Permit (21) CITY OF TIGARD ELECTRICAL PERMIT
A COMMUNITY DEVELOPMENT Permit#: ELC2016-00321
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/18/2016
TIGARD Parcel: 2S110AA00900
Jurisdiction: Tigard
Site address: 14050 SW PACIFIC HWY
Project: Ellingson/Lassen Subdivision: None Lot: None
Project Description: Basement storage room: install spider/power distribution box for temp/restoration of power.
Contractor: SQUIRES ELECTRIC Owner: ELLINGSON REVOCABLE INTERVIVOS T
657 SE YAMHILL ST BY ELLINGSON, JOSEPH M&JEAN E TRS
PORTLAND, OR 97214 420 W LASSEN AVE
CHICO, CA 95973
PHONE: 503-252-1609 PHONE:
FAX: 503-253-5831
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 04/18/2016 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 04/18/2016 $6.74
Type of Use: COM Electrical
Class of Work: ALT 1 ea Investigation Fee 04/18/2016 $90.00
1 ea Investigation 12%State 04/18/2016 $10.80
Type of Const:
Surcharge
Occupancy Grp:
Total $163.72
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: regon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 ough OA 52-001- 90. ou may obtain a copy of the rules or direct questions to OUNC by ca •• • . 987 or 1.800.332. 344.
Issued B C 2„,rpt • Permittee Signatur .• ( CEJ
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' ,LA--14 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 1.0k OFFICE I'SE ONLY
City of Tigard RECEIVED DatetB ;mark Permitii: Etc-ao.I'- co 3.2-...,;
liq
. 14 13125 SW Hall Blvd„Tigard,OR 97223 Plan Review
Phone: 503.7182439 Fax: 503.598,196 P R 1 8 2016 Date, Related Penttk a:
Inspection Line: 503.639.4175 Ready Date/By: ]oris: El .ce Page Z for
' •UARO. Internet: www.tigard-or.gov • _ - '..i
i , Notified/Method: Su elemental Information
- r , 15^374, 14t 7 . "51ti' r � ', di'- - . rGR'. .: ''"' lL'''I''',,
i'�t u •!+p.:
L..' .- ,_.�x..:14 �..P . �v :. ?Mk!• LA,A..riva L .. t .. : . . . . m. •::-.� •
❑New construction l► Addition/alteration/replacement Please check all that apply(submit j sets of plan w/nerns chocked).
0 Service or feeder 400 amps or more 0 Bui ding over three stories.
❑Demolition D Other: where the available fault current 0 .' as and boatyards. •
" exceeds 10,000 amps at 150 volts or 0 Fl• ,• g buildings.
���_._. �:!•w'�ur���;•;-..4;.0.,7C'•h t(i)rc l�.'9 t,.,'�.�,(�yM,`ZrS"`� t,.� uL. „ ;:.1; � �;,a
❑ 1-turd 2-family dwelling E ommercial/industrial ❑Accessory building less to ground'or exceeds 14,000 ❑Co •crcial-use aericuhurdl
amps for all other installations. bui Ings. .
❑Multi-family El Master builder 0 Other: ['Fire pump. ❑ins,dation of 150KVAor,
7".. -_ , tv n ., .i _1(i t�., a) gy, ❑Emergency system. ler, separately derived
":.� n rf„_ i ' J`';' .N `. _ 5�' !l,ti, ;•,,...•:,,l7,;,. ❑Additton of new motor load of s , M.
Job*: Job site address:'LIo o Sw �A� ‘c. (N 100HP or more. ❑"A' '•F""1.2""I.3"
r( 0 Six or mole residential units. occ panty.
City/State/ZIP: \J
l ❑Health-care facilities. ❑Re eational vehicle parks
Suite/bldg./apt.#' Project name:CM / t as�� 0 Hazardous locations. 0 Su.,.1y voltage for more than
` 1 0 Service or feeder 600 amps or more. •"volts norninal-
Cross street/directions to job site: : Fd -. ..
, i:17. > 7-jl t;('Et: :.�ir1r:::7.1� !'%
orseripeton Qty.•.I Each .I . Total
New residential single-or multi-family ,welling writ.
subdivision: Lot#: includes attached garage. • -
- w 1,000 sq.ft.or less -' 168,$4 "f 4
j Tax map/parcel# Ea.add'i 500 sq.1t.or portion 33.92 1
, . '. '? w:a1V..` e+ Limited energy,residential 75,00
^� �+ Ski.'
- WC/
,,,� (with above sq.ft.)
S 1 UJ J ` k 1 l W 1 10(1 Limited energy,multi-family
1 1 residential(with above sq.tl.) 75.00 2
� + �' ` �� � (..44)..r. Renewable Energy ❑ Se Page 2
: ' O f ar i�tr• g " Services or tbeders Installationolterati-nk,nnd/trr relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
"v/StatefZlP: 601 amps to 1,000 amps 301.04 2
..Lone:( ) Fax:( ) Over 1,000 amps or volts J 552.26 2
Temporary services or feeders installati.n,alteration,and/or
Email; relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 ' '1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature; Date: 401 amps to 599 amps 168.54 2
r, i� Branch circuits-new,alteration,or ex nslon,per panel •.-.
. . ,1[ . t : f a ' .� '. A.Fee for branch circuits with
Business name;Squires Electric,Inc. above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address;651 SE Yamhill 5t_ service or feeder fee,first 1. 56.18 SC•13 '2
branch circuit
City/State/ZiP:Portland,OR 97214 Each add'l branch circuit 7.42 z
Miscellaneous(service or feeder not inc,uded)
Phone:(503)252-1609 Fax:;(503)253-5831 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email;Andrew@SquiresElectric.com • Reconnect only 67.84 2
'•?.'('- '`;-'''''-i;':'::::)...:.';'."':-.... oto e i C <. a:.G ti: F'74..;r.`. .3'7 ?'`i . . ..3 - Pump or irrigation circle 67.84 2
Business name:Squires Electric,Inc. Sign or outline lighting 67.84 2
Address:657 SE Yamhill St. - Signal circuits)or limited-energy ❑ ger Page 2 2
panel,alteration,or extension.
City/State/ZIP:Portland,OR 97214 Each additional Inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)252-1609 4 .x:(503)253-5831 investigation(I hr min) 90.00/hr
Email:An(Irew®SquiresElectric.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90,00/hr
CCB Lie.: 135085 [EIe.t'cal Li ; 1101C Suprv.Lic.: 4882S specifically listed /s hr min
w" • hart' tii1tP.. . %.',;44-',.R" r11Ct
,env. Electrician sign re,requi d; „..--"---- Subtotal:-54 ,E'S
. -Alt name: Joe Squire• Date: 3 r ❑Plan Review Required(25%of permi r fee): . .
low State surcharge(12%of permi fee): 4P,
Authorised signature: TOTAL PERMITJFEE:0 ,
This permit application expires if a permit 1 not obtained within 180
Print name: Joe Squires Date: I'/ 6 days after it has been accepted complete.
//'u� • Number of inspections allowed per permit. 0
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