Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00077
TICARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/03/2012
Parcel: 2S110AC00400
Jurisdiction: TIGARD
Site address: 14799 SW 109TH AVE, APT# OFFICE
Project: Timberline Apartments Subdivision: 2003 -083 PARTITION PLAT Lot: 2
Project Description: Pool house panel replacement.
Contractor: WEST SIDE ELECTRIC CO INC Owner: TIMBERLINE APARTMENTS LLC
1834 SE 8TH AVE 5335 SW MEADOWS RD #190
PORTLAND, OR 97214 LAKE OSWEGO, OR 97035
PHONE: 503 - 231 -1548 PHONE:
FAX: 503 - 736 -0677
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 02/03/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 02/03/2012 $12.08
Type of Use: MF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 -0090. You may obtain a c•. of the rul - = t questions to OUNC by calling 503.232 1987 or 1.800.332.234
—
Issued -- _ — 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..forthe 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.
2012 -02 -01 14:30 WEST SIDE ELECTRIC 15037360677 » 5035981960 P 2/2
Electrical Permit Application y � � 1'.‹ ,, tr,', r I' t ., t t) \1.3
City of Tigard � �' oia .ie , _ �, PemitNo,,..- • a r _ 4 7
- • 13125 SW Ball Blvd.. Tigar `➢7223 `%\ Pia Review
.. Phone: 503.639,4171 Fax: 503. 98. •••• � Date/B : Other Pamir
i 1 l , on Line: 503.639.4175 - �� 0. c-,10 �,` Date Roody/8Y. ® Bee Paw 2 for
,
Internet: www.tigard- or.gov "\ \G` \`s Notified/Method /,, SupplementalInfarmspco
ri, \r , - ...�'.n .a.l :z , k` : : , tg{• .��.y.; ;1 �'+aW , • - ,rte „ �yfd :� v�?fltYlYi.':� • ,i0�r. ? (St .+i' r+�'' s ' i i s ' 4' 2.' :.: ". 4 p. �'L• ; ,' A7 ∎,V s.::' ' e r + ' ' •;; # }i 6r.1 :',r"'i ?t i ...,. » .. e•iga.i. if: !a
:x l6ir....
❑ New construction RAddition/alter gioiiiggilitiement
Please chock all that apply (submit j, sots of plans whit= checked below);
❑ Service or feeder 400 amps or more ❑Building over three storks.
❑ Demolition Other: where the available fault current ❑ Marinas and boaryarda.
1 0 .',....,',,,.• �r { t t 1 ; in:1 ;ZaV ' , d' •• •, , . > :: 'Y' a'( :) monde 10,000 amps at 150 volts or ❑ Floating buildings.
:y ; ; � :.r ::t ^ , R S:r,� .%kl , �' � ' 4 ' ; ; �:�irs : _. less toground'er exceeds 14,000 ❑Canunemial♦taeagnculturd
r ❑ d 1- and 2- family dwelling ❑ Commercial/industriai [{ Accessory building amps for all other installations. buildings.
f Multi- family ID Master builder. ❑ Other: ['Fire pump. _ ❑ E 2" Instillation of 75 KVA or
❑ Eniei eney system Ironer separately derived system,
: ! ..lode r . ; :.:.:1.7,...0..,, • a. h ) , ❑ �; �'� -r. �t7yi ' :i � : s: -- r';+,j2r. itl�,. �+ •r.. .. 'sp;:r' "fi•Y ..i7:.: t, '; ' :+.: ' i ?,.. S'
_ ..� r d'"a i'� ' - ;', Addition of new moor load of ❑ "A ". "", "I - "I -3 ",
Job no.: j'' J /� / Job site addres6. ( f , .r ti 0 - 100HP or more. occupancy.
J �(j V ( /L / ❑ 3i>< or mote residential units.
❑ Rareetional vehicle parks.
City /State/ZIP: , a„ r,[ a72?. 9 ❑ Health-care facilities. ❑ Supply voltage for more than
/ / ! El Han2rdoua locations. 600 volts nominal,
Suitc/bldgJapt no.:
j P roject name:' A , r l /i El
or fee 600 amps or more. r
/A • 1.' I!L' / :ij %:I_, '40,1; :+ >'At�" :., r�,�i', Y.''�iq.�k',I: ;. .Si'�,?'iei.,i : 4 1 '.
Cross street/directions to job site: Description I our. I Fen _ Tow I Y.;
New residential single or multi - family dwelling unit,
_ Includes attached garage.
1,000 11. or less 168,54 4
Subdivision: Lot no.: �'
- P.a add'1500 N. ft, of portion 33.92 1
Tax map/parcel no.: Limited energy, residential -
't k1v °,N 'n ' :
, '7' . ••iI TMti_ :1 !lra,7.7" N 1 "i1S, . 1 ,
, ',_,.•. 0Y nt ... ,' (with above sq. R) ., 75.00 2
Limited energy, multi- family 75,00 2
A P C ', w M i OUd.Q I Q/tt . residential (with above so, fI)
Services or feeders Installarion,,aiteration, and/or relocation
200 amps or less j 100.70 /Q0 2
-
ki P �. )? t �' q , r t ,� t: t , 00 amps 133.56
2
.1." '" 1" Zp b',:15F.'�';�._,ti h"fG'i�a.i�irtl. r:31 - i .g'; : . 201 amps to 4
401 amps to 600 amps 200,34 2
Name:
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
Owner installation: This installation is being made on property that I own which is not tot amps to 400 amps 125.0e 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, per panel
Owner signature: Date: _ A. Fee for branch circuits with
i; ' p y�:,� i alxrve rvice or abater feo
,s ¢._.,:: : A r ' , k r R Sa@ :talttI .. tSTk75 O -', 7.42 2
s e ach branch se cimtut
Business name: B. Fee for branch circuits without _
-
. service or feeder fee, first 56, 18 2
Contact name: branch circuit
. Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not Included) -
Ci /StateIZ1P: Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder
Phone: ( ) Pax: : ( )
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: �_ •.�
)k` ' - e j 1i �4 : ` �stel�r ;'�ati %';d`f1r.a :r; 'iii •1r Sign or outline lighting 67.84 2
u«... ;� i ' . R�„�i '' i .1:. ni h �' Signal circuit(s) or limited-energy
Business name: _panel, alteration, or extension. Pals: 2 2
West Side Electric CO. , Inc • E ach additionalinspeedon over allowable inany the above
Address: 1834 SE 8th Ave. Additional inspection (1 hr min) 66,25/ hr
City /Stete/ZIP: Portland /OR/97214 Investigation (I _ 66.25 /Lr
industrial plans (1 hr min) _ 78.18/ hr ,
Phone: (503) ( Inspect for which no fee is
hr
(503) 231 -1548 503) 73 6 - 0677 _ ificall listed' / :hr min 90
CCBLic.: 13306 Electrical Lie': 26- 135C Suprv.Lic': 465 -S t : ; 43 : :'a.r w':erea :37 rs, .•' " , -:: Y
`--"" r ,/ subtotal: { /U(� !.--1:-/ Suprv. Electrician signature, required: , / 1
Plat r eview ( 25 %ofpermit fee):
Print name: Randall F Robert Date: 2 / F_____. State surcharge (12% of permit fee): /7 �Ss
Troy TOTAL PERMIT FEE: - / / 7 7�
Authorized signature:
permit applkadon expires If a permit is not obtained within 180
- days after It bas been accepted at complete-
Print amt: I Date. • Number of inspections allowed per permit,
m&aldintlPtmuts\ELGpmruUpp.duc 07,01 /10 440- 46111111/03/COM/WEp