Permit ,�
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CITY OF TIGARD ELECTRICAL PERMIT
II g 'a CO MMUNITY DEVELOPMENT Pe rmit #: ELC2009-00309
.TIGAR. D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/23/2009
Parcel: 25101 DB00100
Jurisdiction: Tigard
Site address: 7320 SW HUNZIKER RD 203
Subdivision: Lot: 0
Project: Supplemental Health Services
Project Description: Add /alter (6) branch circuits.
Owner: FEES
HILLTOP BUSINESS CENTER LLC & Quantity Description Date Amount
HUNZIKER LLC, 9430 NW KAISER RD
PORTLAND, OR 97231 6 crt Branch Circuits 06/23/2009 $80.10
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/23/2009 $9.61
Electrical
Contractor:
AC & E ELECTRIC
3535 DEL WEBB AVE #100
SALEM, OR 97303
PHONE: 503 - 363 -2301
FAX: 503- 363 -2302
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $89.71
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 OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issued By: ' lU c ?- Permittee Signature: " P gr-- 4 " --------
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 an inspection that business day.
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 OFFIC RECEIV. USE ONLY
City of Tigard JUN 2 3 200 Received .� Q ct b?� , 60,309
Date/By: ve Permit No.. l
III
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Q r , lil • O V
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CITY OF TI GA F
Phone: 503.639.4171 Fax: 503.598.1960 Date/By:
Permit: G
TIGARD Ins ection Line: 503.639.4175 Date Read /B luris H See Page 2 for
• P BUILDING 1, y y:
Internet: www.tigard- or.gov YIS nfied /Method. Supplemental Information
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ELAN ='I2
El New construction ®Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
1=1 Demolition I=1 Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards
-
<CATEGQR Fa:
Y QCQNS C
TRU- ! 'r r °'z ° r , exceeds 10,000 amps at 150 volts or ❑Floating buildings.
, ._, " '" '" "�' .., "� "g ' less to ground, or exceeds 14,000 0 Commercial agricultural
❑ I- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings:.
❑ Multi- family El Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
� .'4,'S If i > ,; ;'erg. :.;> , >.;•,. -,i:- . ei system.
� r -- �,� Emergency cyst n larger separately derived s st e
JOB' E= INFQRMAP9N.AND'- QGATION z. * >X°' ❑ 2
... „- ,,,,., , Addition o f new motor l o f ❑ :. . = .. l 3 „
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Job no.: Job site address: 7320 Hunziker Rd 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks
City /State /ZIP: Tigard OR, ❑ Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite /bldg. /apt. no.: 203 Project name: Hill Top ❑ Service or feeder 600 amps or more.
SGHEAU!4E ' , °''
' ", ,:, - '.,FEE', .:
Cross street /directions to job site: Description 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 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.:
Limited energy, residential
s;F „ mod. ��., = .a��.� �x,. 75.00 2
„
;DESCRIPTION OF =k WQR'K� °••;• ,, :'' "" <x � ���,� (with above sq. ft.)
Limited energy, multi - family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
itatthr-i4,,It' OPERTY ,,QWNER ❑ °TENANT ”: ;„+ ` `' 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
" ; • f % o ; 3 t . above service or feeder fee
r1P.1?T ICANT„ -.;y . " ❑ 'CQVTACTPER$ON, • ., " 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, 1 46.85 46 2
Contact name: first branch circuit
Address: Each add'l branch circuit 5 6.65 33.25 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
' ,:,_ °•' " " :`f`>- Sign or outline lighting 53.40 2
C ON f I2AC�TQR' -;
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T: v., ,_� ,,. n . -- -.ter;.. -a+
Business name: &E Electric Signal circuit(s) or limited -
energy panel, alteration, or
Address: 3535 Del Webb Ave extension. Describe: Page 2 2
City/State /ZIP: Salem OR 97301 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 363 -2301 Fax: (503 ) 363 -2302 Investigation per hour (1 hr min) 62.50
CCB Lie.: 591 Electrical Lie.: 24 -1C Suprv. Lie.: 5391S Industrial plant per hour 73.75
/ 0 >,,,, 7;44.vi`,t E'LEC`I`RI ki oatuIT FEEs' " , ? :;
Suprv. Electrician signature, required: C �?c Subtotal: 80.10
Print name: V "` ?YY^��"" Date: 06/22/09 Plan review (25% of permit fee):
P ?1 n �) es State surcharge (12% of permit fee): 9.61
Authorized signature: TOTAL PERMIT FEE: 89.71
Print name: Date: 06/22/09 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\Building \Permits \ELC- PermilApp doc 05/23/06 440- 4615T(11/05 /COM/WEB