Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC201300471
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/08/2013
Parcel: 2S104AA90302
Jurisdiction: Tigard
Site address: 12646 SW KAREN ST 30
Project: Bellwood Terrace Subdivision: BELLWOOD TERRACE CONDO Lot: 30
Project Description: (5)branch circuits for dryer and space heater removal.
Contractor: OMNI ELECTRIC INC Owner: BELLWOOD TERRACE LLC
16670 SW WRIGHT ST PO BOX 189
BEAVERTON,OR 97007 YAMHILL,OR 97148
PHONE: 503-747-0805 PHONE:
FAX: 503-649-2709
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo/Purchase 08/08/2013 $85.86
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/08/2013 $10.30
Type of Use: MF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $96.16
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 952-001-0090. You may obtain ; •• of the questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By — Permittee Signature: L ^
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.
Aug.05.2013 10:11 PM PAGE. 2/ 2
Electrical Permit Application _-_ ...r•(,it(>1 11( 1 1 tie:a\ci- . . .. •
�� Received ^
City of Tigard \3 �teB : Permit No,: 1;L< < / ,,c t_
n 13125 SW Null Blvd.,Tigard.OR 311/.. �" �4 Plan Review
; g Phone 503.718,2439 Fax: 503.54:, '•list \ 1,Date/ Other Permit:
-
(I C.All n Inspection Linc: 503.639.4175 n�C? r R�� Ready/13y: Ed See Paget fur
Internet: www.tigard-or.gov r 1\V Q�• ed/Mothod: Suppkmental information
TYPE OF WORK " PLAN REVIEW
❑New construction ®Addition/alteration/re■ 1t M Please cheek all that apply(submit 3 acts of plans w/itonw choked below):
•`
❑Demolition Other: ❑Service or feeder 400 amps or msav ❑Building over three stories.
❑ ` _ where the available fault current d Marinas and boatyards.
CATEGORY OF CONSTRUCTION - ' exceeds 10,000 amps at 130 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 150 KVA Of
JOB SITE INFORMATION AND LOCATION ❑Emergency Addition system. Inrger separately"1-3",d system.
❑Addilian of now motor load of []"A" "l:" "I.2","l-3"
Job no.: Job site address:12646 SW Karen 10011P or more. occupancy.
❑Six Of MP,rwident;ol tali L,. ❑Recreational vehicle parks.
City/State/ZiP: #Tigard ❑Health-0ara facilities. ❑Supply vohngc for mare than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:30 T Project name:Bellwood Terrace ❑Service or fouler 600 amps Or mare.
FEE SCHEDULE
Cross street/directions to job site: . Derrrlpllen I Qty. I Fm I Total I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
` -Subdivision Lot no.: 1,000 sq.rt or leas -. 168.54 4 -
- iii add'I 500 sq.D.or portion 33,92 I
Tax map/parcel no.: Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 75,00 2
Dryer/laundry circuit residential(with above sq.ft.)
Renewable Energy ❑ See Parse 2
Space heater removal/replacement Services or feeders installation,alterationiand/or relocation
❑ PROPERTY OWNER ❑ TENANT " 2(0 amps or leans __..._... .._.._.r_ 100.70 2
---- 201 amps to 400 amps ' 133.56 2
Name: '401 amps to 600 amps 200.34 - 2
Address: 601 amps to 1,000 mops 301,04 2
-
City/State/ZIP: Over 1.000 amps or volts ___ 552.26 2
_ y Temporary services or feeders installation,alteration,and/or
Phone:( ) J Fax:( ) relocation
200 maps or less ^59.36 1
Owner installation;This installation is being made on property that 1 own which is not 201 amps to 400 amps 125.08 2
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: _—� ____ __Date; Branch circuits-new,alteration,or extension,per j anel
❑ APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee.
742 2
Business name:. euch'brunch circuit __-
--. .-..-.— H.Pee for branch circuits without
Contact name: brat h citcfeedet lee.fire 1 56.18 56.lx 2
it
Address: Each add'l branch circuit 4 7.42 29.68 2
City/Slate/ZIP: Miscelluoeouv(service or feeder not Included)
Each Inatlufacturod or modular 67.84 2
Phone:( ) Fax::( ) dwelling,service und/or feeder
- -- .. .. Reconnect only 67.84 2
E-mail. Pump or irrigation circle 67,84 2
CONTRACTOR Sign or outline lighting 67.84 2
_Business.nano:Omni:Electric'Inc Signal tiro iii(:c)orlimited-energy Sec
,pangi,alteratipl Or extension. Pugc 2 2.
Address:16670 SW Wright St Each additional Inspection over allowable in of the above _
City/5tatc/ZIP:Beaverton,OR 97007 Additional inspection(1 hr thin) 66.25/hr
City/St a. Investigation(1 hr mgt) 66.25/hr
Phone:(503)747-11805 Fax:(503)649-2709 hidtrstrial plant(I hr min) 78.181 hr M
� Inspections for which no fee is
CCB Lie.: 176615 (r it//1 --Electrical l,ic.: C297 7/r/rte Suprv.Lie,: 4270S�o It 1pn) �ecificatly listed(G hr min) 90.00/hr
Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES 7_
Suhlahtl: 115116
_ ._.—_ ---- �--- ^^-^^^— Plan review(25%of permit fee): -
Print name: John M.Kelso Date: 08/07/13
-- -- .- State sur•clutrge(12%of permit foe): 10.3(1
Authorized signature; TOTAL PERMIT FEE: 96.16
_PriRl Rattle: Dale: This permit application expires If a permit La not obtained within 180
days after it has been accepted as complete,
^•--
• Number of inspections allowed per peunit
imuit Ngwettnits\ti ',rernl!App RTaJar..acw Roe 05/212013 440-16iSTp1/0ecoMrwaa