Permit CITY OF TIGARD ELECTRICAL PERMIT
; 111 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00159
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/22/2012
Parcel: 2S103AB00800
Jurisdiction: Tigard
Site address: 11345 SW WALNUT ST
Project: Bank of America Subdivision: CLYDESDALE Lot: 24
Project Description: Reconnect only.
Contractor: Owner: BANK OF AMERICA
931 CORPORATE CENTER DRIVE
POMONA, CA 97169
•
PHONE: PHONE: 303 -467 -8044
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 03/22/2012 $67.84
Specifics:
1 ea 12% State Surcharge - 03/22/2012 $8.14
Electrical
Type of Use: SF •
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 • 2- 001 -0090. You may obtain a copy of th. . • - I questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: — / _ 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. 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.
Cc)
Electrical Permit Application c4.• FOR OFFICE LSE ONLY
\r� Received City of Tigard ti� Received
City �' Pe • No. _ v
I ll „ib • 1 3125 S W FIaII Blvd., Tigard, OR 97
C Phone: 503.718.2439 Fax: 503.598.1960 Y BOG C^ Other 1'crmit:
c
T I G A R U Inspection Line: 503.639.4175 0` \,\ • Date Ready/By: 65 See Page 2 for
Internet: www.tigard- or.gov c \ '� t �_`fT� Notified/Method: Supplemental Information
TYPE OF WORK , :z ),— PLAN REVIEW
Pleas check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ❑ Addition /alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ® Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION meals 10.000 amps al 150 volts or ❑ floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other 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 "F ", "I - "1 -
Job no.: I Joh site address: 11345 SW Walnut St 100111' or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard OR 97223 ❑ I lealth -are facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: I Project name: ❑ Serviu: or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 99W & 121" Description I qty, I Fee. 1 Total I
*( 1 011 / -Q C r 2 ] New residential single- or multi - family dwelling unit.
`/ 1Y �r ,c tC J L(') � V- Includes attached garage.
Subdivision: Acres .27 Lot no.: 1.000 sq. ft. or less 168.54 - 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: R0470109 Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. It)
Limited energy, multi- family
75.00 2
Electrical reconnect only residential (with above sq. tt.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
® PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: Bank of America / PMH Financial
601 amps to 1,000 amps 301.04 2
Address: Contact: Kristin Bailey -I, I 6 , ,},C /.. .J drt 1/'� Over 1,000 amps or voles 552.26 2
City /SlattJ /_ll': Den Temporary services or feeders installation, alteration, and/or
it 111 /2C,r ll (4.. i ` /. 6 `I relocation
Phone: ( ) 1 1 Fax: ( ) 200 amps or less 59.36 1
703 �( °� _ 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 sale. Ic, , rent, or .xcha . accordi to ORS 447, 449, 670. and 701
1 ^ Branch circuits — new, alteration, or extension, r panel
Owner signature: a , • _ J _. _ 7 / Date: t i /� �/ ``•0 I �. Fee for branch circuits with
above service or feeder fix,
❑ APPLICANT r fv I ® CO I ACT P • . 0 / 7.42 2
each branch circuit
Business name: Rose Country Realty 0 ' ° Fill �1 �<
B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Annie Wrucke branch circuit
Each add'I branch circuit 7.42 2
Address: 2050 Beavercreek Rd #101 Miscellaneous (service or feeder not included)
City /State /ZIP: Oregon City OR 97045 Each manufactured or modular 67.84 2
dwelling, service and/or tier
Phone: (971) 570 - 2216 Fax:: (503) 200 - 1298 Reconnect only I 67.84 67.84 2
' Pump or irrigation circle 67.84 2
E - mail: annie®oregonreo.com Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (I hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City/State/ZIP: Industrial plant (I hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
90,00/ hr
specifically listed (' /• hr min)
CCI3 Lie.: Electrical Lie.: Suprv. I.ic.: ELECTRICAL PERMIT FEES
Subtotal: 67.84
Suprv. Electrician signature. required:
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): / Pi
TOTAL PERMIT FEE: 52''" ~ cie
Authorized signature: This permit application expires if a permit is not obtained within 0
days after it has been accepted as complete.
Print name: I Date: • Number of inspections allowed per permit.
1: laui ldingTermits.FJ.C•PemitAppdoe 07/01/10 440.46t51(11/OS /COMIWL•a
•