Permit CITY OF TIGARD ELECTRICAL PERMIT
2 ' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00641
F IGARID 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/15/2011
Parcel: 1S135DD02001
Jurisdiction: Tigard
Site address: 11635 SW HALL BLVD 2
Project: MB INVESTMENTS LLC Subdivision: METZGER ACRE TRACTS Lot: 28
Project Description: (1) service and (1) branch circuit.
Contractor: AC POWER SERVICES INC Owner: MB INVESTMENTS LLC
18010 S HOLLY LANE 8320 NE HWY 99
OREGON CITY, OR 97045 VANCOUVER, WA 98665
PHONE: 503 - 780 -6807 PHONE:
FAX: 503 - 557 -5765
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 11/15/2011 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 11/15/2011 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 11/15/2011 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
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 fo h In OAR
952 - 001 -0010 through OAR • 1 -0090. You may ortain , • • •f the r :. • • ec • • - ••ns to OUNC by calling 503.232. 87 or .332.2344.
Issued By: ‘"- ermit Signature:
NER 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.
Electrical Permit Application FOR OFFICE USE ONLY
lig Re City of Tigard y ) Date an /B R e v :O, Permit No.: � � ' C
- v 13 125 SW Hall B lvd., Tigard,OR 97223
ceived
17 ' Phone: 503.718.2439 Fax: 503.598. f- Date/By Pl i ew Other Permit:
T I GA RD Inspection Line: 503.639.4175 ��� Date Ready/By: lur s: ®See Page 2 for
Internet: www.tigard - or.gov 4. `� ® Notified/Method: '7 Supplemental Information
TYPE OF �W OI �1� �.. ., \O PLAN REVIEW
NrfaIew construction ddition / alteration /rep `aVenlettV`� Please check all that apply (submit 2 sets of plans w /items checked below):
eN\ ' ' ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Other: Ni`
'`
e 0 where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUXCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
l and 2- family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
Multi- family ❑Master builder ❑Other: less
pump. buildings.
of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 11' 5c PM L IL.( 100HPormore occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: ' 1Z D e ❑ Health - care facilities. ❑ Supply voltage for more than
�" ' _ 0 locations. 600 E volts nominal.
job site: /V
Suite /bldg. /apt. no.: l Project name: gi 0 i / >, �� t& � , ❑Service or feeder 600 amps or more.
Cross street/directions to FEE SCHEDUL
J 77 ..„, 912.... D �L/� Z�- n Description 1 Qty. I Fee. I Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.:
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
1 V R —T / 2 S/ ' y/ �` .
Limited energy, tial (with mu fv sq. 75.00 2
S a residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 100.70 fop 7 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 /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
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, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
7.42 �, 2
each branch circuit t
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'/ branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 67 84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( )
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: A , -- c w �C,' K _ 5' ': IA nc /+� I panel, alteration, or extension. Page 2 2
lC Each additional inspection over allowable in any of the above
Address: /A E9 ( 0 f ., ,4 f L / L- , Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: V� e. 7 - y 0E_ c3 7 o 411 Investigation (1 hr min) 66.25/ hr
/ / Industrial plant (1 hr min) 78.18 / hr
Phone: (jV c� D 62 p' Fax: ( 3) , - t9 6 L Inspections for which no fee is 90.00/ hr
specifically listed CA hr min)
CCB Lic.:1■- ac1 Electrical Lic.:5 -s - o - f _ cl Suprv. Lic.: 78 s ft ELECTRICAL PERMIT FEES _
� Subtotal: Or / )- -
Suprv. Electrician signature, required: '"V ai ,(gbk ../... Plan review (25% of permit fee): ----._
Print name: A , 4 /7 E Date: / f...- 1 y - 25/) State surcharge (12% of permit fee): i /, . q 7
/ TOTAL PERMIT FEE: ) ed it dq
Authorized signature: R.--,_.... ��
{ This permit application expires if a permit t is not obtained within 180
Print name: ,(q t CA/b- Date: (I y � I * days after it has been accepted as complete.
N 1 J N u m b er o i ns inspections ections allowed per permit.
ermit.
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440 - 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \ Building 'Permits\ELC- PermitApp.doc 07/01/10