Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00288
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/21/2012
Parcel: 2S115AB00200
Jurisdiction: Tigard
Site address: 16082 SW 113TH AVE 8
Project: Woodspring Apts Subdivision: WILLOW -BROOK -FARM Lot: 25
Project Description: Units 121, 122 due to fire reconnect
Contractor: SQUIRES ELECTRIC Owner: WSTPI LLC
1001 SE DIVISION STREET #1 4260 GALEWOOD ST #A
PORTLAND, OR 97202 LAKE OSWEGO, OR 97035
PHONE: 503 - 252 -1609 PHONE:
FAX: 503 - 253 -5831
FEES
Quantity Description Date Amount
2 ea Reconnect Only 05/21/2012 $135.68
Specifics: 1 ea 12% State Surcharge - 05/21/2012 $16.28
Electrical
Type of Use: MF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $151.96
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 O • ' 2- 001 -0r 0. You may • btain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
n
Issued By: I - 1 _ Permittee Signature: Q ^I 4 PiPLI 64-77.0k1
1&
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.
,„..-
05/17/2012 14:51 5032535831 SQUIRES ELECTRIC #1522 P.001/002 -.) c /
Electrical Permit A licati EcEivED FOR ()FACE USF. ONLY
City of Tigard Received
Dlite/13 : 5' *r" Permit No,.e,Le 0 1 . 0 eg ),.. 09;_if
,111 .,..- " 13125 SW Hall Blvd.. Tigard. OR 9722MAY 17 2012 Plan Review 1=211111111111111111
: Phone: 503.718.2439 lax: 503.598,1960 . Dinc/R 1
TIGAR Inspection Line: 501639.4175 CITY OF T1GAPD Dale Ready/By: El See Page 2 for
Internet: www.tigard-orgov lipt\n r:1,:1:1()Ni NotifledUctbod: UM Supplemental Information
.- ;. -' -t : . - ' ' . ; •t : ',.. :. 'T . E . .. - ifR..': '' '. : :g,,: C: .4 ; .*)i.,Lkqk'Ni.A3.4:RW.';..':.i ' : i :; : ' ; : . . : :4',: % ': ' ;::! . .47 , 1 r :a; :. .. : ; : .... :!: '.. : : : ' S. ‘.. • ••• :1. •14 41- W.IM.: 7 k'•:'• 7 ' , :;• <r•P''''. .. ::". ".: T.
Please check aft that apply (submit 2 sets of planb w/itcms choked btlow):
0 New construction NJ Addition/altcrarion/replaccmcnt
0 Service or feeder 400 amps or more EI Building over three stories,
0 Demolition 0 Other: where the available fault current 0 Marinas and I
'"" .. k:-.:--... • ';' . ';'. 'alidWili.'tbi '..':'''-'::.. ..;"' '.. .' I.': .. exceeds 10,000 amps at 150 volts or El Floating buildings.
lass to ground, Or exceed:: 14,000 1:1Commercial-use agricultural
0 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building pmps for all other utstalluttons. lun Win g.5.
& 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
..44--: . ."kl
- ii‘.. iell 4O -
iRMAT itik
.' 'D tOtATIOM :...1 El Emergency system. larger separately derived system. system. . :'::5::::' :.- 1.:1':'.-. ':...'••• ' '...... ,.,-. , ' •. ,..::.t . • ....,-- ,,,....:...*,:',.1.-..---,-..v- - -,... :.:....-;.- .......1:,:' - .' . 1 - . : - ; . 1 .. 0 Addition of new motor load of
0 "A "E", " 1.2", "1-3",
Job no.: Job site address: 1 6 0 SW 8 i 44e. 0 tOOHP or more.
Six or more residential units. 0 occupancy.
Recreational vehicle parks.
City/State/ZIP: Mogi
of % 09' ‘71.72a 0 Health-care fseilides.
0 Hazair.lous tix.vi ions. 0 Supply voltage for more than
600 volts nominal.
Suitc/bldg./apt. no 1 U t zm Project name: 0 Service or feeder 600 amps or more.
46 I I ...:•:.:i;... tkfrii t..,..::..4
Cross street/directions to job site: , Description I Qtv. I Fee. t _ Total 1 •
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: [Lot no.:
1,000 sq. ft. or leSS 168.54 4
LA. aad'I 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
- .. ... . .
