Permit 4 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00125
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/02/2012
Parcel: 1 S 126CA01000
Jurisdiction: Tigard
Site address: 9009 SW HALL BLVD 140
Project: Santiam Bicycle Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: (8) branch circuits.
Contractor: NORTHSIDE ELECTRIC Owner: CAFARO NORTHWEST PARTNERSHIP
PO BOX 12323 PO BOX 422
SALEM, OR 97309 FLORHAM PARK, NJ 07932
PHONE: 503 - 585 -4879 PHONE:
FAX: 503 -364 -0248
FEES
Quantity Description Date Amount
8 crt Branch Circuits wo /Purchase 03/02/2012 $108.12
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/02/2012 $12.97
Type of Use: COM Electrical
Class of Work: ALT
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 forth in OAR
952- 001 -0010 ugh OAR 001 -00 . You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 87 or 1.800.332.2344.
Issued Permittee Signatu
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.
FEB /29/2012/WED 02:11 PM NORTHS I DE .. ON C FAX No, 503-364 -0248 P. 001
Electrical Permit Application O'' O .' , ro' OFFI:C:E USE ONLY �
14 q City of Tigard � Q� �Q 4O .• Received Dare/a ; 2 � �� permit No.: 070/ r ex 13125 SW Hall Blvd., Tigard, S ." ' 'y , ... �5 plat Rem • Phone: 503.7 Fax 50 := :7:v60,43) ' DateB : Other Permit.
T IGARD: Inspectio Line: 503.639.4175 F Ore Q?) Date Ready/By: lam: H Sec Page 2 for.
Internet: www.tigard -or.gov ,c Notified/Method: • Supplemental lnfarmafiae
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❑ New construction ® Addition/alteration/rep1 � �r • ent please check all the! apply (submit z sets of pleas w /items checked below):
• ❑ Service or feeder 400 amps or more ❑ Building over three stories. .
El Demolition ❑Other
_ _ where the available auk current ❑ Marinas and boatyards.
R t is e mu - .E p4 �`�ii - ` city, 1 �K. .p 4' '
1 -4i 3 exceeds 10,000 amps at volts Floating bldtn
��e iE .�,: >�f . k�!'l,:l'{I.',r:4J. � . ®) a �L {�4:4.w•::�L �l,U.::l..�ti :.::la!y11 . ' 1' � ' 000 50 L t 150 t9 Or ❑ C1Cat in�e.
� ' Tess to ground, or exceeds 14,000 ❑ Commereiol• use agricultural
❑ 1- and 2- family dwelling 0 Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other. ❑ Fire pump. ❑ Installation of 75 KVA or
�. sa a [ `s � ❑ Emergency system. larger separately derived system.
l , '� is � A, t7 r'a r t. 8 rhSTT t'3 x.6 I:4� hr- i '' 6.• ..-11 %I -r t�!'-Y.' v 1� ❑
.'� tias.�frN � ���f�T;i:f� v., L.'�:._4'x7..� !�!��;. n . •y-•:IFY., � . • �•� Addition of new motor load of 0 'A ",'E",'1.2 ", "1.3 °,
Job no.: 60711 Job site address: 9009 SW HALL BLVD 100l or more. occupancy.
❑ Six or more residential omits. ❑ Recreational vehicle parks.
City/ State / ZIP: TIGARD ❑ Health -care facilities. ❑ supply voltage for more than
❑ Ha ous locations. 600 volts nommaL
Suite/bldg./apt no.: 140 I Project name: SANTIAM BICYCLE ❑ Service or feeder 600 amps or more.
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Cross street/directions to job site: nestrtpdoo ay. sce. mat •
New residential single- or multi- famlly dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1.000 sq. 1t or lass 168.54 4
Ea add'I 500 sq. iL or portion 33.92 1
Tax map /parcel no
Limited energy, residential
h r "!- rj�., � -I T4i :5. � l am - lis € •a s err � i 'is ii a i w. , l u a * t ' q ;t (with above sq. ft) 75.00 2
;s="1'' " `L "`'� `, wr � "� " a l' Limited energy. multi- family
ADDING CIRCUITS FOR RECEPTACLES residential (with above sq. R) 75.00 2
Services or feeders installation and/or relocation
200 amps or less 100.70 2
40
't 7 ,.,' - a . y 1 l? ; , d n •Y `L , �2k� :� l!d G }, n : k to 0
Y" �: i�1.. ...i',,.�r- ,r.. ✓.'� 'wt. ,. ,..��N`t3.r �.. is� _,z.c.��1
:,:nv�'._uha.:..L:1`. Y.iEw,: ,.. � , 201 �� (IMPS 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: ( ) I 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 401 amps to 599 amps 168.54 2
intended for sate, lease, rent or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, panel
Owner '• signatu • Date: A. Fee for branch circuits with
l `' i _ t' 5f��i r`� I.:i la ,IN lill1: ;1 /4 t al - � �z 6 it'it each bove erviceeiorfeeder 7.42 2
Business name: B. Fee fbr branch circuits wtdrovr
service or feeder fee, first 1 56.18 56 2
Contact name: branch circuit . •
Each add'l branch circuit 7 7.42 51.94 2
Adder: Miscellaneous (service or feeder not included)
Each manufactured or modular
City / State/ZIP: dwellintr service and/or feeder 67.84 2
Phone: ( ) I F ax; : ( ) Reconnect only 67.84 2
E-mail: - Pump or irrigation circle 67.84 2
,.1; �.;;:rl' I'Y :5: '''''"q d,�t Sigel or outline lighting r limited-energy i , . 67.84 2
).
�� ^ %i^ ;. Signal circuit(s) orlimited- energy
. Business name: NORTHSIDE ELECTRIC • panel, alteration, or extension. Page 2 _ 2
Each additional inspection over allowable in any of due above
Address: P.O. BOX 12323 Additional inspection (1 br mot) . I ( 6625/ hr
City /State/ZIP: SALEM, OR 97309 investigation (1 hr min) 66.25/ hr
— _- industrial plant (1 hr min) 78.18/ br '
• Phone: (503) 585 -4879 Fax (503) 364-0248 Inspections for which no fee is
c ps ecifrcally listed ( ltr rain) 90.00/ hr
CCB Lie.: 80593 Electrical" Lie.: 24.14C Suprv. Lic.: 5301S 'aC a M 2 y Yt24 ';; .. vans,t
Subtotal: 108.12
Suprv. Electrician Signature, required: ","` Plan review (25% of permit fee): _ 0
Print name: BRYAN EPPING Date: 02 -29 -12 State surcharge (12% of permit fee): 12.97
Authorized signature: TOTAL PERMIT FEE: 121.09
This permit application expires if a permit Is not obtained within IS
days after It bas been accepted as complete.
Print name: BRYAN EPPING
Date: 02 -29 -12 • Number of inspections allowed per permit.
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