Permit .r CITY OF TIGARD ELECTRICAL PERMIT
34 I COMMUNITY DEVELOPMENT Permit#: ELC2015-00128
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503-718.2439 Date Issued: 03/02/2015
Parcel: 25101 DC05000
Jurisdiction: Tigard
Site address: 13410 SW 76TH AVE
Project: Albertina Kerr Centers Subdivision: PACIFIC RIDGE Lot: 2
Project Description: Install new generator, 16k 100amp.
Contractor: BOYLES ELECTRIC INC Owner: ALBERTINA KERR CENTERS
PO BOX 1227 ATTN: JERALD A HOFFERT
BORING, OR 97009 424 NE 22ND
PORTLAND, OR 97232
PHONE: 503-663-2628 PHONE:
FAX: 503-663-9048
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 03/02/2015 $100.70
Specifics: amps or less
12 12%State Surcharge- 03/02/2015 $12.09
Type of Use: COM Electrical(manual)
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.79
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. ATT- - • : • -.on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001 .010 through OAR 2 • 11:1. You may obtain a copy of the rules or direct questions to OUNC by cal I .'32.1987 or 1.800.332.23.44.
Iss =d By:
�/_� Permittee Signature: 'P !L?sQ��ic�=
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' ,._ �✓ �j ��_ Date:
LICENSE NO. c5 0 5
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 �/ FOR OFFICE LSE ONLY �y�y/
Ci}�, of Tigard 1cEIVE Daattee y - al(5.--l /� xi) 1 -W[Ae
III `J g Permit No.:
• 13125 SW Hall Blvd.,Tigard,OR 97 y
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
Date/By:
Inspection Line: 503.639.4175 Date Read /B ruris: El See Page 2 for
TIGARD MAR 2015 y y. g
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK-.. a
K• PLAN REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
❑Demolition ❑Other: ❑Service or feeder 400 amps or more ❑Building over three stories-
where the available fault current ❑Marinas and boatyards.
CATEGORY,OF CONSTRUCTI ' '' ,,,,k.,. 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.
El 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","1-3",
Job no.:3734 OC Job site address: 13410 SW 76th Ave 100HP 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: r� ,w ❑Service or feeder 600 amps or more.
1-T1--rJco_i 1IMG` KCg(Z FEE SCHEDULE
Cross street/directions to job site: pescript;un I Qty. I Fee. j 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 I
Tax map/parcel no.: Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family
INSTALL NEW GENERATOR /6 K 1 00 A- residential(with above sq.ft.)
75.00 2
1 Renewable Energy ' ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER- -- ® TENANT - 200 amps or less 1 100.70 fU0 2! 2
201 amps to 400 amps 133.56 2
Name:ALBERTINA KERB 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 ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
Business name: each branch circuit 7.42 2
B.Fee for branch circuits without
Contact name: service or feeder fee,first 56.18 2
branch circuit
Address: Each add'l branch circuit 7.42 1 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:( ) Fax: :( ) dwelling,service and/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 name: BOYLES ELECTRIC,INC. Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address:PO BOX 1227 Each additional inspection over allowable in any of the above
City/State/ZIP:BORING,OR 97009 Additional inspection(1 hr min) 66.25/hr
Investigation(I hr min) 66.25/hr
Phone:(503)663-2628 Fax:(503)663-9048 industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90,00/hr
CCB Lic.: 137002 Electrical Lic.: -465C Suprv.Lie.: 3404S specifically listed(Y2 hr min)
Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES/� Subtotal: foo r2-°
Print name: JOHN E BOYLES / U Date: 2/20/2015 Plan review(25%of permit fee):
State surcharge(12%of permit fee): (a 0'
Authorized signature: TOTAL PERMIT FEE: � r a. 4
.—
Print name: This permit application expires if a permit is not obtained within 180
Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I.\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(I1/05/COM/WEB