Permit CITY OF TIGARD ELECTRICAL PERMIT
;1 '1 ;;: COMMUNITY DEVELOPMENT Permit #: ELC2011 -00555
Date Issued: 10/06/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 2S113A600300
Jurisdiction: Tigard
Site address: 16037 SW UPPER BOONES FERRY RD 165
Project: Spec Space Subdivision: FANNO CREEK ACRE TRACTS Lot: 38
Project Description: (10) branch circuits for TI
Contractor: ACCURATE ELECTRIC UNLIMITED INC Owner: OREGON STATE BAR, THE
PO BOX 871866 16037 SW UPPER BOONES FERRY RD
VANCOUVER, WA 98687 TIGARD, OR 97224
PHONE. 360- 567 -3330 PHONE
FAX: 360- 567 -3320
FEES
Quantity Description Date Amount
10 crt Branch Circuits wo /Purchase 10/06/2011 $122.96
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/06/2011 $14.76
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $137 72
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 wit- _ • •roved plans This permit wit expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTIO Oregon law require you to follow the rules adopted by the Oregon Utility Notification C • - r Those rules are set forth in OAR
952- 001 -0010 th •ug OAR 952 -001 00 ou ay obtain a copy of the rules or direct questions to OUNC by calling ..:w32 1987 or 1 800 332 234
Issued By: ' 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.
OCT - 06 - 2011 09:47 Accurate Electric, Inc. 3609947013 P.001
Electrical Permit Application t y't FOR OFFICE USE ONLY
a.> t ,
City of f.,x
Tigard Received
, g � Date/B /06,//1 �' ` Permit No
I N
at 13125 SW Hall Blvd , Tigard, OR ,9 ` ` - : -, \ Pl Review
P hone: 5 03 7182439 Fax: 503 ` '' Date By Other Permit- f ' j . 1 /J / I�.,� (a , 7
TIGARD Inspection Line: 503 639.4175 , ti , Date Ready /By, tuns 81 See Page 2 for
Internet: www.ttgard- or.gov ,,wt,;q, ?,‘ "ti}��` Notified/Method. ;. Supplemental Information
f a ° i "" - . TYPE OF WO • \'..1".'
� ' .r., - . -PLAPV REVIEW
❑ New construction ® Addition /alteratlonfreplacement Please check all that apply (submit 2 sets of plans w /items checked below).
`,.a'_ ❑ Service or feeder 400 amps or more 0 Building over three stores.
❑ Demolition El Other: where the available fault current ❑ Marinas and boatyards
CATEG OE 'CONSTRUCTION exceeds 10,000 amps at 150 volts or El Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agncultural
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pomp, ❑ Installation of 75 KVA or
• JOB SITE INFORMATION,AND'LOCATION
O Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1.3 ",
Job no.: 10 -1289 I Job site address: 16037 SW Upper Boones Ferry Rd 100HP or more. occupancy
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: Tigard, OR q -I 224 hi L j b. e �Q ❑ Health -care facilities ❑ Supply voltage for more than
�( r�TL - �i ❑ Hazardous locations 600 volts nominal.
Suite/bldg. /apt. no.: 1 (0S I Project name: Fap.no f rPPO r p Gtfa 1H�1 ❑ Service or feeder 600 amps or more
A -- FEE SCHEDULE ,'
Cross street/directions to job site:
Description I Qry. I Fee. I Total
New residential single- or multi - family dwelling unit.
Includes attached garage
Subdivision: Lot no.: 1,000 sq. 01. or less 168.54 4
Tax Inap /parcel no.: Ea add'I 500 sq. ft or portion 33.92 1
. Limited energy, residential 75 00 2
i " 7 - ,74 I) ESCltl OF WOlitK � • ' " - , (with above sq. ft.)
f ` n Limited energy, multi- family
Renovate suite 165 & 200 y �r 1, 75.00 2
IC %� (t �c.�-: i1J -(b. s„..1;--it ((p5y / f� - j ;i` residential (with above sq. ft )
/ Services or feeders installation, alteration, and/or relocation
BUP2011 -00198 and BUP2011 -00197 r
` }C :f` (- �t'-,t}3 t ' -(' 1297 k 6: / 200 amps or less 100.70 2
❑ PROPERTY' OWSE.R ' , , . ' ❑ TENANT - 201 amps to 400 amps 133.56 2
Name: .` u c n _ _p 401 amps to 600 amps 200.34 2
t 1 Y — 601 amps to 1,000 amps 301.04 2
Address: t ie," - 11 A, r�(3 Over 1,000 amps or volts 552.26
City /State/ZIP c' S t _ e , Temporary services or feeders installation, alteration, and/or r
relocation
b kCY
Phone: ( ) I Fax: ( ) ?�""' � r" 411 8 ` 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is n 201 amps 10 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Q , 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with • ❑ APPLICANT ' , I '., []:4co TACT, t'EIt80N . . , above service or feeder fee,
each branch circuit 7.42 2
Business name 1 B. Fee for branch circuits without
+ � � service or feeder fee, first I 56.18
Contact nam y �� 1 .. w � 1 . � - branch circuit 56.18 2
�— Each add'l branch circuit 2-9: 7.42 ' 2
Address:
Miscellaneous (service feeder not included) 7g
City/State/ZIP: � . r Each manufactured or modular 67 84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( Reconnect only 67.84 2
E - mail:
Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR ,, . , Signal circuit(s) or limited energy
Business name: Accurate Electric Unlimited, Inc. panel, alteration, or extension Page 2 2
Each additional inspection over allowable in any of the above
Address: P.O. Box 871866 Additional inspection (I hr min) 66.25/ hr
City/State /ZIP: Vancouver, WA 98687 Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr min) 78 18/ hr
Phone: (360) 567 - 3330 Fax: (360) 567 - 3320 Inspections for which no fee is
specifically listed CA hr min) 90.00/ hr
CCB Lie.: 191346 Electrical Lie.: C638 Suprv. Lie.: 5590S ' ELECTRICAL PERAUT FEES
Suprv. Electrician signature, required: Subtotal: 36 W. q(p'
I Plan review (25% of permit fee).
Print name: Bill Dixon Date: 10 -6 -11 State surcharge (12% of permit fee): / f>' /1-4 7e,
n k ` I } N. TOTAL PERMIT FEE: 303.92 13 ,. 7)
Authorized signature: X/) V�1
This permit application expires if a permit is not obtained within 180
Print name: Debi Watts Date: 10 -6 -11 days after it has been accepted as complete.
° Number of inspections allowed per permit.
1 Bmldmg'Permns ELC- PermitApp.dac 07 01 10 440-46157'01 05 WEB