Permit ® CITY OF TIGARD ELECTRICAL PERMIT
' • s � COMMUNITY DEVELOPMENT Permit #: ELC2012 00554
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/24/2012
Parcel: 2S 101 DA00104
Jurisdiction: TIGARD
Site address: 13333 SW 68TH PKWY
Project: Triangle Point Subdivision: VARNS ACRES Lot: 9
Project Description: (12) branch circuits for TI
Contractor: BERGELECTRIC CORP Owner: TRIANGLE POINTE LLC
13650 NE WHITAKER WAY 901 NE GLISAN ST, #100
PORTLAND, OR 97230 PORTLAND, OR 97232
PHONE: 503 - 255 -1818 PHONE:
FAX: 503 - 255 -1919
FEES
Quantity Description Date Amount
12 crt Branch Circuits wo /Purchase 09/24/2012 $137.80
Specifics: Service or Feeder
1 ea 12% State Surcharge - 09/24/2012 $16.54
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $154.34
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 5 - 001 -0090. You may obtain Ei co of of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: e � `[ Permittee Signature:
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 FOR OFFICE USE ONLY
City of Tigard Date Bed Permit No.:e /�, ao1 a - 6 705 -
M. o 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Il ��'�� DO'
11
Phone: 503.718.2439 Fax: 503.598.1960 Date /B Other Permit: �J((/'
TI GA RD Inspection Line: 503.639.4175 Date Ready /By: Jura: ® See Page 2 for
Internet: www.tigard- or.gov Notified /Method: 11G Supplemental Information
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
❑ I - and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A "E " - "I- 2 " -"I -3
68th 1001-1P or more. occupancy.
Job no.: 13677 Job site address: 13333 SW 68 Parkway ❑ Six or more residential units. ❑Recreational vehicle parks.
City/State /ZIP: Portland, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Triangle Pointe Lobby ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street /directions to job site: Description I Qtr. I Fee. I Total I •
New residential single - or multi - family dwelling unit.
Includes attached garage.
Subdivision: Yarns Acres Lot no.: 9 1,000 sq. fl. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: 25101 DA00104 Limited energy, residential
6y 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
Alter 11 circuits for TI residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: Triangle Pointe LLC
601 amps to 1,000 amps 301.04 2
Address: 901 NE Clisan Ste. 100 Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: Portland, OR 97232 relocation
Phone: (503)297 -8791 Fax: (503)297- 8997 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
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, per panel
Owner signature: Date: A. Fee for branch circuits will,
® APPLICANT above service or feeder fee,
❑ CONTACT PERSON 7.42 2
each branch circuit
Business name: Bergelectric Corp B. Fee for branch circuits without
service or feeder fee, first 1 56.18 56.18
Contact name: Paul Peterson branch circuit
Each add'l branch circuit I I 7.42 81.62 2
Address: 13650 NE Whitaker Way Miscellaneous (service or feeder not included)
City/State /ZIP: Portland, OR 97230 Each manufactured or modular 67.84 2
� dwelling, service and/or feeder
Phone: (503) 255 - 1818 Fax: : (503) 255 - 1919 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: ppeterson ®bergelectric.com Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: Bergelectric Corp panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 13650 NE Whitaker Way Additional inspection (I hr min) 66.25/ hr
City /State /ZIP: Portland, OR 97230 Investigation (I hr min) 66.25/ hr
Industrial plant (I hr min) 78.18 / hr
Phone: (503) 255 -1818 Fax: (503) 255 -1919 Inspections for which no fee is 90.00 / hr
specifically listed ('/ hr min)
CCB Lie.: 110521 Electrical Lic.: 37 -682C Suprv. Lic.: 5485S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 137.80
•
Pl an rev (25% of permit fee):
Print name: Ken Filips Date: 9.21.12 State surcharge (12% of pennit fee): 16.54
TOTAL PERMIT FEE: 154.34
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number o inspections allowed per permit.
I: \Building \Permits \ELC- I'ermitApp.doc 07,01/10 440- 4615't( I I /05,COM /WEB