Permit •
CITY OF TIGARD ELECTRICAL PERMIT
,,
e • COMMUNITY DEVELOPMENT Permit #: ELC2013 -00145
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/05/2013
Parcel: 1 S135BD00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST 575
Project: Spec Space Subdivision: ASHBROOK FARM Lot: PTS 5 &
Project Description: (2) circuits for TI
Contractor: DYNALECTRIC Owner: SUN LIFE ASSURANCE CO OF CANADA
5711 SW HOOD AVE BY NORRIS BEGGS & SIMPSON
PORTLAND, OR 97239 121 SW MORRISON ST #200
PORTLAND, OR 97204
PHONE: 503 - 226 -6771
PHONE: 503 - 352 -8113
FAX: 503 - 226 -7720
FEES
Quantity Description Date Amount
2 crl Branch Circuits wo /Purchase 03/05/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/05/2013 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speci- • .des and all other applicable law. All work will
be done in • • -• •a ith approved plans. This permit will expire if work is not started within 180 days issua ce, or if work is suspended for more the 180
days. AT NTION: Orego law requires you to follow the rules adopted by the Oregon Utility Notifi •tio +-nter. Those rule -re set forth in OAR
952 -001 • , 10 through OAR 952 % -0 may obtain a copy of the rules or direct questions to OUNC by calling '03 '.M ;7 or 1.800. . 344.
r �//
Issued : Permittee Signature: a
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'
4 //� r 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
11111 .. City of Tigard Received g ��� Permit No.: 2 ` /l 5... 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
TI G ARD Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction 21-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 JaCommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
_
JOB SITE LNFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "l -3 ",
Job no.://AogA site address: 9bee i oet.4. 100H more residential occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: j ❑ Health -care facilities. ❑ Supply voltage for more than
�9Qy ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: - S 7 3 Project name: .F Zq. ,_ t vez,/_ev e y 7 , ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Ott. I Fee. I Total
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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
/ residential (with above sq. ft.)
,5/0 y �/ r /" Services or feeders installation, alteration, and/or relocation
I ` - i e /` 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:
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 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
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, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT - CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: �� / l ` Q � ,, B. Fee for branch circuits without
[Y service or feeder fee, first 56.18 1� 2
Contact name: �. � Cam / ‹� branch circuit
< Each add'I branch circuit 1 7.42 7 4-,q 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
tY dwelling, service and/or feeder
Phone:,( 25) a 7 7/ 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
y panel, alteration, or extension. Page 2 2
Business name:
.e� v Each additional inspection over allowable in any of the above
Address: ? ,/f S .) 01/49/ ‹. Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Af 9 74. g Investigation pn ( min) 78.28/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: 53) ,, 7 7 � I Far. (503) aa, 7-7„›,e, Inspections for which no fee is 90.00/ hr
specifically listed (% hr min)
CCB Lic.: a 6 793 I Electrical Lic.: V `x/71 Suprv. Lic.: L1 17- S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: (/r �� '/` /o(! ('I3 Subtotal: Z /
q Plan review (25% of permit fee):
Print name: 20642 (4-- W..t I Date: -13 State surcharge (12% of permit fee): 74.3
TOTAL PERMIT FEE: ' .. .3
Authorized signature: 4 111111110 , - _ i 4.e...-0/ This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: -" - Date: _.5 • Number of inspections allowed per permit.
I\ Building \Permits\ELC- PermitApp,doc 07/01/10 440- 46t5T(11/05 /COM/WEB
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
9600 SW OAK ST 575, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
03/06/2013 00:00
ELC2013-00145
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
9600 SW OAK ST 575, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
03/06/2013 00:00
ELC2013-00145
PASS - No C of O
Violation Summary:
Inspector Contractor