Permit CITY OF TIGARD ELECTRICAL PERMIT
e COMMUNITY DEVELOPMENT Permit #: ELC2012 -00410
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/25/2012
Parcel: 1 S126DB02800
Jurisdiction: Tigard
Site address: 9735 SW SHADY LN 307
Project: Dr. Weinberg Subdivision: 1991 -018 PARTITION PLAT Lot: 1
Project Description: (1) branch circuit Reconnect RTU
Contractor: WILLAMETTE HVAC Owner: FRANKLIN COMMONS ASSOCIATES, LLC
3075 SW 234TH AVE. #206 BY NORRIS & STEVENS
HILLSBORO, OR 97123 621 SW MORRISON STE 800
PORTLAND, OR 97205
PHONE: 503 - 259 -3200 PHONE:
FAX: 503 - 848 -2597
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 07/25/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/25/2012 $6.74
Type of Use: COM Electrical
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 thro O • ' .52 -00 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 84.80 33 . 344.
Issued By: • _ _ - _ Permittee Signature: X
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.
Electrical Permit Application REC I1I . FOR OFFICE USE ONLY
/' �il
City of Tigard "'` ceived
Permit No.:L„g4 G �j« _ w itty
7 ° 13125 SW Hall Blvd., Tigard, OR 97223 2 Date/By:
JUL 1 2012 Plan Review f / /�
I ` • Phone: 503.718.2439 Fax: 503.598.1960 l Z - Date/By: �✓ 'rT Other Permit ee aa..03
T I G A R D Inspection Line: 503.639.4175 CITY OF TICARD Date R /Meth : 2� AZ n .!, tun ' �r ®S ie Page 2 for
Internet: www.tigard- or.gov N o t ified/Method: /� (tJ Supplemental information
1.I i "\ , a ,f =i r :r 1'01.7
TYPE OF WORK ° PLAN REVIEW
❑ New construction ® Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the 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 ❑ 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. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
Addition n
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: 1 Job site address: 9735 SW Shady Ln i 00HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: 307 I Project name: Dr Weinberg ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I 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
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
Reconnect RTU 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 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 /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
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, er panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: same as below B. Fee for branch circuits without
service or feeder fee, first 1 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
Y dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: Willamette HVAC, LLC panel, alteration, or extension. Page 2 _ 2
Each additional inspection over allowable in any of the above
Address: 3075 SW 234 Ave Suite 206 Additional inspection (1 hr min)' 66.25/ hr
City /State /ZIP: Hillsboro Or Investigation (1 hr min) 66.25/ hr
Industrial plant (I hr min) 78.18 / hr
Phone: (503) 2593200 Fax: (503) 848.2597 Inspections for which no fee is 90.00 / hr
. specifically listed (%] hr min)
CCB Lic.: 56951 Electrical Lic.: 34346CRE Suprv. 4025LEB ELECTRICAL PERMIT FEES
y1 � Subtotal:
Suprv. Electrician signature, required: �(I .44, Plan review (25% of permit fee):
• Print name: mike sicard n Date: 7/12/12 State surcharge (12% of permit fee):
TOTAL PERMIT FEE:
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: michael malstrom Date: 7/12/12
• Number of inspections allowed per permit.
I:t Building \Permits\ELC- PermitApp.doc 07/01/10 44046t5T(tt/05 /COM/WEB