Permit q CITY OF TIGARD ELECTRICAL PERMIT
1 11. = COMMUNITY DEVELOPMENT Permit #: ELC2012 -00246
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/26/2012
Parcel: 2S103DD00800
Jurisdiction: Tigard
Site address: 13815 SW PACIFIC HWY 50
Project: Spec Space Subdivision: MELROSE Lot: 7 -
Project Description: (4) branch circuits for TI
Contractor: ATLAS ELECTRICAL CONTRACTORS Owner: D W SIVERS CO
4403 SE ROETHE RD 4730 SW MACADAM AVE #101
MILWAUKIE, OR 96267 PORTLAND, OR 97239
PHONE: 503 - 659 -2212 PHONE:
FAX: 503 - 659 -4944
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 04/26/2012 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/26/2012 $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 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 95 00 . You, ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. .
Issued By: Permittee Signature: �/ /V /9-70/0/6,"--7-7a."/
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 603.639.4176 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.
•
Apr. 25. 2012 8:55AM �i ontractors Inc No. 9701 P. 1
Electrical Permit A FOu OI'IICE USF. ONLY
City of Tigard pR 2 5 2012 oa,� 9Ag ai Permi °�LC2O /2 — 6/
" 13125 SW Hall Blvd„ Tigard, O 97 Plan R eview
1 C Phone: 503.718.2439 Pax: 503.598.1960 OF n Date/1B ; OtherPermir:
TIGARD Inspection Line; 503,639.4175 CITY OF I T IG A' r D Date Ready/By: El See Page z for
Internet; www.ligard•or.gov BUILDING DIVISION Notified/Method; Supplemental Information
TYPE OP WORK PLAN REVIEW
❑ New construction ® Addition /alteration/replacement Please check all that apply (submit 2 eels of plans whims checked below):
0 Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where site available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings,
less to ground, or exceeds 14,000 0 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. 0 installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION
0 Emergency m. larger separately derived system.
❑Additionof new aewtnolorloadof ❑ "A ","E", "1.2 ", "1-3 ",
Job no.: 21323 Job sitc address: 13815 SW PACIFIC HWY IOOHP or more. occupancy.
❑ Six or more residential units. 0 Recreational vehicle parks.
City /Slatc /ZIP: TIGARD, OR 97223 ❑ Healh -care facilities. ❑ Supply voltage for more Than
/f _ _ ❑ Hazardous locations. 600 volts nominal,
f Suite/bldg. /apt. no.: SO r 'roject name: TIGARD TI 0 Service or feeder 600 amps or more.
c FEE SCHEDULE
Cross street/directions to job sitc: DesuApnoa I Qtr 1 Pee. I Tout I •
. New residential single- or multi- family dwelling unit.
/
CB / J! /A/E X1.4 / % ES Yo e -S 3 /n/7-0 Oi f sei '- Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 168.54 4
Pa. add'1 500 sq. ft. or portion 33.92 1
Tax map/parcel no.:
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq, R.)
Limited energy, multi - family 7S 00 2
PROVIDE ELECTRICAL FOR VACANT TENANT SPACE 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
401 snips to 600 amps 200.34 2
Name: 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 lostallation, alteration, and/o
relocation _
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner Installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. r 401 amps to 599 amps 168,54 2
Branch circuits— new, alteration, or extension, per panel
Owner signature; Date; A. Fee for branch circuitS irirh
® APPLICANT I ❑CONTACT PERSON above service or feeder fee,
7.42 2
_ each branch Circuit
Business name: ATLAS ELECTRICAL CONTRACTORS B. Fee for branch circuits u'frhour
service or feeder fee, first 1 56.18 56.18 2
Contact name; CATHY MUNSON branch circuit
Each add'/ branch circuit 3 7,42 22.26 2
Address: 4403 SE ROETHE RD Miscellaneous (service or feeder not Included) _
City/State/2H: MILWAUKEE, OR 97267 Each l% service a or modular 67.84 2
tY dwelling, service and/or feeder
Phone: (503) 659 -2212 Fax: : (503) 659 -4944 Reconnect only 67,84 2
Pump or irrigation circle 67,84 2
E -mail: ca thym @atiaseleetricalcom Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited energy
Business name: ATLAS ELECTRICAL CONTRACTOR panel, alteration, or extension. Page 2 — 2
Each additional Inspection over allowa in any of the abov
Address: 4403 SE ROETHE RD Additional inspection (I hr min) I 66.25/ hr
investigation (1 hr min) 66.25/ hr
City /State /ZIP: MILWAUKEE, OR 97267
Industrial plant (1 hr min) 18.18/ hr
Phone: 593 659 -2212 Fax: (503) 659 - 4944 inspections for which no fee is
( ) ( ) specifically listed (y, hr min) 90.001 hr
CCH Lic.: 1532 Electrical Lic.: 3 - 2C Suprv. Lie.: 5009S ELECTRICAL PERMIT FEES
Subtotal: 78.44
Suprv. Electrician signature, required: t4 Irrc...A Plan review (25% of permit fee):
—
Print name: TY W SHEPERSKY \ 416•, le: 4/24/12 Stale surcharge (12% of permit fee): 9.41
TOTAL PERMIT FEE: 87.85
Authorized signature: iiJ . This permit application expires if a permit to not obtained Within 180
days after It has been accepted ea template.
Print name: TY W SHEPER Y / �• _ f Date: 4/24/12 • Number af inspecsions allowed per permit,
t:tBuiIdintPerauts ■EEC- PermilApp•Coc 07/01/10 440-4615T(11/OS /COME WED