-. ..: ' : '. f . g .". '. :( ..'': :: '.. :- . ; : .., .....:. " as::: ; .** 1 301Q 1 1'.. ,15 g ? .*ORg' ' 'f 4`: . with at3vSaU-----.75.00 2
• Limited energy, multi-family
75 00
1
A residcntial (with above s ft.)
it._ ., f. t - Gm . — • I _T:. ... t % Mk,
Services or feeders installation, alteration, and/or relocation
X I' it - . -t \VP- E)c 4P —ir. / 7E 200 amps or less 100.70 I 2
•::''':,'• ;:i : " .7.-, l..a;00:11tfti.Y, .01:01ffiliPM .4.:, "7- :! I tk o tf#,....... :.-':::.: :.: 201 amps to 400 amps 133.56 2
401 amps 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
' — Temporary services or feeders installation, alteration, and/or
City/State/Z1P: . relocation
Phone: ( ) 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
401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, arpanel
Owner signature: Date: A. Fee lbr branch circuits with
'".. '' '. '.. - • V. ,' 'v.,: •1:,:■.;:• , ai , s.' '7% • •.V.' :*•••;- • ••••• •-r, •;-.■•••:•■• • • ,---• ';,
•;,,,-.: 7) 4 • • •• t• '• '. • above ServiCe Or feeder fcc '-'"'-' ':".- - • • • , - -APPauCAmt. F 'e •••-^:‘ '. 4,...- -7 1_1 , CLArti ACT TEitbN ...... --• -. 7.42 2
each branch circuit
Business name: t i a i tec C‘et.o ‘ v... v 1 1ft c . B. Fee Co r branch circuits without
serviCe or feeder fcc, first
-- 56.18 2
a
Contact name: ) be_ • 1 fte branch circuit
S
— Each add'I branch circuit 7.42 2
Address: 1 Oalia 0 14 vs i cv SA... ( 0.. 1 ..N (service or feeder not included) _
City/State/Z1P: v or .t rat 4 ()9._. GI 7z2 . I Each manufactured or modular
dwelling. Service and/or feeder I 67.84 , 2
Phone: - ... 1 _ a ' Fax: : ip , =IA Reconnect only 2 1 67.84 2 2
. - Pump or irrigation circle 67.84 2
E t , ii , • % ' e IL.. Coon I Sign or outline lighting I 67 84 2
7 , ......?4': ..........,4*:-..-7 - ::.' : .7...'..;-" ..,i'"'. ..,6t.fMCT07*! ' ..,.::-' • . .:57•='• J I Signal circuifts) or limited.energy
panel, alteration, or extension. Page 2 2
Business name: ag like . _ Each additional insisection over allowable in any of the above
Address: 1 QQA .15S. 0 Ni i s i■ ov , d s ece. a4 1 Additional inspection fl hr min) 66.25/ hr
, Investigation (I hr min) (,6.25/ hr
City/State/ZIP: 901A OrA. a a sx. q 7767 I Industrial plant (I hr min) • 78,I1V hr
- —
Phone: 4565 )2 V.), .- 16 cyi I Fax: (06) 2 3. T-e i Inspactions tbr which no fee is
specifically listed ch. hr min) 90.00/ hr
J ,
.cca Lic.: tSec)-4 Electrical Ag i f ,- _ ., i , 6 xprv. Lic.:. .. ,,4f.,.. : .:.c ''---;
• 5 hill t, Subtotal: ‘7)5. (ow
Suprv. Electrician s .'• .tu- , required:
I F Plan review (25% of permit fee):
Print name S [ Date: tyl 1//2. State surcharge (12% of permit fee):
. _
TOTAL PERMIT PEE. 161A6, V
Authorized signature: • This permit application expires if a permit is not obtained within 180
— ..
days after it has been accepted as complete.
Print name: Date: - Number of inspections allowed per permit.
Liouileing‘rcrinittiFIC-PermilApp.aoc 07/01110 440.4615T( II/OS/COM/WEB
05/17/2012 14:51 5032535831 SQUIRES ELECTRIC #1522 P.002/002
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
° Payment Authorization Form
13125 SW Hall Blvd. • Tigard, Oregon 97223
T I GARD Building Division: 503.718.2439 • Planning/Engineering: 503.718.2421
Fax: 503.598.1960 • Internet: www.tigard- or.gov
Permit No.: `
Job Site Address: O Z 5 l 1 0j � .,
Project Name: W A •
Credit Card Informati • n: Please print clearly.
