Permit . CITY OF TIGARD ELECTRICAL PERMIT
t COMMUNITY DEVELOPMENT Permit #: ELC2012 -00233
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/24/2012
Parcel: 1S133AD16200
Jurisdiction: Tigard
Site address: 12700 SW NORTH DAKOTA ST 180
Project: Spec Space Subdivision: 1995 - 073 PARTITION PLAT Lot: 3
Project Description: (6) branch circuits for lights, plugs and switches
Contractor: BOB'S ELECTRIC Owner: PACIFIC CREST PARTNERS SCHOLLS L
2700 NE BURTON ROAD STE A 7000 SW HAMPTON ST, STE 130
VANCOUVER, WA 98662 TIGARD, OR 97223
PHONE: 360 - 254 -7200 PHONE:
FAX: 360- 254 -8219
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo /Purchase 04/24/2012 $93.28
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/24/2012 $11.19
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
•
•
Total $104.47
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 9 . You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permutes Signature:
p.cl .9-1,/ /C4-770 �v
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.
FROM (SAT >APR 21 2012 6:10 /ST. 6: 08 /No. 9302926680 P 2
Electrical Permit Application r/ (fit ( ) . H ( . I I ( : \ I . \
City of Tigard '5
., ®
0� ,L�1'L m �1�., Permit No e i ®G23 •
: II -- 13125 SW Hall Blvd, Tigard, OR 9 .. ` �p h O y ,
Phone: 503.639.4171 Fax: 503.598.1 • •r % . t ,? . ,.; ;,:,
lie ,: ot'rr Permit:
Ins Line: 503.639.4175 VC \'S. li7 See P 2 for
Internet v/arw: 503.639.4175
(3 � .�.,: to
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El New construction : Addition/altemtion/ • ' t Please cluck all that apply (submit l sets of plans w /itean checked below): N
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑Other
where the available fault current 0 Marinas and boatyards.
1iT . , v exceeds 10.000 amps at 150 volts or ❑ Floating buildings
`• - -' ti leas to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ® Commercia]industriai ❑ Accessory building amps 63r all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other ❑ Fire pump. ❑ Installation of 75 KVA or
' ` l' „« ..,.. :. ...,s ❑ Addition of new load of 0"A", "E" separately " 1_ - 3' , system.
Jobno.: 12 -488 Job site address: 12700 SW NOrth Dakota St. 100HPorroam. occupancy.
❑ Six or more residential units. ID Recreational vehicle parks.
City/State/ZIP: T i • and OR 97223 u e ' ❑ Healthcare facilities.
0 Supply voltage for room lion
❑ Hazardous locations. 600 volts nominal.
SuitelbldgJapt no.: 0 Project name: ❑ Service or feeder 600 amps or rmre
l is 1 x ; -
r . .33_ ... .
Cross street/directions to job site: theme tar Fes Tent r .
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no
Es. add'l 500 sq. ft. or portion 33.92 1
r a Limited energy, residential 67.84
(,.1I _,.:1r: ,, (with above coq. ft.) 2 • 6 clots for li hts, plugs switches r Co multi-tinnily 67.84
$ P $ residential (with above sq. R)
Services or feeders Installation, alteration, and/or relocation
200 amps or less 100.70 2
: F r x
`F*.i,: ,1 ' L.; _ ..?,.n r:: L - ..':..r: s ;.,:r .,v .> . 7.. : Lv �`.' 201 amps. to 400 mops 133.56 2
401 amps to 600 amps 200.34 2
= ' 601 amps to 1,000
amps 301.04 2
Address: 12700 SW North Dakota St. Ste. 180 Over 1,000 amps or volts 552.26 2
City/State/ZIP: services or feeders Installation, alteration, and/or
Ti: and OR 9722 relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 I 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 1 1 123'08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168. 2
Brandt clrcalls— new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
'I J 'll , '
each branch or feeder fee,
.. x. .,..., . 7.42 2
". circui
Business name: B. Fee for branch circuits without
service or feeder fee, fist 1 56.1E 56.18 2
Contact name: branch circuit
Each add'I branch circuit 5 7.42 37.10 2
Address:
Miscellaneous (service or feeder not in cluded)
City/State/ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
•
�� u Sign or outline lighting 67.84 2
t24 ;�, i' 4, P 1 :. r, b ' - ,7 z ", 1, . i t s ' ". wall l z � 2 0 ' :
_ - , ,: � .. . . �.5._:... <_ r >; , "f i : •_..: � . _ S c ircu i ts) or l energy
Business name: Bob's Electric panel, alteration, or extension. Page 2 2
Each additional Inspection over allowable in any of the above
Address: 2700 NE Burton Rd. Ste. A Additional ) 66.25/hr
inspection (1 hr min
City /State/ZIP: Investigation (I hr min) 66.25/ hr
I • • • • Industrial plant (1 hr min) 78.18/ hr
.hOne:( -7200 Fax ( 60)254 - 8219 Inspections for which no fee is 90.00 /hr
Electrical 8call hated fibrmm
Lic.: 7 Suprv. Lic.: 4 3225 ° r t " tea
Suprv. Electrician signature, reci Subtotal: 93. 28
Plan review (2536 of permi &:e):
Print name: Kevin Broselle Date: 4/20/12 State surcharge (12 %of permit foe): 11.19
Authorized signature: TOTAL PERMIT FEE: 104.4 7
Thb permit application expires If a permit la not obtained within 180
Print name: days after It has been accepted as complete.
Date: • Number of
inspections allowed per permit
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