Permit I n CITY OF TIGARD ELECTRICAL PERMIT
g • COMMUNITY DEVELOPMENT Permit #: ELC2013 -00034
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/16/2013
Parcel: 2S102AB05300
Jurisdiction: Tigard
Site address: 9169 SW BURNHAM ST
Project: Tigard Vision Center Subdivision: KINGSTON Lot: 2
Project Description: (5) branch circuits to install /some remodel cans, sconces
Contractor: MILESTONE ELECTRIC Owner: JB OAK HILL LIMITED PARTNERSHIP
1281 NE 25TH AVE, STE. T 9169 SW BURNHAM
HILLSBORO, OR 97124 TIGARD, OR 97223
PHONE: 503 - 645 -5323 PHONE:
FAX: 503 - 690 -4843
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo /Purchase 01/16/2013 $85.86
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/16/2013 $10.30
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $96.16
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 -0 0. You may obtain a co y of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: i.L off' t/`l.� Permittee Signature:
o/U 4 P, jet - TWU
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. 15. 2013 10:58AM Milestone Electric No. 3328 P. 2
Electrical Permit Application RECEIVE
City of Tigard RDae ° (/ i t,, / 3 S r Permit wo, i -Lad b /3 - 000 34-
7 1 ■ 13125 SW Hall Blvd„ 1 Tigard, OR 97223 JAN 1 5 2013 Plan Review Other ■ • Phone: 5017182439 Fax: 503.598.1960 Date/By:
I ! i; ,\ I Inspection Line: 503.639 C . t r t . V O Dare Ready/1sy; lam' m sae Page 2 for
Internet: www.tigard- or.gov l l i l�1�L Nodfiea/Method: I r(2 Supplemental information
7t 'r v �Wi? i �^nU.4V ,- .c 'r - .1e.••,• . -, ,q. '•i ;I,2P.P`' 7.iV "� -: FArtV'in " ]tea' 17,rr .,Lwa:2 1. •
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❑ New construction !tea • ddition/alteration/repla,eement
Please chock all that apply (submit 2 sets of plans w /items checked below):
❑ Serviot or El Demolition ❑ Other: where the available ble current om ❑ Building
Marinas and boatyards.
:� :, n r r • S''+ I� r1 rii 'F a t . a .4 t exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
r w� 1 �, a te " ATE oll.�Q ` oN r., 5Si^ ' 51'ulrs)6. a ; +(i /I +f $ 19
:c less us ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling Immercial/industrial ❑ Accessory building amps for all other installations, buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
err f p(� 6 Sri /xr r� y e , a.q. , ::= ._rtes' -. ❑Emergency system. larger separately derived system.
of ry i SiiSt��`, ;!.kf, y' e.7 . u� ..- ;' • ,.A l „,,Y.;,. e .!Ps.V. 4�'Y.'ti'�s;:.,�:�.,._" �J,rnfr5^y',
. '�<� ''" . 1.. o•. .,� .a, 'iLf1i�`,unwn.iriLL��,'oFdi � ❑ Addition of new motor load of ❑ 014 ^, "E", "1- 2 ". "1 -3 ".
Job no.: ( op '2, Job site address: q l , f $i„) f1 � N a r� loo or more. occupancy.
v ❑ six or more residetpal units. ❑ Recreational vehicle parks.
City /StaIe/ZIP: n ❑ Healthcare facilities. ❑ Supply voltage for more than
' / t1 ` 7 / El Hazardous locations. 600 volts nominal.
Suitt/bldg. /apt. no.: Project name: V ` ! ❑ Service or feeder 600 amps or more.
r .t1 I f O„ rq a { >. �.rxm ir/z�a , n - , '^ a�3' 9, c° �� /•r;
Cross street/directions to job site: Description ' � 'tA: l: 1 .n.,, T• t � :3a1rr 'E+ ,t 4 ,, '
Qty- Fee IoW • _
New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less _ 168.54 4
Subdivision: I Lot no.: Ea add'l 500 sq. ft, or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
above S9.
r - o' ,r� , .y�.,�; ` /�� t qF ��� E_ '! .... /dl ft.) ) 75.00 2 • ', ;S bS M :�P.; d Vk''' �': ii 44 1 b ?0,, :: �wl1
S o e Limited ener multi- family
r residential (with above sq. k) 75.00 2
-L• n 6'4 / / 9rre At vie I r 04 S„ 5 Con a rl , Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
'TT qq'' �`s � ;O , N?
,°y / '5.i c�'r ° `T ' '' 4. sE: t i 7"tY, ' i
�9 y�' '.:�!�1. ,.. _.,.... �' f,. !.��Y±�R:'k.r'-.•�7f ., .M : 'rhia!:�z•�-Y , � • C ";� �V.wrvtLS'+!�fJ�.l1 „"��,�'.. 201 amps to 400 amps 133.56 2
TT 401 amps to 600 amps 200.34 2
Name. 601 amps to 1,000 limo 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: ( ) I Fax: ( ) 200 amps or less 59.36 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.
Branch circuits - new, alteration, or extension, r panel
Owner signature: Date: A. Fee for branch circuits with
CO '' . ;; i w�� ❑j %.A1Pl°IGJt ' V, MA�i 1 g . ')i� `•i z F ONT 'r �, s. above service or feeder fee. 7.42 2
l'741: •t : 1.......,,..,...... ,� .,... .;'..fiN,p.= '. ^.F..i,!t.:F'7fi. Y. ri. y�. j, 4 ,fj,n,'r�,{..3 :.. '.r�et•4.W�Jly'�' {t t� each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, rust 5618 54 dg 2
Contact name: branch circuit
Each add'I branch circuit 1 y 7.42 Al4, 6 g 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail
•r•, •� r "°r '+ r{ � cry ,. , 4t , rc r Sign or outline lighting 67.84 2
:?12 " ag' , f 'M °'y�,,�•,M.r.1 s` t d>th �' i4.i� 11,'tt r• r + TZ;g
:�. u .7, .. s „1„1- .,�.Lc vc...,; Signal c5rcuit(s) or limited - energy
Business name: Milestone Electric peel. alteration or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 1281 NE 25th Ave. Suite T Additional inspection (1 hr min) 66.25/ hr
City /State/ZTP: Hillsboro, OR 97124 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 645 -5323 Fax: (503) 690-4843 Inspections for which no fee is 9000/ hr
s • s. 'frcall listed 'h hr min
C B Lie.; 153480 Electrical Lie.: 34.618C Suprv. Lis 116 5 „ t ,t..: nE, u ,[g,�F Iy ` 1 \�'' „°
Suprv. Electrician signature, required: ' Sual: .7,5". ,
��.� Pam review (25% of permit btot fee):
Print name: 4,,. / .. S 74 DDate: / 7 7 /3 State surcharge (12% of permit fee): / 0, 3.)
! TOTAL PERMIT FEE: f4,/ 6
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 of inspections allowed per permit.
t: \Suildina∎ ermita\ELC- PermitApp.doc 07/01/10 440_4415T(11/05/COM/WFB
Jan.15. 2013 10:58AM Milestone Electric No.3328 P. 1
Mi 1ictric
1281 N.E. 25th Avenue. Hillsboro, OR 97124 CCB #153480
FAX COVER SHEET
Date: / / 5 / 3 Fax: 5" C • 3 — lg ' t/ 9
Attention: Number of Pages
P er» - { t / . to Follow:
/7
Company: ri /7 a 4 7 . c R e'eff
From: <', / - 57
Message:
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Phone: (503) 645 -5323 Fax: (503) 690 -4843