Permit •
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00302
T j G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/03/2013
Parcel: 2S114AA00200
Jurisdiction: Tigard
Site address: 16285 SW 85TH AVE 103
Project: Happy Campers Subdivision: 1993 -078 PARTITION PLAT Lot: 2
Project Description: (4) branch circuits.
Contractor: CROWN VOLTAGE Owner: WH SHIPMAN LIMITED
609 SW EATON BLVD BY NORRIS & STEVENS INC
BATTLE GROUND, WA 98604 621 SW MORRISON STE 800
PORTLAND, OR 97205
PHONE: 360 - 666 -0995 PHONE:
FAX: 360 - 666 -4673
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 06/03/2013 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/03/2013 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 OA 952- 001 -0090.Y You may ob, •■ a co.y of the rules direct questions to OUNC by calling 503 1987 or 1.800.332.2344.
Issued By: - - �� Permittee Signature: i /�f.5 -.111-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' 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.
•
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Electrical Permit Application Er���T FOR OFFICE. USE ONLY
LL
City of Tigard iL! Received ��
II
Date/B S - Permit No.: C
• 13125 SW Hall Blvd., Tigard, OR 972 Plan Review
C : • Phone: 503.718.2439 Fax: 503.598. Date/B ''AY 2 9 2013 Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE oMblilINUDIViSION PLAN REVIEW
❑ New construction ® Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑ Other: ❑ Set or feeder 400 amps or more ❑ Building over three stories.
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 g
y g ®Commercial /industrial ❑A ccessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A", "E", "1 -2 ", ' l -3 ",
Job no.: C13350 Job site address: 16285 SW 85 AVE IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: TIGARD OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 103 Project name: HAPPY CAMPERS ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:
Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
1 Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'1 500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
MOD 4 CIRCUITS Limited energy, multi - family 75.00 2
residential (with above sq. ft)
Renewable Energy ❑ See Page 2
Services or feeders installation, alteration, and/or relocation
❑ PROPERTY OWNER ® TENANT 200 amps or less 100.70 2
Name: LJL ENTERPRISES 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Address: . 601 amps to 1,000 amps 301.04 2
City/St /ZIP: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
Phone: ( ) Fax: ( ) relocation
200 amps or less 59.36 1
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. 201 amps to 400 amps 125.os 2
401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit
B. Fee for branch circuits without
Contact name: service or feeder fee, first 1
b ranc h circuit 56.18 2
Address: Each add'I branch circuit 3 i 7.42 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
Phone: ( ) Fax: : ( ) dwelling, service and/or feeder
E - mail: Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84
B
2
usiness name: Crown Voltage, Inc. Signal circuit(s) or limited - energy See
panel, alteration, or extension. Page 2 2
Address: 609 SW Eaton Blvd Each additional inspection over allowable in any of the above
City /State /ZIP: Battle Ground WA 98604 Additional inspection (1 hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
Phone: (360) 666 - 0995 Fax: (360) 666 - 4673 Industrial plant (I hr min) 78.18/ hr
`t Inspections for which no fee is
CCB Lic.: 153934 t Electrical Lic.: 37 -984C Suprv. Lic.: 57775 specifically listed ( %hrmin) 90.00/ hr
Suprv. Electrician signature, required: ELECTRICAL PERMIT FEES
Subtotal: 78.44
Print name: Daniel Tucker Date: 5/24/13 Plan review (25% of permit fee):
State surcharge (12% of permit fee): 9.41
Authorized signature TOTAL PERMIT FEE: 87.85
—
Print name: Stacy Lacombe Date: 5/24/13 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
' Number of inspections allowed per permit.
I:\ Bu; Iding\Permits\ELC_Perm;tApp_ELR ERE.doc Rev 05 /212013 440.4615T(I1 /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
16285 SW 85TH AVE 103, TIGARD, OR, 97224
Commercial - Electrical
199 Electrical final
06/07/2013 00:00
ELC2013-00302
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
16285 SW 85TH AVE 103, TIGARD, OR, 97224
Commercial - Electrical
199 Electrical final
06/07/2013 00:00
ELC2013-00302
PASS - No C of O
Violation Summary:
Inspector Contractor