Permit ' n CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00189
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/26/2013
Parcel: 1 S135DC00200
Jurisdiction: TIGARD
Site address: 11845 SW GREENBURG RD 200
Project: Spec Space Subdivision: TIGARDVILLE PARK Lot: 8
Project Description: (5) branch circuits and (1) low voltage permit for TI
Contractor: VAST ELECTRIC Owner: TWO G'S REAL ESTATE LLC
1525 SEATTLE SLEW DR. SE 18395 WOOD THRUSH ST
SALEM, OR 97301 LAKE OSWEGO, OR 97035
PHONE: 503 - 566 -7274 PHONE:
FAX: 503 - 585 -8828
FEES
Quantity Description Date Amount
1 ea Limited Energy 03/26/2013 $75.00
Specifics:
5 crt Branch Circuits wo /Purchase 03/26/2013 $85.86
Service or Feeder
Type of Use: COM 1 ea 12% State Surcharge - 03/26/2013 $19.30
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $180.16
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 95 - 01 -009 . You m y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: W Permittee Signature: O`u ( 41PP1.-, /CAfl0a-
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 Application RECEIVED FOR OFFt('F USE ONLY
City of Ti MAR 2 6 2013 Received ��(o 1i3
Sr Wi
• Date'Bv
13125 SW Hall Blvd Tigard, OR 97223 Plan Review
' a . Phone: 503.718.243 Fax: 503.598.l Qb( }., y OF TTG�D pate/B . Olber Petmit:
7 . ; (3 A 1` D Inspection Line: 503.639.4175 1.11 Y Date Rcady/By: Jura. ® See Page 2 for
Internet www.tigard -0egov BUILDING DIVISIO Notitied/Method: Ti So Supplemental Infarmadon
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
El Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current
❑ Marinas and boatyards. i
1 CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 1511 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.
❑ 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 - 3"
Job no.: Job site address: 11845 SW Greenburg Road IOOHP or more. occupancy.
❑ six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
/ �
CI Hazrreoas locations. 600 volts nominal.
Suite/bldg. /apt no.: 200 1 Project name: 6- SP•4
C ❑ Service or feeder 000 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I 9tv.. 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
Tax map /parcel no.: , Ea. add'l 500 sq. ft. or portion 33.92 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family
75_00 2
Tenant improvement residential (with above sq. ft)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER 0 TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1.000 amps 1 301.04 2
Address: Over 1,000 amps or volts I 552.26 2
Temporary services or feeders installation, alteration, and /or
City / State/ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 i I
201 amps to 400 amps 125.08 12
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670. and 701. 401 amps to 599 amps 168.54 i 2
Branch circuits— new, alteration, or extension, per_pauel
Owner signature: Date: A. Fee for branch circuits with
Dgi
I above service or feeder fee,
APPLICANT 1 ❑CONTACT PERSON each branch circuit 7,42 2
Business name: Vast Electric, Inc. B. Fee for branch circuits without
' service or feeder fee. first 1 18 56.18 2
Contact name: branch circuit '
Each add'l branch circuit 4 7.42 _ 29.68 2
Address: Miscellaneous (service or feeder not included)
City/ State /ZIP: Each manufactured or modular 67 84
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 : 2
Pump or irrigation circle 67.84 I 2
E -mail:
Sign or outline lighting 67.84 i 2
CONTRACTOR Signal circuit(s) or limited-energy
Business name: Vast Electric, Inc. panel. alteration, or extension. I Page 2 75.00
Each additional inspection over allowable in any of the above
Address: 1525 Seattle Slew DR SE Additional inspection (1 hr min) 66 25/ hr
City/ State/ZIP: Salem, OR 97317 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18 / hr
Phone: (503) 799 -5627 Fax: (1 -503) 585 -8828 Inspections for which no fee is 90.001 hr
specifically listed (Y: hr min)
CCB Lie.: 175531 I Electrical Lie.: C -280 Suprv. Lie.: 51865 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:` I /,
Subtotal: 160.86
` rrl�c 4 t 3f � i Plan review (25% of permit fee):
ir Print name: Tim Vander Stoep ' v Date: /26/2013 State surcharge (12% of permit fee): 19.30
TOTAL PERMIT FEE: 180.16
Authorized signature: This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete
Print name: Date: • Number or inspections allowed per permit.
1.\BuidirglPermits'ELC- PermirApp doe 07/0100 440.40:57111 /055COM.'WE0
£ 8Z88 '3ul o!- ;oeBB 1Sen 0 617:60 £1 9Z JOW