Permit y p CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2013 -00735
T I G A RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/11/2013
Parcel: 1 S136DCO2504
Jurisdiction: Tigard
Site address: 7301 SW DARTMOUTH ST
Project: Lumber Liquidators Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: Relocate (1) panel and (6) branch circuits
Contractor: HILLSBORO ELECTRIC LLC Owner: AMERICAN INDUSTRIES INC
21185 NW EVERGREEN PKWY #110 1750 NW FRONT AVE STE #106
HILLSBORO, OR 97124 PORTLAND, OR 97209
PHONE: 503 -439 -9666 PHONE
FAX: 503 - 601 -3680
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 12/11/2013 $100.70
Specifics: amps or less
6 crt Branch Circuits w /Purchase 12/11/2013 $44.52
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 12/11/2013 $17.43
Electrical
Type of Const:
Occupancy Grp:
Total $162.65
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 rdance wi 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. AT NTION: Oregon w s you to follow the rules adopted by the Oregon Utility - Net'. - - enter. Those rules are set forth in OAR
952 -001- 010 through OAR 952- -0090. ou may obtain a copy of the rules or direct questions to OUNC by •-.I ng -5' • .1987 or 1.800.332. 44.
Issue By: - e2/14_01_1 /4 Permittee Sig ,� /:.' �' ASSa 1
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' r l` i _
I 7/ � / 75 — — � 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.
From. 12/09/2013 13.08 #107 P.001 /002
Electrical Permit Application ! r- . FOR OFFICE ISE ONI.1
i x A 4 0^ Received
City of Tigard C Date /B /ij-� i _� [. I Permit No,: �! L-of 3 j -(�7'3�j
1 14
U 13125 SW Hall Blvd., Tigard, OR 97223 l E C 9 2013 Plan Review
= Phone: 503.718.2439 Fax: 503, 598.1960 Date /B : Other Permit: /10 5-co a g
Inspection Line: 503.639.4175 Date Ready /By: Juis: @ See Page 2 for
Ttt,AHD UTYC r
Internet: www.tigard or.gov Notified /Method: Supplemental Information
I �
' ' TYPE OF WORM PLAN REV
❑ New construction ® Addition /alteration /replacement Please check all that apply (submit 2 sets of plans wiitems checked below): %
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ 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 w
' SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system
JOB .
CI o Addition of n ew motor load of ❑ "A ", "E ", "I -2 ", - '1 -3`,
Job no.: 8409 Job site address: 7301 SW Dartmouth IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal
Suite /bldg. /apt. no.: Project name: Lumber Liquidators Shell ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee I Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 1 68.54 4
Ea. add'I 500 sq ft or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
75.00
DESCRIPTION OF WORK ( with above sq. ft.) ,
Limited energy, multi - family 75.00 2
Relocate one panel and branch circuits 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 1 100.70 100.70 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 N�„
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 899 amps 168.Sa 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel p
0 _
APPLICANT �.1 ❑ CONTACT PERSON A. Fee for branch circuits with (`
above serv or feeder fee, 6 . 44.52 .,
Business name: each branch circuit
B. Fee for branch circuits without
Contact name: service or feeder fee, first 56.18 2 k.
branch circuit
Address: Each add'l branch circuit 7.42 1 2
City/State/ZIP: /StattJZiP Miscellaneous (service or feeder not Included)
ty Each manufactured or modular
67.84 2
Phone: ( ) Fax: : ( ) dwelling, service and/or feeder
I Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
t
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Hillsboro Electric LLC Signal circuit(s) or limited - energy See
panel, alteration, or extension. Page 2 2
Address: 21185 NW Evergreen Parkway #110 Each additional inspection over allowable in any of the above
Additional inspection (1 hr min) 66.25/ hr
City /State/ZiP: Hillsboro OR 97124 i
Investigation (I hr min) 66.25 / hr
Phone: (503) 439 - 9666 Fax: (503) 601 - 3680 Industrial plant (I hr min) 78.18/ hr
Inspections for which no fee is 90.00/ hr
CCB Lie.: 134481 Electrical Lie.: 34 - 499C Suprv. Lie.: 4941S specifically listed (% hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Q/ 4 , j ` _ Subtotal 14522
Print name: Joey Vitacco (/� Date: 12-9-13 Plan review (25 % of permit fee):
State surcharge (12% of permit fee): 17.43
Authorized signature: TOTAL PERMIT FEE: 162.65
This permit application expires if a permit is not obtained within 190
Print name: Date: days after It has been accepted as complete.
Number of inspections allowed per permit
1 Building 'Permas.ELC_PennuApp_ELR ERE.doc Re %05 ;21,2013 4404515T(1105,COM,WEB