Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00317
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/24/2012
Parcel: 1 S135AB01006
Jurisdiction: Tigard
Site address: 7800 SW DURHAM RD 500
Project: Kor Subdivision: ASHBROOK FARM Lot: 6
Project Description: (4) branch circuits for TI
Contractor: RELIANT ELECTRIC OF OREGON LLC Owner: METZGER VENTURES, LLC
20200 SE OLDENBURG LN PO BOX 400
SANDY, OR 97055 SHERWOOD, OR 97140
PHONE: 503 -701 -4562 PHONE:
FAX: 503 - 668 -4190
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 05/24/2012 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/24/2012 $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 OA 952 -001 -0 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ► f
Issued By: tilt -tad
Permittee Signature: IN A 14 � 1/4l/ 0 "'
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 503.839.4175 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.
i
5�
I ED •. t �P
Electrical Permit Application) MAY 2 3 2012 ' " li "'' ' I ' ,1 t 1 \ 11
City Of Tigard - )leant( s r g , ��3(
(3125 SW (tall Blvd, Tigard, OR 9727-CITY OF TIGAt �D
Phone: 503.718,2,439 Fax: 503,59109rdh DAM OthotPermit �'1l'wia.�op•
i; , inspection Lirre: 503.639.4175 I� M bale RcadyBy:
IMCmet: www.ligard-or,pv Notified/Method:
TYPE OF WORK - �� PLAN REVIEW
❑ New construction Addition/alteration/roplacement Please thick all that apply (submit j sets of plats wrevme checked below):
0 Service at feeder 400 amps or more Cl Building over three stories.
❑ I)eIr1011Li0n ❑ Offer
eta the available fault arrant Cl Marinas and boatyards.
CATEGORY OF CONSTRICTION exceeds 10,000 amps at 150 sobs or CI Floating buildings.
len ❑ I- and 2- family dwelling 'tommercia/industrial ❑ Accessory building am to g all of ens ons Cl Com agrioalturol
Master builder F � um all other installations. lust .
❑ Multi - family ❑ M
❑ �; q Fire vamp. ❑ inelauatioa of 75 KVA or
J O B S I T E INFORMATION AND I .nr &TIAN Cl Earn oy system. Lugar separately derived system.
lnh no.: ; I 2„.. l r & J UI C3 4,1,11000 u, err. filnvr luau us i. i - A - , --n.... .1.. _ter.
• Jobsitoaddr : . A' ! Al 1aoNpnr occupancy.
(] re Six or mote teafdmrtiaf wire, ❑Recreational vehicle parks.
City /State/ZIP: 7( i je..- i / `7 2-2--) a Health -care &etldes. [] Supply voltage for more (Lao
❑ Neaardotn Inactions. 600 yobs nominal.
e , ldg./apt no.: l E. 0 Project name: K. 0 le 0 Service or feeder 60 amps or more
Cross street/directions to job site: FEE SCHEDULE
oeeeri I Otv. I i.e. J ran.( I •
. New residential single- or mold-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or lass 168.54 4
'lax the _ Pa add'I 500 sq. ft. or portion 33.92 1
p/parcel no.; Limited energy, residential
DESCRIPTION OF WORK (with above sq. It) 75.00 2
i Limited energy, multi- family 75.00 2
'e 1 ii _ . 4- , ariit� :l t� l'� residential (with above sq. ft)
I P , , M n f / Services or feeders installation alteration, and/or relocation
t iv uC 200 amps or Ica 100.70 2
0 ' ' OPERTY OWNER I 0 TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Adore: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/JZIP: Temporary services or feeders Installation, alteration, and/o
• relocation
PhotLe. ( ) l F ax: ( ) 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. 401 amps to 599 amps 168.54 2
Branch eireults- new, alteration, or ex tendon, r panel -
Owner signature; Date: A. Fee ter branch circuits with
0 APPLICANT i ❑ CONTACT PERSON _ above service
branch circuit
f 7.42 2
Business name: ; • ' �,� . - e � B. t=ee for branch circuits wlthow
�`— ' �� ^ .: s ervice or feeder fe o, first
r Contact name: 5 ` , t 1 1�..� kc j — ? \ branch circuit 56.18 l 2
Address: 2.0i �,G Each add'I branch circuit 7.42 2.Z. Z� 2
Js� J11.`7I lJ . ,� Miscellaneous (service or feeder not Included)
City/State/ZIP: p� r'I - � c.. 4}» Each mawlactured or modtdar
t^� >� dwelling, service and/or fader 67,84 2
Phone: 61 ...._4_, ip i l ax :: ( / / I' '- 4. C O Reconnect only 67,84 2
ail. e 0 . 1 .1R - e / 1 /y A y Pump or irrigation chili 67.84 2
Jr CO 1(Z� 1 IO r� I -7.""N Sign or outline lighting 67,84 2
Business name: Signal circuit(s) or limited- energy
alte el ret
man_ - iory_ ar extension Paget 2
Each additional inspection over allowabk in any (tithe abov
Address: Additional inspection(' hr tam) 66.25/ hr
City /StateJZ
/ - . / Investigation (1 hr min) 66.25/ hr
l/ ���� ,� „ r � pL (1 hr mm) 78.18/ hr
}� Phone: ( 'tA F 'S". ) r inspections for which no ft a is
" '
CCB Li'.:' $ L /Electrical Lic_' 4 h , S ' . specifically IiatodiR hr min) 90.00/ hr
F,LECTRICA PERMIT PEES
A `� Suprv. E trician si: , required: Subtotal: , "� 8
w Plan review (25%of permitfee): . Print name: $ „ / B1 4 1 1 Date: F _ State surcharge (12% of permit fan); L t7 Authorized signtlture: _ TOTAL PERMIT FEE:
- / 1 1 � I. . • 4'Y\ This permit appliatioa =area a permit ie not • • o 1
` ��
�} G^ days after it has tea! accepted u mm p�
mnia
Print name: l� n Vra, t h tt / Date: 5 — . ,3 --i • Number of inspections allowed per introit. f
it. a
1:1Dull t tm.0 -r Arv.dee: 071,/10 •40461srp In vp,H fuser
•
•
Z /Z ' 39Kd 06T17899£09 0b8a0 30 0zal0aTa quETTag hid 817:Z0 ZTOZ•£Z'AEW