Permit 4 CITY OF TIGARD ELECTRICAL PERMIT
1 a COMMUNITY DEVELOPMENT Permit #: ELC2013 00327
T (GAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/12/2013
Parcel: 1 S135BC00202
Jurisdiction: Tigard
Site address: 10763 SW GREENBURG RD 110
Project: Mattress Closeouts Subdivision: HILLSBORO Lot: PTS 1 -2
Project Description: Electrical for TI.
Contractor: RELIANT ELECTRIC OF OREGON LLC Owner: BELANICH, ROGER M
20200 SE OLDENBURG LN 22020 17TH AVE SE #200
SANDY, OR 97055 BOTHELL, WA 98021
PHONE: 503 - 701 -4562 PHONE:
FAX: 503 -668 -4190
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 06/12/2013 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/12/2013 $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 OAR 952 -001 -0090. 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: / i i — _ — _ _ ,� �— Permittee Signature:
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.
Jun.11.2013 03:19 PM Reliant Electric of Orego 5036684190 PAGE. 2/ 2
Electrical Permit C AppIicationJ aI VD I ill: (11 I I1 I I -.I ()NI N Received
City of Tigard g \ J- j �l Permit N ,.:
if
I 13125 S W Hall Blvd., Tigard. OR 97223 ! ! ! N 1 1 � O 13 D �' ,/ •r_ Ot Permit: I ' i — a, • 7
Phone; 503.718.2439 Fax: 503.598.196 l `"' Plan Review
D ate/B : �� J*�n1d8'
. Inspection Line: 503.639.4175 Date Rawly/Fly: �. _ __ _ ]lads: ti! era. Peen 2 fix
Internet: www.ligard.or.gov CITYOFTIGARD Notified/ Method: . Supplemental Information
µ
TVP - 57IA T SP INerBIVISIeN PLAN REVIEW
C:1 z r. g. �..1a:.: .,..'.14.. « :... .,.•.t,l «..,,..•• a.• eheolc ell that wally (ubmit 2 sett nf.plutie w /items checked helowl:
U Service or feeder 400 amps or more U Building over three stones.
Q r, IL:.. t1 n.l ...� -. ......- -° - ^ -• - ---- a -.•_ ^- + - -•
1:A1t!AiUK UP l.VPOI KM.I IVA .. «..t, 10,006 ....,....1 1R4 .ell.. -. 0 1`1.,.,r..t, b,.a.l :..a,..
❑ 1- and 7- family dwelling enmrlprgiuliturbiF:tri:ri ❑ Arrstctr+.ry building I Y.. r „ tb. dl Yt6.,r in;la.IlYti....+ 4uiltli
Ilbi.
❑ Multi - family Muster builder ❑ Other: Ohre pump, 0 Installation of 75 KVA or
['Emergency Autuuvu Le system. larger separately derived system.
_ _ - •• W Vu ! • UMW/ RAW VI L , J
5 /' j � _ / I O ,, or ,, re more. occupancy. cceRt
Job no.:1 3_2!
{•G� � I Job site address: \ (� � ((� � to to l "��t?- �� ;�� n Y
` ❑ B ile or mo nsid.alHel „is. ❑ Cfii0oal vehicle parka.
t ;:ly /: h I.I .11• ^'7� ��1 i�1 . G ,l I O �` � • L� r i ITrakh -r.wrt: f,.rilitira ❑ S,v iv vullaa0 for mono than
J1 I.l. 1 :11Ia7Srdous locations. _ oVU volts nominal.
3uttvu1ttg.fap uu.. ' rru7evt ueuue_ Y) -1L1- ` Y " s trio '�i u t< I:14....-.;...... a..o., coo ..,.
FEE SCHEDULE
Cross street/directions to job situ: Iberlpllmo 1 Qtr. J Bea I Toul I
New naltecuttal single- or multi -6mily dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. II. or less 168.54 , 4
Tax map/ parcel no.: Ea. add'I 500 so. ft. nr mutton 33.92 1
P Limited enemy, residential
DESCRIPTION OF WORK (with above ""
/j residential (with above sq. ft) I5'uu l
�p 4
e , .ICrvlces or metiers tuatauanou • sumnr retoesaon
` � i+�,"� nj►� ( .± 200 amps or less 100,70 2
0 PROPERTY O R ! 0 TENANT 201 amps to 400 amps 133.56 2
Name: •
401 olllpi its 000 a111IA1 200. J4 t
•,.• _ 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.2E 2
City /State/ZIP: I Temporary avrvlcea or feelers Installation, alteration, and/o
relocation
Phone: ( ) Fax: ( ) 200 amps or Its 59.36 1
Owner installation: This installation is being made on property that i owlrwhich is not 201 amps to 400 amps 125.08 2
lulcudcd rya aalc, it/04c, tout, 1.11 wuhm .w
lgu, ata dt,, gm ORB 447, 449, 670, and 701. 401 a..0 w 599 cum,* I4a, 2
Branch circuits - new, alteration, or extension. er panel
Owner signature: ..... _ ...._... _... _... _ ........ Date: __ ..__. -..__ A. Fee for branch circuits with
shove service or feeder fee
f1 APPLICANT I Cl CONTACT PERSON � ,a, y a ,a, �i,�,i 7 2
I1 11 1 n nl
Business name: , 1). l'.rt tor Vl nlndl 1A 14Y /li na /i;i
(���� �LQ �� U r=te service or feeder fee, first
Contact name: ` l l ���i - a, y-- branch circuit 56 l 2
l
Address:�� (�� � Each add'1 branch circuit � 2
(�1 -1 l J Miscellaneous (service or feeder not included)
City/State/ZIP: 0 • "! ! p 5 _ dwclli Rns orvice and/orufocdlcr 67.84 2
Phone: ( � ) 4 R(nC), r 4 4-3 I Fax: : 61.1) &i(nq ...4 j (1 Reconnect only 67.84 2
un p or 1 I ganon stele oi,x 2
E-mail: _ m
or outline lighting 67.84 2
----- CONTRACTOR Signal circuit(s) or limited•oncrgy
Business name" . panel, alteration, or extension. _ Page 2 2
.-.r - - - - . WICu auultwnm tostltcuuu'uVer awn-AU: ft Ili guy ut tut auvve
Address: , I = Additional inspection (1 mi)- 662/hr City /State /ZIP: X JIk W f , d ustha l pl 18 industrial plant (I hr mi 78.18/ lir
Dh,wa: ( ). I .� • ) + Inaprrtinno fhr whirh nn fha is
wifcaliy listed (%t hr min) WIN/ m -
in.: Q .... � Electrical Lic.:
CCD L Sup 1 'x:4,4 3 IR
<. ELECTRICAL PEI4siT FEES
d: �/ i --- RIIhlntn{ �. I
Suprv. lifeetriotan ciestuture. roquiro
` �� . -� =� f -' __ Plan r eview (25% of permit flee): /� /
Print mune: ��-1, 0, 1 l • ' - . , (.1 / D ata: I ( :Jute e./..dler (I296..[F" . ' 'L ILO. 't , 1 l� .hi 1
Q� TOTAL PERMIT FEE:
Authorized signature: / t � ... 4. '+f/11.1.41'"\ rbb; permit application e*pirss if a permit is not obtained witbin 180
..- P a ul IInu1G. i 5..t l r, diva »rMr It Asa nr+. IKCtpted as tomPl!
J r' va f 1 (r( 7 1 r:t».t f •` I :•2 • Nemo r of impelliuua allowed per permit. t 7 r $�
I: 111ui1din81Permitt \ELC•PermiaApp.duc 07/01/10 4404615T(II/05/COMIwSB 111