Permit CITY OF TIGARD ELECTRICAL PERMIT
:11111 • COMMUNITY DEVELOPMENT Permit #: ELC2013 -00084 •
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/04/2013
Parcel: 1S126DC04700
Jurisdiction: Tigard
Site address: 9575 SW LOCUST ST
Project: Phoenix Inn Subdivision: LEHMANN ACRE TRACT Lot: 5
Project Description: (1) branch circuit for bonding ADA pool lift
Contractor: P B ELECTRIC INC Owner: PIH TIGARD LLC
1108 SE DOGWOOD LN ATTN: JOHN KATZ
OAK GROVE, OR 97267 4 WORLD FINANCIAL CENTER
NEW YORK, NY 10080
PHONE: 503 - 936 -5226 PHONE:
FAX: 503 - 786 -6005
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 02/04/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/04/2013 $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 through OA 9 -001 -0 0. You ma btaiin y of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.3 32. .2 23 _ 44 4. . ] /)
Issued By: `w't_' 2 Permittee Signature: OW � OW C ► / via
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.
02/04/2013 09:17 5037866005 E4D PB ELECTRIC (y- /f 3 sit P�E 01/02 sli
`2 � cn,-->vr� Q CLE 1� 13`� 0
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:. YPT3: OF, WO ' ' 'Please abed( all that apply (submit 2 sets plans o wihms checked below • r `. • • • • ... " ' TIGARD:: Service or 400 ): • DIVISION . amps or t as � >�� es
New construction ,AdditioD/alttaati0 i ;• 1 ti :� � :,�, � ■ � where the available fault eurtent
Demolition Other: exceeds 10,000 amps at 130 volts or Floating buitrbiaga.
• less so maim& or exceeds 14,000 Commw a1.ese agricultural
4 AT EGORY: O F' CO UCI7 : • : : • : '•. ". , : amps for au other installations buildings.
1- and 2- family dwelling Commercial/indusu.lal)< Accessory building Fire pomp. ttramttetiam oils KvAor
Multi-family Master builder A hem large separately derived system.
:.-:21.7.••:.'..••:'::.:.. _ Recreational vehicle occupets
motor of
JOB. Stf : !0EMAtt.IN A100 Q 1001TP or more. m parks,
Xe0C.A71� 1�; Six or more residential twits. 1 v
110.: ob site address: � ^ �pP Y voltage for more than
ob
/ c -) ' S W c -i— s Health rice facilities. 600 volts nominal -
Ilaard l oca d ema
ity/State/ZJP: d Arm /'rr "7 7-2 Service or feeder 600 wove or moan • uitc/bldgfapt. no.: 1' . jest name: ph i lG� .•.� .0 /l ice: SCHR,OT7LE� ., :: '. •
toss street/ directions to job site: New ,reside eiagte or meld- family dwelling mil
Includes attached garage, _
1,000 sq. ft or less 16854 — .
ubdivision: I , n0 Ea. add'l 500 sq. ft. (nixed= 33.92 •
Litimited energy, residential
ax map/parcel no.: 75.00
_kith above so. a)
. .. . . . ' DESCB>P ' TIIN:OP:WORK a Limited eat, multi-family 7500
.
i rn , � 1 Et r2 [ vic or (with above e ll ft.)
• f+ �•S- r Servi or feeders installation, altera4on, and/or relocation
200 amps or less 100.70
; PROI'Elt[ Y.OW(V)EIt 201 awes to 400 amps 133.56
:: ' TE1�IA1V 1?• 401 amps m 600 amps 200.34
+m 501 amps to 1,000 amp 301.04 -
ddless: Over 1,000 amps or volts 55226 .
•
Temporary services or feeders installation, alteration, and/or I
ity /State/ZlP
+'hone: ( ) sic ( ) 200 amps or less 593
s er installations This installation is bale made on property 201 amps to 400 amps 125.0 ,
B p perty that I own which is not 401 amps to S99 Fain 168
' . tended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch eiusuits - new, alter adon, or earhaslon, per panel
a • er signature: A. Fee for branch circuits with
above service or feeder fee, each
i l l , breach circuit 7.42 -
::. .:.. .i ppue . r:= `. CONIAC1P i; ERSON'•r'' 11 Fee for brans h exams withla
I. service or feeder fee, first branch I 56.18 i 4
' usiness name: exraiit
ontaet name: Eetcb'aeid'l branch circuit 7,421
1Vlsceflaneons (service or feeder not included)
• dam Each menu /echoed or modular
—
ity /State/ZfP:
dwelling service and/or feeder 67.84
Rammed only 67.84 ,
hone: ( ) ax : ( ) _ Prm3p or irrigation circle 67.84 .
I -mail: Sign or outline lighting 67.84
. . G : COlin ttt#CJ['ORy , or lim
.. : ::: panel, alteration. or eode,OSion. Page 2 •
I: usiness nom a :� G Faith b addl6onal inspection Over allowable in any of the above
ddl ass: L OK r- t yt,. , Additional inspection (1 by lilt) 6625/ hr
uu v v ul investigation (1 hr min) 66251 in
ity/State/ZIP: YI fr___ e Q e 1 -7 ' I _ ) Industrial plant (1 hr min) 78.18/ br
I' hone: ( 3) " 3 (P - S""' 2 Z - i' ax: (�'Q •� • / r - bons far which no fee is "-Min.
� ]' • �' Co � d Q J specifically listed ('/x hr min)
CB Lies.: % - c - , \ I , uprv. Lie.: T?T:ECTRICAT `PER1K17 `. plr>E5 . .
wry. Electrician gi�0 �— 1 1` Ic r 1 ._ Subtotal III ,
/ ,req Plan re view % of . • fee)
I' • E earn e: //� t /. y * ��� I s ate: .. State surcharge (12% of permit tee) 6 ,
TOTAL PERMIT- a . 2_,- - --
• lrthot7zed signature: This permit application expires if a permit is not ob •. . . within 180
• ' name: / L r ' ../ / + // 1 days after it beta be® accepted as complete
1 1 -e Lc 1a. 2 • • Number af inspection al1nwed prrpermit_
)PJGAI•j :REVW : . .