Permit CITY OF TIGARD ELECTRICAL PERMIT
IA. 2 ' COMMUNITY DEVELOPMENT Permit #: ELC2012 -00213
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/13/2012
Parcel: 1 S134AA01800
Jurisdiction: Tigard
Site address: 10160 SW NIMBUS AVE F8
Project: Black Rabbit Subdivision: IKOLL BUSINESS CENTER, TIGARD Lot: 2
Project Description: (2) branch circuits
Contractor: ALL AMERICAN ELECTRICAL CONTRACTORS Owner: HANSON, RONALD D
PO BOX 1426 ROBINSON, CONSTANCE A
GRESHAM, OR 97030 ROBINSON, CHESTER TRUST ET AL
203604 EAST FINLEY RD
KENNEWICK, WA 99331
PHONE: 503 - 657 -4351 PHONE:
FAX: 503 -496 -3995
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 04 /13/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/13/2012 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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. ATTENT on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0010 rough OA 52- 1 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling . 2.1987 or 1.800.332.2344.
Issued By: Permittee Signature: e''�_.....
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' � � e e y� ' Date:
LICENSE NO. `'°7
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.
V )
Electrical Permit Application O � `ti
Cl of Ti and Received A Per No.:
h' g � A S. q 9 � oaten,Y: y �� F �e4 a o/2 -, ooai3
1 111 1 13125 sW Hall Blvd.. Tigard, 0 Q' 1 Plan Review
Phone: 503.639.4171 Fax: 503- . 960 % ,•1 Plaee/ny: plherPsami ,
Inspection line: 503. 639.4175 Q date Rcady/Dy: ' luris: SI See Page 2 far
I' I t ;,\ It D Y P 0°.( � ,_, Notified /Method: Supplemental information
interne[: www,tigard- nr.gnv --_ , ,.�I TYPE OF WORK G PLAN REVIEW " -
❑ New construction 18t Addition /Alter /r emCnt Please check all that apply (submit / ante of plans w /items checked below);
❑ service or feeder 400 amps or moms ❑ Huildi0 8 over three stories.
E l Demolition a Other: where the available fault current ❑ M;u 11189 and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 Tetra or ❑ Floating buildings.
less to ground, or exceeds 14.000 ❑ Commercial -son agricultural
❑ I- and 2- family dwelling VCnmmercial /in(lustrial [] Accessory building amps for all caber installations. Moldings.
❑ Multi- family 8 Master builder 0 Other: El Fire pump. ❑ Installation of 75 KVA or
.— ° ❑ Emergency system, larger separately derived system.
JOB SITE !INFORMATION AND LOCATION _ o Arkin inn of new man, Inn(' of 0"A". ••E ". "1 -2••, ••1.3••,
1001.1P or more. occupancy.
1 �
Job no.: Job si a address: Ituv,catiunil veh icle arks.
(� 1 � b S •� . � v . W oRs � +$ El Sic or snare resldcrllinl units. ❑ P
City/State/ZIP: vy "t 0n- ❑ Health facilities. ❑ Supply voltage for more than
❑ 1 Lwvdnux locations. 600 %ohs nominal.
Suite /bldg. /apt. no,: ;Project name: ❑ service or feeder 600 amulets or more. -
FEE SCHEDULE
Cross street/directions to job sits: , nrrcriMlvo I Ors. I Ft.. I ,. Tara __r'
i " New residential single- ur mulll- funllly dwelling unit.
i Includes attached garage.
1 0410 sq, R, or less 168.54 4
Subdivision; Lot no.: ... _.....
Ea. ndd'I 500 sq. fl. ur purlieu 33.92 I
Tax map /parcel no.: i • I.imitcd energy, residential
D$SCRIPTION OF WORK (with above sq. 11.) 75.00 , 2
� � Limited energy, multi - family
1
2
94 S 4-o- t;` 2.__ ("- . +-i residential (with above sq. 11) 75.00
�" Services or feeders Installation, alteratlon relocation _
200 amps or mess I 00.7() 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400amps 133.56 2
401 amps to 60n amps 200.34 2
Name: 601 amps to 1,000 amps 301,04 , 2
Address: •
Over 1,000 amps or volts 552.26 E.
7'empnrar services or feeders Installation, alteration, and /or
City /Slate /ZIP: relocation
Phone: ( ) Far ( ) 200 amps nr less 59.36 1
Owner installation: This installation is being made on properly t I own which is not 201 amps to 400 amps - 125.08 2 y
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits new, alteration, or extension, per panel
Owner signature: - .... - _.,•. Dade: A. Fcc for branch circuits with
❑ APPLICANT : ❑ CONTACT PERSON
—
shove service or feeder fee,
7.42 2
each branch circuit
Business name: R. Few for branch circuits wlrhour
service or feeder fee, lint
1 f 56.18 51, -'$ 2
Contact name: branch circuit -__ _ _
- - - Each add'I branch circuit 1 7.42 1 r1- /. -2.
Address: • Miscellaneous (service ur feeder 1101 laclu_kiJ)
Each manufactured or modular 67.84 2
City /State /ZIP: • dwelling, service and/or feeder
Phone: ( ) I Fax :: ( ) - Reconnect only 67.84 2
Pump or irrigation circle 67,84 2
E -mail: Signor outline lighting 67.84 2
CONTRACTOR — Signal circuits) or limited- energy
Business name: AI_ w. 1M fga: (A t 2? w•` 0.04ti i _panel. alternation, or extension. Page 2 2
Each additional inspection over allowable In any of the above
Address_ P. i S 61( � Additional inspection (1 hr min) 66.'!5/If1
-r
Investigation (I hr min) 66.25/ hr
City /5tnte/ZIP: _ ter Die- G `7o3a Industrial plant (1 hr min) 78.18/ hr
Phone: (S03) ( 4 s ) _ S/3 r f Fax: (m o3) `f 9 (0 -- 39 a S Inspections for which no fee is - 90.00/ hr
specililally listed (%r hr min)
CCD Lic.: t ;2.1•70 I Electrical Lic.: 2.6 -ally L Suprv, Lie.: V73/ f ELECTRICAL PERMIT FEES —
Suprv, Electrician signature, required:
Subtotal: 3 r (
, -! ` Plan review (25% of permit fee): $'
Print name: �t 0.-1 1 Date: y ,/ Slate surcharge (12% of permit fee): 3
"_ . I % / TOTAL PERMIT FEE: - 71.2_3
Authorized signature: ii;/ This permit a pplicrtinn expires if a permit is not obtained within 180
Print name: ` • days after it has been accepted as complete. a 9 rr.G r \ s / , Viol Date: • y �� i2 _ • N um b er o f inspections allowed per permit.
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