky Town House Propertties 61 , to 1,000 amps 301.04
• / II amps or volts 552.26 2
, Temporary services or feeders installation, alteration, and/or
• Tigard Oregon 97223 .. relocation
11 amps or
I Ll!!tlr*
201 amps to 400 amps 125.08
Date: Owner installation: This inStallation is being made on pro" -rty that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to 0 '.7 447, 449, 670, and 701. Branch circuits- new alteration, or extension .er land
Owner signature: ::,
above service or . 7 42
0 APPLICANT 0 h .1 ONTACT PERSON each branch circuit B. Fee for branch
Contact BuSiness name: I service or feeder fee, first
56.18 2
branch circuit
. Each add'I branch circuit 7.42 2
• 1 - Miscellaneous or t included
Each manufactured or modular
67.84 2
•
and/or feeder
Reconnect only 67,84 2
Phone:
E -mail: sign or outline
CONTRACTOR !
Business name: D &L ELECTRIC INC. , , , : , ec over allowable of the above 2
Address: PO BOX 367 Additional
Investigation (1 hr min) 66.25/ hr
City /State /ZIP: WEST LINN OREGON 97068 Industrial plant
Phone: (503) 656 -5623 Fax: (503) " s. .0 - 1918 III 90.00/ hr -.
CCB Lie.: 88069 Electrical Lie.: 3 -161C Suprv. Lic.: 2662S ELECTRICAL PERMIT FEES
Subtotal: 100.70
Suprv. Electrician signature, required: /,: r Plan review (25% of permit fee):
Print name: DONALD H LE'11L NMAIER f Date: 11 State surcharge (12% of permit fee): 1 2.08
TOTAL PERMIT FEE; 112.78
Authorized signature: 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.