Permit Arh CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00146
.T I G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/05/2013
Parcel: 1S135DD02001
Jurisdiction: Tigard
Site address: 11635 SW HALL BLVD 5
Project: Pacific Mobile Park Subdivision: METZGER ACRE TRACTS Lot: 28
Project Description: Install (1) 200 A modular home service
Contractor: A C POWER SERVICES INC Owner: MB INVESTMENTS LLC
18010 S HOLLY LANE 8320 NE HWY 99
OREGON CITY, OR 97045 VANCOUVER, WA 98665
PHONE: 503 - 780 -6807 PHONE:
FAX: 503 - 557 -5765
FEES
Quantity Description Date Amount
1 ea Manuf / Modular Services or 03/05/2013 $67.84
Specifics: • Feeder
1 ea 12% State Surcharge - 03/05/2013 $8.14
Type of Use: SF Electrical
Class of Work: ALT
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Type of Const:
Occupancy Grp:
Total $75.98
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 - • - 'th 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. A ' NTION: Oregon law • uires you to follow the rules adopted by the Oregon Utility Notification' Cen e . Those rules are set forth in OAR
952 -001 1010 through OAR 952 ' • u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.198 or 1.800.33 4.
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Issu- • By: ' Permittee Signature: •
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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:
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CO CTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
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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.
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Electrical Permit Application . NE FOR OFFICE USL OiNLY' - `
R
Cl of Tigard DateBed „26/ /4
, � City g Date/By: / 3 Permit No.: E e
° 13125 SW Hall Blvd., Tigard, 97223 , MAR 5 2013 Plan Review
9 • Phone: 503.718.2439 Fax: 503 DateBy: Other Permit:
TI G A R O Inspection Line: 503.639.4175 /� �/ /�� T�(� �Q� Date ReadyBy: Juris: El See Page 2 for
Internet: www.tigard- or.gov CITY 1 lJr 1 ra.�r* r' No[ified/Me[hod:
C Supplemental Information
anoti TYPE OF WO PLAN REVIEW
lig 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 El Other:
where the available fault current 0 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
Si 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ",
Job no.: Job site address: // 6 3s— kin. L 2 or A, ix or or more. occupancy.
r /L ` O� f/�� ❑S ix or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ‘,. 9. /L J 0 (,� 9 7 2-�'3 ❑ Health -care facilities. 0 Supply voltage for more than
� V 1' f- ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 5 Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. l Fee. I Total i •
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
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Limited energy, multi - family 75.00 2
/y0E . ,i / gca c-,' f , residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less ' 100.70 /0 D 7e 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 4 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 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
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,
each branch circuit 7.42 2
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: Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 'I
67.84 6 ,�C` 2
dwelling, service and/or feeder r
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E - mail:
Pump or irrigation circle 67.84 2
Signor outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: 4 , < rt i/ W / 4 -' 4 / 5-eV� , , /� panel, alteration, or extension. Page 2 2
q . Each additional inspection over allowable in any of the above
Address: / eV / O S 4 P7J' 19Z z y + Additional inspection (I hr min) 66.25/ hr
t �, e l /
City /State /ZIP: a /z , c _, s Q rJ (2 [L l'1 Investigation (I hr min) 66.25/ hr
� r � Q 7 T J Industrial plant (1 hr min) 78.18 / hr
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Phone: 4) CJ'� T6 0 � D 7 Fax: (5 'j) �' J - S7Q / / Inspections for which no fee is 90.00 / hr
j c.� v o j fo/r� specifically listed (%2 hr min)
CCB Lic.:l9.3 92.4 7 Electrical Lic.3 5 d Suprv. Lic40 18 S ELECTRICAL PERMIT FEES 4,79
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Suprv. Electrician signature, required: � w �. Subtotal: j) 0 q
Plan review (25% of permit fee):
Print name: 1-7, /i/y D :) 7 Date:0 Dy lac State surcharge (12% of permit fee): './
Authorized signature: Q TOTAL PERMIT FEE: •75 • 9 g
_ v This permit application expires if a permit is not obtained within 180
Print name:
p >� •�� Date ) y • J days after it has been accepted as complete.
Number of inspections allowed per permit.
1 :\ Building \Permits\ELC- PermitApp.doc 07/01 /10 440 -46t5T(11 /05 /COM/WEB
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
El Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \Building\Permits\ELC- PermitApp.doc 07/01/10