Permit p CITY OF TIGARD ELECTRICAL PERMIT
1,
-,'' g' • . COMMUNITY DEVELOPMENT Permit #: ELC2013 00024
T.IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/14/2013
Parcel: 2S112AD00700
•
Jurisdiction: Tigard
' Site address: 14830 SW 72ND AVE
Project: Pioneer Waterproofing Subdivision: BONITA GARDENS Lot: 4
Project Description: (20) branch circuits and (1) 200 amps or less for TI
Contractor: HILLSBORO ELECTRIC LLC Owner: UNION CENTRAL LIFE
21185 NW EVERGREEN PKWY #110 TREASURY SERVICES
' HILLSBORO, OR 97124 ATTN: DIANE THOMAS
PO BOX 888
CINCINNATI, OH 45240
PHONE: 503 - 439 -9666 PHONE:
FAX: 503 - 601 -3680
FEES
Quantity Description Date Amount
' 20 crt Branch Circuits w /Purchase 01/14/2013 $148.40
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/14/2013 $29.89
Type of Use: COM Electrical
Class of Work: ALT 1 ea Services or Feeders - 200 01/14/2013 $100.70
amps or less
Type of Const:
Occupancy Grp:
Total $278.99
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 0 9 2 -001- 090. You�bttaiin a copy of the rules or direct questions to OUNC by calling 503.232.1987 orr 1.8
Issued By: o Permittee Signature: fa( ! eNT 1 44 9&.r
. 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.
Jan 10 13 03:57p p.2
Electrical Permit ApplicationRECEJED FOR i i tic El SE ONI.l
City of Tigard Received AriNialrgil Permit No.: i2 dO /,3- ),
II
13125 SW Hall Blvd., Tigard, OR 97223 JAN 1 0 2013 Plan Review ether Perini �p f� o - s
Phone: 503.718.2439 Fax: 503.598.1960 D.. :
T I G R n Inspection Line: 503.639.4175 CITYOFTIGARD NotiffolUcthod: Supplemental Information
www.tigard oc YPE OF 811 I DING DIVISION PLAN REVIEW
❑ New construction ® Addition /alteration/replacement Please check all that apply (submit 3 sets of plans wTgcros checked below):
❑ Service or feeder 400 amps or more El 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.
❑ 1- and 2 family dwelling ® Commercial/'mdustrial less to grin or exceeds 14,000 ❑ buildings. n r se agricultural
Accessory b uilding romps for a n other installations
❑ Multi - family ❑ Master builder ❑ Other ❑ Eire pump. ❑ ImEallatico of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. m ' separately derived fin.
❑ Addition of load of ❑ °A', "E ", °1- 2", "1 -3 ° ,
Job no.: 8191 I Job site address: 14830 SW 72 ad IOOHP or more. ocamency.
❑ Six or more residential units. ❑ Recreational vehicle pasts.
City /StateiZIP: Tigard, OR. 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg.apt. no.: I Project name: Pioneer Waterproofing 0 Sovice or feeder 600 snips or moss.
• FEE SCHEDULE
Cross street/directions to job site:
Description I Qtr. I Fee. I Toni
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: Ea. add'i 500 sq. ft. or portion 33.92 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
11
Limited reidential (with above sq. ft.)
75.00 2
(with
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 100.70 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 55226 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 5936 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.
Owner signature: Date: Branch .. extension, per peach
Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 20 7.42 148.40 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first
56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: 1 Miscellaneous (service or feeder not included)
I City/State/ZIP: 67.84 manufachmed a mod 67.83 2
) dwelling, service and/or feeder
Phone: ( ) I Fait :: ( ) I Reconnect only 67.84 2
E - mail: P e on circle , 67.84 12
Sign or outline lighting i 67.84 i 2
CONTRACTOR Signal circuits) or limited-energy
Business name: Hillsboro Electric LLC panel, alteration. or extension. Page 2 2
Eaeb additional inspection over allowable in any of the above
Address: 21185 NW Evergreen Pkwy #110 Additional inspection (1 hr shin) i 6625/ hr
City/State/ZIP: Hillsboro, OR 97124 Investigation (I hr min) 6625! hr
Inch strial plant (1 hr rain) 78.181 hr
Phone: (503) 439 -9666 Fax: (503) 601 - 3680 Inspections for which no fee is
90.0W hr
specifically listed (55 hr min)
CCB Lic.: 134481 I Electrical Lic.: 34 -499C Suprv. Lic.: 494IS ELECTRICAL PERMIT FEES
Subtotal: 249.10
Suprv. Electrician signature, required: - _ ' , /i I�; .//'� Plan review (25% of permit fee):
Print name: Joey V itacco ' Date: 01/10/13 State surcharge (t2a/o of permit fee): 29.89
TOTAL PERMIT FEE: 278.99
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: I Date
days after it leas been accepted as complete
,
Number of iospx600s allowed per permit.
t',nuiding,Parcha •LCParnhApp,dot 07/a1ry0 40.l61ST(1 U05/COM/VVEa
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14830 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Electrical
199 Electrical final
03/26/2013 00:00
ELC2013-00024
PASS - No C of O
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14830 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Electrical
130 Ceiling cover
03/25/2013 00:00
ELC2013-00024
PASS
Violation Summary:
Inspector Contractor