Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00659
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/10/2012
Parcel: 251 01 AB00100
Jurisdiction: TIGARD
Site address: 12017 SW 70TH AVE
Project: Dr. Sepehri Subdivision: Lot:
Project Description: TI
Contractor: PROMEX CORP Owner: RED ROCK BUSINESS ASSOCIATES LLC
910 W 11TH ST STE B 23077 SW NEWLAND RD
VANCOUVER, WA 98660 WILSONVILLE, OR 97070
PHONE: 503 - 384 -0400 PHONE:
FAX: 360 - 693 -5757
FEES
Quantity Description Date Amount
38 crt Branch Circuits wo /Purchase 04/10/2012 $330.72
Specifics: Service or Feeder
1 ea Plan Review Electricial 04 /10/2012 $82.68
Type of Use: COM 1 ea 12% State Surcharge - 04/10/2012 $39.69
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $453.09
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 100 days of issuance, or if work is suspended for more the 180
days. ATTEN . • . •n law requires you to follow the rules adopted by the Oregon Utility Notification • Center. Those rules are set forth in OAR
952- 001 -00 • th ugh OAR 9 -r : -0• • • ou may obtain a copy of the rules or direct questions to OUNC by calling , 59,3.2371 1 387 or 1.800.332. 44.
Issued ;y: 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:
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.
Electrical Permit Applicati n � : — < r':v,,is, rOR omit 1. i III O\1..) /) /,,
il 41 City of Tigard a e.9 /i , ! PermitN /. `,, vf
13125 SW hall Blvd., Tigard, OR 97223 Plan Review _ I
a Phone: 501718.2439 Fax: 503.598.1: j V 2 9 2011 Date/By: 4! w 12. GIN Other Penn'r
TI G A i i iD Inspection Line: 503.639.4175 Date Ready/By: , J . J IB kris: ® See Page 2 for
Internet: www.tigard or.gov �, ;.�� p Notified/Methud: / Supplemental Information
TYPE OI'WORIC'' !, , ;y ;, tf' PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply (submit 1 sets of plans w /items checked below):
❑ Service or feeder 400 amps or mom ❑ Building over three stories.
❑ Demolition ❑ Other: When the available fault current ❑ Marinas and boatyards.
CATE(ORY 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 i�]Q� 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. separately derived system.
13 Addition of new motor load of ❑ "A ", "E", "1 -2 ", "1 -3 ",
Job no.: Job site address: i a, ( ' j 1 7 s t,0 '70 ,4,, , J00HP "more. ICY.
❑ Six or more msidential units. ❑ Recreational vehicle parks.
City/State/ZIP: J. ♦ () g- , ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: Project name: `Zo p�,- f D-e»n� 1 ❑ Service or fa m
der 600 amps or mo.
- �� FEE SCHEDULE
Cross street/directions to job site: ��,r ,„,..0 till E 72 11-a Desatiption I Qtr. I Fee. I Tom I •
New residential single- or multi- family dwelling unit
Includes attached garage.
Subdivision: 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.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
T1 residential (with above sq. ft.)
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
A 401 amps to 600 amps 200.34 2
Name: RA v.. `. 6 t/1
1 601 amps to 1,000 amps 301.04 2
Address: 8 9 '30 Sc....) j // 9 /yd r 5 I `G r Over 1,000 amps or volts 552.26 2
i Temporary senvtces or feeders Installation, alteration, and/o
City /State/ZIP: 'r g d o g 97 ZZ 3 relocation
Phone: (5 7 c.f 7 70 r -4 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
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 I 0 CONTACT PERSON above service or feeder fe
3 7.42 2711.59 2
n
( each branch circuit
Business name: - 4 -- /v► as -�-. p�� a g Q � p y1 B. Fee for branch circuits without
service or feeder fee, first I 56.18
Contact name: /.14.16 r 4. /< branch circuit
Each add'I branch circuit I 7.42 I r 1$ 2
Address: /�i �1 I� Miscellaneous (service or feeder not included)
City /State/ZIP: Y • 11 / Each manufactured or modular 67.84 2
�. dwelling, service and/or feeder
Phone: (S ) r Fax :: ( ) Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Pf0 rt , l .Q x e panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: q I p 6 ,...) //11 5/ ee f- 3 Additional inspection (1 hr mm) 66.25/ hr
City/State/ZIP: V ct.i., i o V y e , ^ f A 9 8 6p (, o Investigation (l hr mm) 6625/ hr
, Industrial plant (1 hr mm) 78.18/ hr
SO$one: r3;1714.3 S OCcO 0 l Fax: (.2/ 0013_ Y-75- y' 7 Inspections for which no fee is 90.001 hr
i r} � S specifically list (5C fir min) �d , — 7"
CCB Lic.: (-72 r" Electrical Lrii.: -
2 , $ Suprv. Lic.: . ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: �/ ' pi' I /13/1 h Subtotal :,,.
Plan review (25% of permit fee): 6i' C V
Print name: H AR �.'T Date: State surcharge (12% of permit fee): ,31,(
Authorized signature: J TOTAL PERMIT FEE: S �
This permit application expires if a permit is not tim ed within 180
Print name: days after it has been accepted as nom ter ! ` J
Date: • Number of inspections allowed per permit. 2/S , e) c7