Permit 1
.1 CITY OF TIGARD ELECTRICAL PERMIT
"4 * COMMUNITY DEVELOPMENT Permit#: ELC2015-00107
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/04/2015
Parcel: 2S101 BB01300
Jurisdiction: Tigard
Site address: 11950 SW GARDEN PL 100
Project: Vesta Subdivision: CROW PARK 217 Lot: 1
Project Description: (1)branch circuit to connect new RTU
Contractor: HUNTER DAVISSON INC Owner: WALTON CWOR PARK BC 8 LLC
1800 SW PERSHING ST BY RYAN
PORTLAND, OR 97202 PO BOX 460169
HOUSTON,TX 755056
PHONE: 503-542-3628 PHONE:
FAX: 503-542-3654
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 03/04/2015 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 03/04/2015 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 pplicable 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 //suspend or more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Tho1 rules set forth in OAR
952-001-0010 through OAR 952-001-0090. You may-- - - ••• - •= i. =s• •'rect questions to OUNC by calling 503.23 i • •f 23'.
Issued By: �r_��` �- __// Permittee Signature: ' ; 10117�'/i/ 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.
Electrical Permit Applicat' n FOR OFFICE USE ONLY
City of Tigard IbCEIVED Received •MAN= Permit No.: gem-----e010
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
_ Phone: 503.639.4171 Fax: 503.598 FEB 2 3 2015 Date/By: Other Permit
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE'dPI1 DIVISION 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 150 volts or 0 Floating buildings.
1• .. less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling Nommercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.: Job site address: \ r-! 100HP or more. occupancy.
t `� S� lJ l.J[ 0 Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: O \ 1 ❑Health-care facilities. ❑Supply voltage for more than
�� t / "� I �� ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:c31a3 `7 Project name: 'y_ 2 I/ _ ' f eG ' , ❑Service or feeder 600 amps or more.
U FEE SCHEDULE
Cross street/directions to Job site: Description I Qty. I Fee. I Total
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 145.15 4
Ea.add'l 500 sq.ft.or portion 33.40 1
Tax map/parcel no.: Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
•
FA"` r\,` � Qy� 1� kj- (1 Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Services or feeders installation,alteration,and/or relocation
200 amps or less 80.30 2
-,� N PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: \ Ijklb l "124.l V OJU 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
relocation
Phone:( ) I Fax:( ) 200 amps or less 66.85 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 133.75 2
Branch circuits-new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with
,:,,,..4504;i44,,';‘,4164..APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: uw ffig l � B.Fee for branch circuits / fe
Contact name: , without service or feeder fee, 2
(4 first branch circuit
Address: let ` GA- Each add'1 branch circuit 6.65 2
Ot, / vl-rZ
Miscellaneous seroceodu feeder not included
City/State/ZIP: (� Z Each manufactured or modular 90.90 2
59.2_ dwelling,service and/or feeder
Phone:(523)Z Li 04" �. I Fax: :(.3 36 ,
Reconnect only 66.85 2
E-mail: 2:11.0-K2--6-1-). h,uRta.s Aow t S 5 ery\, c-,2,0-■ Pump or irrigation circle 53.40 2
1Z.. "'t CONTRACTOR Sign or outline lighting 53.40 2
Business name: Signal circuit(s)or limited-
Business 5 Zn L energy panel,alteration,or
Address: leap i {'c,^; s- - extension.Describe: Page 2 2
N t Each additional inspection over allowable in any of the above
City/State/ZIP: �� /cJ r l ?Ca_( Per inspection 62.50
Phone:(( 7 {—G/ Fax:(SQ7jl 5 (Z -b b 5-� Investigation per hour(1 hr min) 62.50
CCB Lie.: !6 Z "L'ieC calcic , 31 Suprv.Lie.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: 1i ` Subtotal: 362./S
'� 7 /� Plan review(25%of permit fee):
Print name: f t S / gP ao, Date: State surcharge(8%of permit fee): �. 7
Authorized signature: r/ l� m TOTAL PERMIT FEE: (�a, 92,
�l�l This permit application expires if a permit is not obtained within 180
Print name: J g� / Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Penmits\ELC-PermitApp.doc 05/23/06 440-4615T(II/05/COM/WEB
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