Permit CITY OF TIGARD ELECTRICAL PERMIT
"14 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00356
13125 S W Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/07/2012
TIGARD . 9 Parcel: 1 S 126BC01506
Jurisdiction: TIGARD
Site address: 9020 SW WASHINGTON SQUARE RD 460
Project: Bjorkland Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: (1) branch circuit for RTU
Contractor: ATLAS ELECTRICAL CONTRACTORS Owner: WISCO REAL ESTATE EQUITY FUND I
4403 SE ROETHE RD 1501 SW TAYLOR ST STE 100
MILWAUKIE, OR 96267 PORTLAND, OR 97205
PHONE: 503 - 659 -2212 PHONE:
FAX: 503 - 659 -4944
FEES
Quantity Description Date Amount
1 ea 12% State Surcharge - 06/07/2012 $6.74
Specifics: Electrical
1 crt Branch Circuits wo /Purchase 06/07/2012 $56.18
Type of Use: COM Service or Feeder
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 9 2 -001- 90. You ay obtain a opy of the rules or direct questions to OUNC by calling 503.232 or 1.800.332.2344.
Issued By: Permittee Signature: 1
O GEC t. I La
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.
Jun. 6. 2012 3:35PM At la ctrical Contractors Inc No. 0476 P. 1 5r
Electrical Permit A 1icatio � �� 101k 01.1.ii i s U5L: ONLY ;rt'k -•
City of Tigard 44 • ii AAA Da t e / B . Permit N. or . , �^ D 3' , (�
,1 g � �� W
13125 SW Hall Blvd., Tigard, OR 97223 JUN 0 6 2012 Plan Review
Phone: 503.718.2439 lax: 503.598.1960 Date/B : Other Permit:
TIGARD Inspection Line: 503.639.4175 CITY OF TIGA9D Date Ready/By: See Page 2 for
Internet: wwv.tigard - orgov n ^ I� ,r c+ Notified/Method: � 0 Supplemental Information
"- Pi J''LC LTVISION PLAN REVIEW
TYPE OF WORK
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit _ 2 Sc's of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OP CONSTRUCTION exceeds 10,000 amps at ISO volts or ❑ Floating buildings,
less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- fhmily C] Master builder 0 Other: ❑ Fire pump. ❑ Installation of 15 KVA or
. JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", E', "1 -2" "I -3 ",
Job no.: 21350 I Job site address: 9020 SW WASH SQ RD, STE 460 10011Pormote. ,. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle par
City /State /ZIP: TIGARD, OR 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
Q Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: y(p 0 1 Project name: 21349- B.IORKLAND ❑ service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Deuriptlon I Qty. I _Pee. I Total I •
— New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1.000 sq. R. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax mop /parcel no.: d __ _ Limited energy, residential 75.00 2
• DESCRIPTION OF WORK • (with above sq. ft.) •
CONNECT NEW RTU Lu
l al (with above sq. ft.) 75.00 2
Services or feeders installation alteration, and/or relocation
('J am ivee C ri - L / 7 , 7L A7 G(, 200 amps or less 100.70 2
- 0 PROPERTY OWNER I 0 TENANT. 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
City /State /ZIP: - Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I 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. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature; „ Date: A. Fee for branch circuits with
. . ❑ APPLICANT. • .. • ® CONTACT PERSON . above service or feeder fee,
7.42 2
each branch circuit -
Business name: ATLAS ELECTRICAL H. Pee for branch circuits without
- service or feeder fee, first 1 56.18 56,18 2
Contact name; CATHY MUNSON branch circuit —
' - Each add'l branch circuit 7.42 2
Address: 4403 SE ROETHE RD Miscellaneous (service or feeder not included)
City/State /ZIP: MILWAUKIE, OR 97267 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 659 - 2212 I Fax: : (503) 659 - 4944 Reconnect only 67, 2
E -mail: cathym@atlaselectrical.com Pump or irrigation circle 67.84 2 —
Sign or outline lighting 67.84 2
.CONTRACTOR • Signal circuit(s) or limited energy
Business name: ATLAS ELECTRICAL CONTRACTORS panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 4403 SE ROETHE RD Additional inspection (I hr min) 66,25/hr
City /State/ZIP: MIC,WAUK1E, OR 97267 investigation (1 hr min) T 665! hr
Industrial plant (I hr min) 78,18/ hr
Phone: (503) 659 -2212 I Fax: (503) 659 -4944 Inspections for which no fee is - 90 hr
X ....13 specifically listed (54 hr min)
C Lic.: 1532 lecirical Lic.: 3 -2C lot(rv. Lic.: 5009S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Su: 56.18
� _ , Plan review (25% of permit it fee):
Print name: TY W SHEPERSKY i &6/6/12 State surcharge (12% of permit fee): 6.74 /
TOTAL PERMIT FEE: 62.92
✓
Authorized signature:
Thu permit application expires if a penile Is not obtained within 180 •
Print name: TY W SHEPER' Y Date 6/6/12 days after it has been accepted at complete.
• Number of inspections allowed per permit.
1: 113uildingiPerniitstELC •PemritApp.doc 07/01 /10 410.1615T(11 /OS /COM/WED