Permit n CITY OF TIGARD ELECTRICAL PERMIT
; COMMUNITY DEVELOPMENT Permit#: ELC2013-00530
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/09/2013
Parcel: 2S 112AB02300
Jurisdiction: Tigard
Site address: 14150 SW MILTON CT
Project: Medical Teams International Subdivision: BONITA INDUSTRIAL PARK Lot: 5
Project Description: (8)branch circuits for lighting reballast/relamp
Contractor: MODERN ELECTRIC SERVICES CO Owner: MEDICAL TEAMS INTERNATIONAL
PO BOX 532 PO BOX 10
NEWBERG, OR 97132 PORTLAND, OR 97207
PHONE: 503-550-2542 PHONE:
FAX:
FEES
Quantity Description Date Amount
8 crt Branch Circuits wo/Purchase 09/09/2013 $108.12
Specifics:, Service or Feeder
1 ea 12%State Surcharge- 09/09/2013 $12.97
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $121.09
Required Items and Reports(Conditions)
This permit is iss :• b'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes nd a I other applicable law. All work will
be done i. -ccordance with -.• oved plans. This permit will expire if work is not started within 180 days of issuanc- or i work i u • -'ed for more the 180
days. ENTION: Oregon law :qui u to follow the rules adopted by the Oregon Utility Notification C;-nter. Th•.e rule are set fo in OAR
952-041-0010 thro gh OAR 952-001-0 0. You ay o in a copy of the rules or direct questions to OUNC by calling 503.232/98 or 1.809 332 23,
Is- ed By: � /%�� jy_ Permiftee Signature: A I. /,:, _
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:
ONTRACTOR INSTAL TION ONLY
SIGNATURE OF SUPR.ELEC' r:1 ,;ollro- 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 10k OFFICE I SF O\1.1
City of Tigard
Received •
III Dazes : 9 Permit No.: cCi. 3—tom S--(J
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
11 Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit:
l-1 t. 1,t� Inspection Line: 503.639.4175 Date Ready/By: Julie ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition 0 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: ❑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" "I-2","l-3",
Job no.: Job site address: 14150 Milton Ct 100HP or more. occupancy.
['Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Portland,OR ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more.
• FEE SCHEDULE
Cross street/directions to job site: Description I tom. 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
Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 75.00 2
Lighting reballast/relamp residential(with above sq.ft.)
Renewable Energy _ ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER I ❑ TENANT 200 amps or less 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 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: 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 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 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 56 18 56.18 2
branch circuit
Address: Each add'I branch circuit 7 7.42 51.94 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular
Phone:( ) Fax: :( ) dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:Modern Electric Service Co Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address:PO Box 532 Each additional inspection over allowable in any of the above
City/State/ZIP:Newberg,OR 97132 Additional inspection(1 hr min) 66.25/hr
Investigation(I hr min) 66.25/hr
Phone:(503)5502542 Fax:( ) Industrial plant(1 hr min) 78.18/hr
/1//5/ry Inspections for which no fee is 00/hr
CCB Lic.: 184606 Electrical Lie.: C312 71,4 Suprv.Lic.: 4821S specifically listed('Vi hr min)
Suprv.Electrician signature,required: /4/,/i 3 ELECTRICAL PERMIT FEES
Subtotal: 108.12
Print name: Brian Smith Date: 9/9/13 Plan review(25%of permit fee):
State surcharge(12%of permit fee): 12.97
Authorized signature: , TOTAL PERMIT FEE: 121.09
Print name: Brian Smith Date: 9/9/13 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:tBuildi�Per ias\LC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440•4615Tt11ro5/COM/WEB