Permit M s
t . q CITY OF TIGARD ELECTRICAL PERMIT
' r i 1 COMMUNITY DEVELOPMENT Permit #: ELC2009 -00149
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/07/2009
Parcel: 25101 DB00103
Jurisdiction: Tigard
Site address: 7360 SW HUNZIKER RD 105
Subdivision: Lot: 0
Project: Surplus Line Association of Oregon
Project Description: TI, (6) branch circuits.
Owner: FEES
HILLTOP BUSINESS CENTER LLC & Quantity Description Date Amount
HUNZIKER LLC, 9430 NW KAISER RD 6 crt Branch Circuits 04/07/2009 $80.10
PORTLAND, OR 97231 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 04/07/2009 $9.61
Contractor: Electrical
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 ac ordance 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 TTENTION regon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001- 010 through OAR 9 -00 0 0 . You may obtain a copy of the rules or direct questions to OUNC by calling 603.246. 99 or 1.800. 2.2 4.
Issue By: L • tp �'v"ut. ` .( Permittee Signature: v
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'N f t—LJ Date: l 7 Zp l."i
LICENSE NO. 6 - 7 3
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.OFFICE' ONLY .
Permit No: /,
III City of Tigard RECEIVED Received DateBv. 7 09 / ��icr - �7r
13125 SW Hall Blvd.. Tigard, OR 97223 flan Review
- a = Phone: 503.639.4171 Fax: 503.598.196 Date/By: Other Pemm�
�1PR - 7 ?np9
TIGARD Inspection Line: 503.639.4175 Date Ready/13y: ® See Page 2 for
Internet: Wtvw.tigard- or.gov �!It OF TIGARD Notified /Method: 4....;,-
Supplemental Information
I 111
�.. TYPE OF •fUI ING.DIVISION" "
❑ New construction ® Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Budding over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings
less to ground, or exceeds 14.000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all abet installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
" JOB SITE: INFORMATION -AND ,LOCATION ❑ Emergency system. larger separately derived system
❑ Addition of new motor load of ❑ "A" "E° "I _� I -3°
Job no.: Job site address: 7360 Hunziker toollP 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.: 105 Project name: Hill-Top-- ❑ Service or feeder 600 amps or more.
job site: d�+.e�l�l.ea9 �` "aL '¢ ° F � 4U� „ FEE ;SGH b. I : <- �:_ :'Z''.;;''': I ,
Cross street /directions to
Description - I 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 145.15 4
Ea. add'I 500 sq. tt. or portion 33.40 l
Tax map /parcel no.: Limited energy. residential
• ' `DESCRIPTION OF.;- WORK•" (with above sq ft) 75.00 2
TI Remodel Limited energy. multi - family 75.00 2
residential (with above sq. tt.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
PROPER? Y',OWNER 'o -
❑ , .. : ' w _ '„ ❑ : TEN:I NT • , „ 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
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, 6.65 2
each branch circuit _
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 1 46.85 46.85 2
first branch circuit
Address: Each add'I blanch circuit 5 6.65 33.25 l 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 90.90 2
Phone: dwelling, service and /or feeder
( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
, , CONTRACTOR" - _ , , , . Sign or outline lighting 53.40 2
Business name: AC &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.: ? C Suprv. Lie.: 5387S Industrial plant per hour 73.75
„ i :'. .EEECTRICAL':PERMV11T'F.EES =. ' '' ���
Suprv. Electrician signature. required: Subtotal: 80.10
A 1�
Print name: Carl Duncan Date: April 6, 200
Plan review (25% of permit fee):
State surcharge (12% of permit fee): 9.61
Authorized signature: TOTAL PERMIT FEE: 89.71
Print name. Dale: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
* Nuntbei of inspections allowed per permit.
l: \nuilding \ Pet mils \ELC- PermitApp.doc 05/23/06 440- 4615T(i I /05 /COI \1 /WEO