Permit " CITY OF TIGARD ELECTRICAL PERMIT
' ¢'�' ' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00377
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/07/2011
Parcel: 25101 CA00400
Jurisdiction:
Site address: 7940 SW HUNZIKER RD
Project: Charter Mechanical Subdivision: Lot:
Project Description: (3) branch circuits.
Contractor: MILESTONE ELECTRIC Owner: GOULD FAMILY PROPERTIES VI
1281 NE 25TH AVE, STE. T 105 PINE ST
HILLSBORO, OR 97124 IMPERIAL, PA 15126
PHONE: 704- 519 -6130
HONE: 503 - 645 -5323
FAX: 503 - 690 -4843
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 07/07/2011 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/07/2011 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 OA: •52- 001 -0090. You ma obtain - . . • . th- .: _ _ - ct questions to OUNC by calling 503. 1987 or 1.800.332.2344. C
Issued By: -� -� _ �` Permittee Signature: G
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.
Jul, 7. 2011 10100AM Milestone Electric No. 0099 P. 2 • r. sue- — -_ —. _ �:.iwarw 3
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard deceived
n p ate/B : Ag i Permit No.: .. , ;20 __ ,e 7
1 3125 SW Hall.I3lvd., Tigard, OR 972
t ' � Plan Review
Phone: 503 .639.41 Fax: 503.'`: J 0�� Oata�r: OtherPennit. t P, I •
TIG•ARI)
Internet: www.tigard- or.gov Inspeotion Line; 503.639,4175 Date Ready/ y; See page 2tar
\ Q - • otifedMletbe4: BM Supplemental Information
TYPE OF WOR , 1 PLAN REVIEW
❑ New construction 1 _ ' , Addrtion/alteratio .. - ' ' ; , :, . ,,, 0 Please check all that apply (submit 2 sets of plans w /items checked below):
S ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: . where the available fault ourrent El Marinas and boatyards.
CATEGORY OF CONST CTION exceeds 10,000 amps at 150 volts or 0 Floatin Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling II Commercial/industrial 0 Accessory building amps for all other installations, buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 K VA or
0 Emergency system, larger separately derived system.
'
JOB SITE INFORMATION AND LOCATION . ' . • ['Addition of new motor load of El
Job no.: J f Job site address: 4 , (.4 .,
I Six or or more, occupancy,
❑ Six or more residential units. ❑ Recreational vehicle parks.
❑ Haza dous locations. facilities. ❑ Supply voltage for more than
['Hazardous I 600 volts nominal.
Suite /bldg. /apt. no.: Project name: h 6. . �/ �;, Gbh a r ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Oty. I Pee, I Total I
New residential single» or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1 ,000 sq. ft. or less 168,54 4
Ea. edd'l 500 sq. ft. or portion 33,92 1
Tax map /parcel r10.: Limited energy, residential
DESCRIPTION OF WORK (with above sq, ft,) 75.00 2
Limited energy, multi - family
residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT • ' 201 amps to 400 amps 133.56 2
Name; 401 amps to 600 amps 200.34 2 -
601 amps to 1,000 amps 301.04 2
Address: Over 1.000 amps or volts 552.26 2
City /SCateJZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 MN 1
Owner Installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange. according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, er panel
Owner signature: Date: A. Fee for branch circuits with
§? " "''` ❑ APPLICANT :. . • . ❑ CONTACT' PERSON above service or feeder fee,
, ^i; 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without -
service or feeder fee, first
Contact name: branch circuit i 56.18 ~ , i g 2
Each add'1 branch circuit 7,42 / 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modula 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67,84 2
E - mail:
` r�3 fLO r' I M:i�Fi, : r ' . ;r4 ' •::.i;' CONTRACTOR i' ••. .•I , '; . Sign .l outline li l 67.8a 2
' :. n +`.;iii'- � ��' ,::, `r Signal circuit(s) or limited - energy
panel alteration, or extension, Page 2 2
• Eac additional inspecdon over allowable in any of the above
Address: 0 e Lam- eii- Additional inspection (1 hr min) 66,25/ hr
C /State /ZIP: i y ' Investigation (I hr min) 66,25/ hr
i
U, .i - a � e , 7 23. 5 Industrial plant (1 hr min) 78.18/ hr
Phone: ( • ' ) ' t 15 .— _ 3 z 5 Fax (4;, 3) 00 _, —7 1 - -I (�G� 3 Inspections for which no fez is
rJ specifically listed ('Y hr min) 90.00 / hr
3 _
Electrical Lie.; 616 Suprv. Lic.: 5 '5'3c 5
r p : •';z:`: -;:,,,,,;...;,: ELECTRICAL PERMIT FEES' .:. • ..•,,.;;,.:.;:.;':
Subtotal:
Suprv. Electrician signature, required: j- 0-- ' -+r Plan review (25% of permit fee):
Print name. Oh, eo di ' p ; State surcharge (12% of permit fee): `
r T.. 5
Authorized signature: TOTAL PERMIT FEE: • - 3 - 1q , `Pi
This permit 4pplicanion expires if a permit in not obtain - . within 180
days after it has been accepted as complete -
Date: * Number of inspections allowed per permit.
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