Permit q CITY OF TIGARD ELECTRICAL PERMIT
IN _
. : COMMUNITY DEVELOPMENT Permit #: ELC2012 -00140
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/14/2012
Parcel: 1 S136DCO2504
Jurisdiction: Tigard
Site address: 7275 SW DARTMOUTH ST 160
Project: Shell Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: Prepare space for new tenant. (4) branch circuits.
Contractor: HILLSBORO ELECTRIC LLC Owner: AMERICAN INDUSTRIES INC
21185 NW EVERGREEN PKWY #110 1750 NW NAITO PARKWAY
HILLSBORO, OR 97124 PORTLAND, OR 97209
PHONE: 503 - 439 -9666 PHONE: 503 -478 -6603
FAX: 503 - 601 -3680
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 03/14/2012 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/14/2012 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 a - • = 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. ATT • ION: Oreg. law equires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0 through OAR 9 ' .1 - , 19' ou may obtain a copy of the rules or direct questions to OUNC by • $3. 32.1987 or 1.800.332.2344. •
Issue • By: C I /'0✓ A Permittee Signa .11110 . /
..---- 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:
i
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.
From:Hillsboro Electric,LLC 5036013680 03/10/2012 16:21 #800 P.003/004
Electrical Permit Application RECEIV FOR IICt_ 151- 0 A•
City of Tigard CC - `
Datd13 m Permit No.. ", 6 ap B , 1 /1,rC f�jt
. 10 13125 SW Hall Blvd., Tigard, OR 97223 MAR 1 3 2012 Plan Review ': r�CJ[ CJ
Phone: 503.718.2439 Fax: 503.598.1960 Date /By: Other Permit:
1 . i R6 inspection Line: 503.639.4175 .. Date Ready /By: Saris: El See Page 2 for
- - Internet: www.tigard- or.gov CITY OF TIGA iD NotifiedMethod: Supplemental Information
. TYPE OF Wo1dILDING DrvISION :'; -,.... . ...,,:.: •PLAN REVIEW .. <`'::: 4 = "Y ,.- : ?_:.:; •
P lease check all t hat a • ,
❑ New construction Addition /alteration /replacement apply (submit � sets of plans w�items checked below '
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CA a ' OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground. or exceeds 14.000 ❑ Commercial - use agricultural
❑ 1- and 2- family dwelling /.t Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ■ Master builder ❑ Other: ❑Fire pump.
❑ Installation of 75 KYA or
JOB SITE iNNFORMATION AND LOCATION O Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ -A ". ••E ". "1 -2 ". "1 -3 ".
Job no.: -79, ,7 Job site address: 70/7.- �01 Ave I i or or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
C tateJZiP: �' „J . / _ ❑Health -rare facilities ❑ Supply voltage for more than
Aiii. / � ❑ Hazardous locations. 600 volts nominal.
0 .1dg. /apt. no.: % Project name: /u0 ,/ ljy 4 /^ ❑ Service or feeder 600 amps or more.
`'��" FEE. SCHEDULE
.ross street /directions to job site: • Description 1 O I see I Total ) •
~ New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. IL or less 168.54 4
Ea. add'I 500 sq. fl. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential '
DESCRIPTION OF WORK • (with above sq. ft.) 75 2
� Limited energy, multi - family 75.00
-T residential (with above sq. fl.) 2
Services or feeders installation,alter•ation, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT • • : 201 amps to 400 amps 13156 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 t
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 . . • • K : CONTACT..P SON. f..:: above service or feeder fee,
each branch circuit 7.42 2
Business name: B. Fee for branch circuits without '
service or feeder fee, first
branch circuit 61 56.16 2
Contact name:
Each add'l branch circuit 3 7.42 j.2 . x, 2
Address: Miscellaneous (service or feeder not included)
City/StatelZlP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
CTOR lighting 67.84 2
:::: _':CONTRA ,
Sign or outline r
. , ' ' •' , ` ' . Signal circuit(s) or limited-energy
Business name: Hillsboro Electric, LLC panel, alteration, or extension. Page 2 2
Each additional Inspection over allowable in any of the above
Address: 21185 NW Evergreen Parkway #110 Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Tigard Investigation (I hr min) 66.25/hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 439 -9666 Fax: (503) 601 -3680 Inspections for which no fee is
specifically listed (Yr hr min) 90.00/ hr
CCB Lic.: 134481 Electrical Lic.: 34 -499C Su rv. Lic.: y2l�- / S ,, "; g g- 4;.-•:EI CnUCAL ,ERaarF +EES;` s -'' t si7.
Subtotal: ,
Suprv. Electrician signature, required: !, . xiidee_e_4:;, Plan review (25a/o of permit Tex): r --+.
Print name: / e , /� i / ,# Date: 3h 0 D I State surcharge (12% of permit fee):
tesugc�
/ TOTAL PERMIT FEE:
Authorized signature: This permit application expires If a permit Is not obtained within 1 r\
days after It has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
I:' Building\Pamirs■ELC- PamitApp.doc 07/01'10 440.461 ST(11'05/COM•WEB