ISA ❑ MasterCard 2 (p 5 ! t3 6 0 20
❑ Discover (credit card account number)
Expiration date: 07 /1 4
Cardholder name on card: •
Contact phone number: )O3 — 252 - I 6
Billing address for this card: l od t 5z 01 V vS t an sk . 1
Billing ZIP code: 49 72 o 2
Trust Account Information: For permit fees to be paid from established trust account.
Trust account number:
Contractor /Business name:
Contact phone number: T.
.l hereby give the City of Tigard permission to pay for the above referenced
permit with the credit card or trust c ount rovided above.
Authorized Signature:
Name Printed:
Date: C, i (7 12„ —
Please FAX this completed and signed form to 503.598.1960,
* ** DO NOT EMAIL THIS FORM. ***
For your protection, this form will be destroyed after your payment has been processed.
1 :\ Buildin \Foal ArnymcntAurhnrikaiun_u3141? dnc
5/2 May.25. 2012 2:02PN6 PGE -TCC QUAD A SQUIRES ELECTRIC No. 2407552P. 1 /1/oot
, ' May. 24. 2012 2: 58PM PGt: -I CC QUAD A No, [sY r. I
' ,s> Request to ;nergize an Electrical Installation
5 ' ' 4, Ju address: J
rrV pbe RECEIVED
54Ul5 x07) 2153-- s5 1 3 7012
i '- :i -„ g - _ i i.'I ... E Q RMAT - 1=- #};�I_;41j> � .;IIJk`
_ :may= �,,: - '�,� :...._ ._ - Q � �Sl)P R �WA �h1= = . :- : :;�,'`;� =-'. . � N
Name . fsupetvising electrician: Date of re ut lIJ I , '.` ' (% e.
Su 'sin electrician's license number. �'
Supe g � , 1 Date Installation was completed: 5 0/
near'. at tno.• _ i e A _ , it ' . �i,�. permit is posted or the ob :sno, please Include a copy ii wish Mk form. a
. 4 = : - - 6 A • ' • r a I , e ELEO M t e I - fR I • N T R A C - i ' G F INF . TIQN , . as. ;M.0 ' . =_ Name 1' electrical contractor: . .. , IP License no,: !
Buslne. address: lie '"'' _ __-an. �+,, • 'N _� i • ,
UP ll. a ■ t . ..4 f. State: a ! VP: - tfi; ii Phone: _ - - Fax: ' E-
' - E mail:: A %.7 y _' f e4.1 P II a �3
Cus . : is name: 4 a g' b t A. . i ro
Custo,n er's address: , • : , t .42 ' . `'
City: I st, CLic State: /512_ . ZW: A .1! 1
Addres : of I . tallation if different than customer's address: _ _
Cit Stater , ZIP:
-- 4'
'st ; 5'w.. � 6 Ia�.► t'Atty. r e ,UlHoRi. - - == IN _, a_ .1 : T Q :. =: IRAT � - '4 - ' - .I ' J TE.
Audio ty havingjurisdiction to inspect: _ A V. , r i . / (kr , Phan: 7 • - !'—
Address: 1 31 - 2-s g (� 4�i' t ! • ' - -
City: i a`( State: � zip: .
Name g electric utilit re ceiving request: p rr Phone: - -
Addre :: . _
Cit - State: ZIP:
hS v •. , . :� ^` _ - !tea - ._ I 1�'rl. -'-ii 'r
�ar :�: - Y i. a .._� _- _ .a.. . , I. { .Y, 1 . - � Q • _ .. .. .. - __ -r I..' ,
A. ' taring electrical service that . - inteuvpted or disconnected because of either a:
III Service change or 11 0 ncontrollable event, such es flue, flood, or severe weather;
or
B. El • tricot service at a remote location needs to be: .
I Initialized 0 Restored
TrAr. '`fir 'i LI :11 0, Z 7 - • 9. . F:5: _WAND:.z 5 • -r-'- a. =E• W;.±. 2
Supe ':' 1 g electrician ) lectric contractor
Pleas : note —After sending this form to the electric Please note — By close of business on the first business
utili named above, you mast send a copy of this fowl to: day, following energizing of a completed installation in •
(1) the electrical contractor, (2) the customer, and (3) the response In they above request, you must: (1) notify the •
inape , ting authority. authority havhlg jurisdiction that the installation has been
•
energized, and (2) request that the authority inspect the
\ � 0 completed Installation.
' ape -l e i k - 7 " n's nature _ Date • -• - --
If ii 41 ,
• I •
•
440-0948 1(9108!C01.1 •
rAAACOi0 1 AY .A4 IAA1A Ie - ,.A morn run. • - .e. MYC /A AAI