Permit 11111 y q CITY OF TIGARD ELECTRICAL PERMIT
s COMMUNITY DEVELOPMENT Permit#: ELC201500100
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/18/2015
Parcel: 1 S 133AC14300
Jurisdiction: Tigard
Site address: 10825 SW HUNTINGTON AVE
Project: Rose City Ventures Subdivision: HAWK'S BEARD TOWNHOMES Lot: 61
Project Description: Electrical reconnect only
Contractor: Owner: AFM ASSETS LLC
BY DLB CAPITAL MANAGEMENT
6915 SW MACADAM#250
PORTLAND,OR 97219
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 02/18/2015 $67.84
Specifics: 1 ea 12%State Surcharge- 02/18/2015 $8.14
Electrical
Type of Use: SFA
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98
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
952-001-001 rough• 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 B 0 4l AIL . _ Permittee Signature: L k , !t re—_
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.
Electrical Permit Application RECEIVE FOR OFFICE USE ONLY
r Received
City of Tigard (( Permit No.. 1-L' 1 -0000
II • 1 3125 SW Hall Blvd.,Tigard,OR 97223 Date/Bv: 1 /f/5�y � p(�
. g Plan Review Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960FE8 17 2015 Date/By:
f 1 C A ILL) Inspection Line: 503.639.4175 Date Ready/By: June 6d See Page 2 for
Internet: www.tigard-or.gov t TIl A(�{, Notified/Method: Supplemental Information
TYPE ON 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 ®Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
® I-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","1-2","l-3
Job no.: I Job site address: 10825 SW Huntington Ave 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.: I Project name:
❑Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site:SW Hawks Beard St Description I Qty. I Fee. I Total I
'-- — New residential single-or multi-fancily dwelling unit.
includes attached garage.
Subdivision:HAWK'S BEARD TOWNHOMES I Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 I
l'cw tcc`cp p`11C11 no` Limited energy,residential 75.00 2
DESCRIPTIONlOHWOR (with above sq.ft.)
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 ,S4f,, I ❑`TENANTn 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: Rose City Ventures Inc. 401 amps to 600 amps 200.34 2
Address: 12776 SE Geneva Way 601 amps to 1,000 amps 301.04 , 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Happy Valley Temporary services or feeders installation,alteration,and/or
Phone:(503)267-9772 I Fax:( ) relocation
200 amps or less 59.36 1
Owner installation:Thik',,installs'on is being made on property that I own which is not '
intended for sale,lee rent;'or exxc7Jange,according to ORS 447,449 670,and 701. 201 amps to 400 amps 125.08 2
2/13/2015 1:05 PM PT 401 amps to 599 amps 168.54 2
Owner signature:_ E`�"� O.te.s�y vale: Branch circuits—new,alteration,or extension,per panel
® APPLIC`�Ari '* sl4L4... I ® CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
Business name:Rose City Ventures Inc. each branch circuit 7.42 2
B.Fee for branch circuits without
Contact name:Eugene Pahomsky service or feeder fee,first 56.18 2
branch circuit
Address: 12776 SE Geneva Way Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Happy Valley OR 97086 Each manufactured or modular
67.84 2
Phone:(503)267-9772 I Fax: dwelling,service and/or feeder( ) Reconnect only 1 67.84 2
E-mail: Pump or irrigation circle 67.84 2
TRACTOR
Sign or outline lighting 67.84 '_
Business name: Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address: Each additional inspection over allowable in any of the above
City/State/ZIP: Additional inspection(1 hr min) 66.25/hr .
Investigation(1 hr min) 66.25/hr
Phone:( ) I Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00'hr
CCB Lie.: Electrical Lie.: Suprv.Lie.: specifically listed(''s hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal 67.84
Print name: Date: Plan rev iew(25%of permit fee):
State surcharge(12%of permit fee): 8.14
Authorized signature: TOTAL PERMIT FEE: 75.98
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit.
1:1Building\Permits\ELC_PermitApp_ELR_ERE doe Rev 05/21/7013 440.4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY e � ; FEE SCHEDULE
Fee for all residential systems combined $75.00 Description Qty. Fee Tots •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
Audio and Stereo Systems*
15.01 to 25 kva 200.34 2
Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
I I Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
❑ Heating, Ventilation and Air Conditioning OAR 918-309-0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
n Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
Other: Each additional inspection is
charged at an hourly(I hr min) 66.25/hr 1
Inspections for which no fee is 90.00!hr
�syecificall listed(' hr min)
COMMERCIAL WORK ONLY: "tAR ELECTRICAL PERMIT FEES
Fee for each commercial system 575.00 Subtotal.
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1\Building\Permits\ELC_PermitApp_ELR_ERE.don Rev 05/21/2013