Permit {i
a CITY OF TIGARD ELECTRICAL PERMIT
III . P :. COMMUNITY DEVELOPMENT Permit #: ELC2013 00191
ri.GA t,D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/26/2013
Parcel: 2S104BA00100
Jurisdiction: Tigard
Site address: 12085 SW 135TH AVE 52
Project: Greenfield Village, #52 Subdivision: 2009 -055 PARTITION PLAT Lot: 2
Project Description: Reconnect only
Contractor: Owner: GREENFIELD VILLAGE LLC
BY NANCY L COWGILL
STOEL RIVES LLP
900 SW 5TH AVE STE #2600
PORTLAND, OR 97204
PHONE
PHONE: 503 - 524 -6327
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 03/26/2013 $67.84
Specifics: 1 ea 12% State Surcharge - 03/26/2013 $8.14
Electrical
Type of Use: MF
Class of Work: ALT
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 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 Notificatio Center. T se rules are set forth in OAR
952- 001 -0010 through 0 2-001-0090. You � may e obtain / aa copy of the rules or direct questions to OUNC by callin 0 .232.19 1.8 .332.2344.
Issued By: >t /W L t� (.r /1 Permittee Signature: ,f'
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.
Electrical Permit Applicatio RE u CEIVED FOR OFFICE USE. ONLY
City of Tigard Date/By: 3 /a I( Permit No.: L(_,e_ 40/3 - 0010? I
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598.196U AR 2 6 2 01 3 Date/By: Other Permit:
TI G A K D Inspection Line: 503.639.4175 Date Ready/By: Juris: 63 See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: 11 Co Supplemental Information
TYPE OF villtDING DIVISION PLAN REVIEW
El New construction El 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 4 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 ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
Z i Multi- family ['Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
■ ❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I - ",
Job no.: Job site address: I _, b 5� 1?)� Six or or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 'Ght-+Y UR r tar ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: . Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: a V Description I Qtv. I 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 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family
residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
g PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
� ` , ` t Ik e 401 amps to 600 amps 200.34 2
Name: �1� v
601 amps to 1,000 amps 301.04 2
Address: `'(Oi'S J X35 '' Over 1,000 amps or volts 552.26 2
City/State/ZIP: Y . / AQ Op . C1 4 - 2 . i Temporary services or feeders installation, alteration, and /or
t e / /ZIP: �7 relocation
Phone: (30.3) 524-001327 Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: • ' stallation is being made on property that I own which is not
intended for sale, le. - ent, a according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, Rer panel
Owner signature: w - Date: S `' A. Fee for branch circuits with
❑ APPLI A CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: C,Gmi)r �5k:,� Se.". i�S 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
(Q 3
Address: 1 79 c .t qM
1'` 1 !_ Miscellaneous (service or feeder not included)
City/State/ZIP: T O at 9' F 2 3
Each manufactured service and/or dr r modular
Cit
Y I �� Q. dwelling, service and/or feeder 67.84 2
Phone: (Sd>3) s- r. 6,s T Fax: : ( ) Reconnect only I 67.84 2
^F CCtSOR � C Sump irrigation circle 67.84 2
E -mail: t d vlfYt
Sign or r outline ine lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed (V2 hr min) 90.00 / hr
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Subtotal:
Suprv. Electrician signature, required:
� Plan review (25% of permit fee):
Print name: Date: ' A� - 1s State surcharge (12% of permit fee): �/
TOTAL PERMIT FEE: LS.gK
Authorized signature
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: C O. AgL?tl� Date: • Number of inspections allowed per permit.
:\ Building 'J'ermits\ELC- PermitApp.doc 07/01/10 440- 46t5T( 1 1/05 /COM/WEB
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
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1: \ Building \Permits\ELC- PermitApp.doc 07/01/10