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Permit CITY OF TIGARD ELECTRICAL PERMIT 12,;!,•' COMMUNITY DEVELOPMENT Permit#: ELC2015-00954 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/03/2015 p Parcel: 25101 DB00200 Jurisdiction: Tigard Site address: 7582 SW HUNZIKER RD 30 Project: Hillcrest Apartments Subdivision: VARNS ACRES Lot: 9 Project Description: Reconnect only. Contractor: OWNER Owner: HILLCREST HOLDINGS LLC NFN INVESTMENTS 9 SE 3RD AVE, STE 100 9 SE 3RD AVE SUITE 100 PORTLAND, OR 97214 PORTLAND, OR 97214 PHONE: 971-279-2295 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Reconnect Only 12/03/2015 $67.84 Specifics: 1 ea 12%State Surcharge- 12/03/2015 $8.14 Electrical Type of Use: MF 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 Cente Those rule ate et forth in OAR 952-001-0010 through OAR 952-001-0090 You may obtain a copy • he rules o •irect questions to OUNC by calling 503.23 101.8 .332.23 Issued By: _r Permittee Signature: c( 1 /` 401111. 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 FOR OFFICE USE ONLY City g ofTigard Received , DateB': jl� _..- 't Phone: 503.718.2439 Fax: 50341 eillittP 13125 SW Hall Blvd.,Tigard,OR 9 Plan ReviewRelated Permit#Date/BInspection Line: 503.639.4175 'a Ready Date/By: INIMI El See Page 2 for TIGARD Internet: www.tigard-or.gov ep Notified/Method: Supplemental Information TYPE OF R 07 201 PLAN REVIEW ❑New construction ❑Addition/alteration/replla a to Please check all that apply(submit 2 sets of plans w/items checked): Of 1`Ly�a� ❑Service or feeder 400 amps or more ❑Building over three stories. ❑ Demolition ❑ Other: Iatni Aj where the available fault current ❑Mannas and boatyards. CATEGORY OF t .* ii 4#41V��I® exceeds 10,000 amps at 150 volts or ❑Floating buildings. ❑ -and 2-family dwelling ❑ Commerci Y' •ustrial ❑Accessory buildingTA44 ulti-family El Master builder ❑Other: less to ground,or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations buildings. ❑Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived Job#: Job site address: } e� t 31, �q'��,y a1 ❑Addition of new motor load of system. 1 6$L .7W 'TR 1'c7 N.eC.r t,n 100HP or more. ❑ A„ E„ 1_� I.3 *,L�ry Yd ❑Six or more residential units. occupancy. City/State/"LIP: _Y� > Off- 11 q:-t' ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: 30 Project name: 0 Hazardous locations. 0 Supply voltage for more than 0 Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to.job site: FEE SCHEDULE Description I Qtv. I Each 1 Total 1 New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 �`�� y CC'�-� C© (with above sq.0.) -� Y �� t/, t`��` 1 �Y ��-` Limited energy,multi-family residential(with above sq.ft.) 75.00 2 Renewable Energy 0 See Page 2 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation Name: 1.1.-N TAAQ, A-S 200 amps or less 100.70 2 Address: (\ Ira _ \�— 100 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP:' < 06...; V cli zA Li- 601 amps to 1,000 amps 301.04 2 Phone:MI ) 2:10t - 22,c Fax: ( ) 2Fi --I Over 1,000 amps or volts 552.26 2 --IK Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation: This installation is b 'ng made on property that I own which is not 200 amps or less 59.36 ' 1 intended for sale, lease `li or exc„` -ording to ORS 447,449,670,and 7 1.......-- 201 amps to 400 amps 125.08 2 Owner signature: 1J' Date: 12. N '7 ?4 1, 401 401 amps to 599 amps 168.54 2 0 APPLICANT CONTACT PERS �N Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: W 11\C .1-ry - - above service or feeder fee, b�\ each branch circuit 7.42 2 Contact name: 'VIA\`2L ack-Ak...0 B.Fee for branch circuits without seAddress: 116252_ .-t-rt `-�` ey branchae it feederitfee,first 56.18 2 .-t-rt i' circuit City/State/ZIP: Ti(: d I O G?17.72-3 Each add'I branch circuit 7.42 2 r� Miscellaneous(service or feeder not included) Phone: (cm ) Lace) Fax: :( )g4+3 3399 Each manufactured or modular 67.84 •�-' CCM dwelling,service and/or feeder 2 Email: `\`�..} N\PkQ r CC/1> ' Reconnect only l 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: Sign or outline lighting 67 84 2 Signal circuit(s)or limited-energy 0 See Page 2 2 Address: panel,alteration,or extension g City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr Email: Industrial plant(I hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lie.: Electrical Lie.: Suprv. Lie.: specifically listed(A hr min) ELECTRICAL PERMIT FEES Suprv. Electrician signature,required: Subtotal: 6'7-/1 Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Q;J1 Authorized sign. r4. TOTAL PERMIT FEE: 75":ciy This permit application expires if a permit is not obtained within 180 Print name: ` ` �.�'1 i Date: 1243 / days after it has been accepted as complete. * Number of inspections allowed per permit. I'\Building\Permits\ELC_ itApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/CONI/WEB