Permit CITY OF TIGARD ELECTRICAL PERMIT
s COMMUNITY DEVELOPMENT Permit #: ELC2013 -00229
T t G A.R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/22/2013
Parcel: 1 S136DA00100
Jurisdiction: Tigard
Site address: 11308 SW 68TH PKWY
Project: Comcast Tech Ops West Subdivision: PFAFFLE PLAZA CONDO Lot: 2
Project Description: (1) branch circuit and (1) low voltage for equipment
Contractor: OREGON AIR REP DBA ENVIRONMENTAL CONTROL Owner: BENENSON 68TH PARKWAY KEY LLC, T
15860 SW UPPER BOONES FERRY RD BY PROVIDENCE HEALTH SYSTEM
LAKE OSWEGO, OR 97035 ATTN: PROPERTY MANAGEMENT
1235 NE 47TH STE 160
PORTLAND, OR 97213
PHONE: 503 - 517 -9109 . PHONE:
FAX: 503 - 968 -1029
FEES
Quantity Description Date Amount
1 ea Limited Energy 04/22/2013 $75.00
Specifics:
1 crt Branch Circuits wo /Purchase 04/22/2013 $56.18
Service or Feeder
Type of Use: COM 1 ea 12% State Surcharge - 04/22/2013 $15.74
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $146.92
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 OAR 5 -001-009 .. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: � Lc-C y a -I Permittee Signature: 0 LI i#eee_i ( A — nDki,
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 442 FOR OFFICE: USE ONLY
City of Tigard Received 0. — ° �
Date /B : Ol. 1 � 3 5 1 Permit No.:E1 C 90 /3 - 42610)-0)-9
13125 SW Hall Blvd., Tigard, OR 9 Plan Review
I Phone: 503.718.2439 Fax: 503.59 Date /B Other Permit: 64 P 3.) (3 - 00, -
TI G A R D Inspection Line: 503.639.4175 Date Ready /By: Jur s: Fa See Page 2 for
Internet: www.tigard - or.gov Notified /Method: (0 Supplemental Information
APR
" 2Ol3
,TYPE OF WORK rl, �L� PLAN REVIEW
❑ New construction Addition /altel i�}'/I4al RD Please check all that apply (submit 2 sets of plans w / i
Y tems checked below):
❑ Demolition BUILDING DIVISION ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ 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.
❑ Multi- family ❑ Master builder
❑ Other: 0 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 -2 ", "1 -3 ",
Job no. s� i 3 o L $ Job site address: / f 4 IOOHP or more. occupancy.
�/ 30 5(...0 G 8 pa.Ykfw/4t� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 7, 4r1 Br'e 9n., 97 22.3
11 ❑ Health -care facilities. ❑ Supply voltage for more than
/ ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: L•Q),r Ca, S ./. 0 Service or feeder 600 amps or more.
Cross street/directions to job site: p FEE SCHEDULE
SL✓ �RC , i , L N(y 1, * Description I Qty. I Fee. 1 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'I 500 sq. ft. or porti20 33.92 1
Limited energy, residential ■
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
�
,� n Limited energy, multi - family
4,044# w
- /
t " , / 4- /J Nf s 5754— -4i / /L t r v residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
e N ',, ISM 200 amps or less 100.70 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 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
made on property 201 amps to 400 amps 125.08 2
Owner installation: This installation is being p perry 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 2
Owner signature: Branch circuits — new, alteration, or extension, per panel
Date: A. Fee for branch circuits with
❑ APPLICANT ' ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first
Contact name: branch circuit r 56.18 56./9 2
Address: Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(s) or limited- energy -
es
Business name: b�t►� A t Y r ( b ENI/ /to►+ 0..4. �n /'e s r �fd �s panel, alteration, or extension. Page 2 )s.ov 2
Each additional inspection over allowable in any of the above _
Address: ! 5k6 v S (...../ tour ✓ ` r,4,,.. 14.44....7 Additional inspection (1 hr min) 66.25/ hr
/e/.
City /State /ZIP: Investigation (1 hr min) 66.25/ hr
L e. ic. G SL✓ ci a 0,2_ 970 5- 446 plant (
Industrial lant 1 hr min ) 78.18/ hr
Phone: (50, ) 3t7 /� /!/ 9 Fax: (s `l c2 — !
Lam/
7 Q Inspections for which no fee is
specifically listed ('h hr min) 90.00 / hr
CCB Lie.: 3 I Electrical Lic.: 3.. 3 Suprv. Lie.: !s ELECTRICAL PERMIT FEES
Suprv. Electric sign required: f� ? / 1 t - Subtotal: /3/, /Er
l a, A-- r k/
(,' .. ..... . Plan review (25% of permit fee):
....: ..... .
Print name: ,'rt4 h iif e/Hh `dO Date: 3 State surcharge (12% of permit fee): /5 • 7 el
Authorized signature: l /� / [ ' TOTAL PERMIT FEE:
A .ene4-1C... W vj 0. ~`_ This permit application expires if a permit is not obtained within
Print name: 7r# W #1.4 Date: days after it has been accepted as complete.
Y�g / 3 * Number of inspections allowed per permit. / n Z.
1: \ Building \ Permits \ELC- PermitApp.doc 07/01'10 4 40- 461ST(II /05/COM/WEB r, 5 / / Z it e Y