Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2016-00232
T fGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/25/2016
Parcel: 2S 102AD02900
Jurisdiction: Tigard
Site address: 12790 SW ASH AVE
Project: Burnham&Ash Apartments Subdivision: BURNHAM TRACT Lot: 5
Project Description: Building 2-Electrical for new multifamily building.
Contractor: BEAR ELECTRIC Owner: PREMIUM PROPERTY-TIGARD LLC
PO BOX 389 1015 NW 11TH AVE, STE 243
DONALD, OR 97020 PORTLAND, OR 97209
PHONE: 503-226-1972
HONE: 503-678-1355
FAX: 503-678-1108
FEES
Quantity Description Date Amount
4 ea Services or Feeders-200 05/25/2016 $402.80
Specifics: amps or less
1 ea Services or Feeders-Over 05/25/2016 $552.26
Type of Use: MF 1000 amps or volts
Class of Work: ALT 35 crt Branch Circuits w/Purchase 05/25/2016 $259.70
Service or Feeder
Type of Const: VA 1 ea Plan Review Electricial 05/25/2016 $303.69
Occupancy Grp: R-2 1 ea 12%State Surcharge- 05/25/2016 $145.77
Electrical
2733 Electrical Permit 05/25/2016 $2,733.21
683 Plan Review-Electrical 05/25/2016 $683.30
328 12%State Surcharge- 05/25/2016 $327.99
Electrical
Total $5,408.72
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: Oregon law requires you to follow the rules adopted by the gon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. Yo<may oota - =•• of the rules or dir sti s to OUNC by calling 503.232. or 1/10. 2.2344.
j
Issued By: '' - —' Permittee Signature: �� Y
dire Of •
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.
1 _...„
. , '.Ns ,
Electrical Permit Application , V, ' FOR OFFICE. t St. OyI.v
0"*": Received
City of Tigard %Ta1i E y ,"`i! • , '..%1 Permit No. E�cdoi6--(�d
ja
13125 SW'flail Blvd `Figard.OR 97223 c) k�-
MPR le Plan ft ieit atJ . J Other Permit: 44 G��1 vs
' 1 Phone: 503 [18.2439 tax: 503.598.1960 ( :/ O
J
I f, ,R u Inspection Line: 503.639.4175 a y� f' tads ® See Page 2 for
Internet: www.tiaard-or. ov y r 9S od 5/�P /, , Supplemental Information
TYPE OF WORK .* `'�1� 4444.4444_,..... PLAN REVIEW
ELN construction ❑.4d(Jitiotl/itlteration!replr �{A Please check an that apply(submit 2 sets of plans is items checked below)-
EfisSaviee or feeder 400 amps or more VIL Building user three stones.
�
El Demolition El Other: where the available fault currant ❑Marinas and boat aids.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 soils or 0 Floating buildings.
less to ground.or excetxls 14.0(5) ❑Conmtercial-use agricultural
0 I-and 2-family dwelling ❑Commercial`industrial ❑Accessory building amps for all other installations buildings
Ea-Multi-family ❑Master builder ❑Other: ❑Fire point). 0 Installation of 7'5 Kv'Aor
0 Lntergencv system. linger separately derived system.
JOB SITE INFORMATION AND LOCATION 0 Addition of iteis 1110101 load ci ❑".v A . t' -1.2", I
Joh no.: Job site address: o) `(it Asti
/)
-
{ � � �L- JSt� �� IOWIP or moreoceu ncy
� �Sii or more nsidcmial amts. 0 Recreational vehicle parks.
City�Sttte..'LIP: ��� .tia� 1 �'7 3
'—
Health-care facilities 0 Supply voltage fin more than
/��, ❑Ilazanksus locations 6[0 v dt,nominal
Suiterblda!apt.no.:4 Project name: t2�� { - . ( Service to feeder('00 am or more.
name:/30‘24/.04A I Asti rI J FEE SCHEDULE
Cross street/directions to lob site: _Description I Qty. I Fre. I Total_ 1_,,
'I n New residential single-or multi-family dwelling unit. a
Vii E ;-- Includes attached garage.
Subdivision: Lot no.:
I Largest Unit Size 168 54 4 t�
Each Additional at Half 84.26 I n
Tax map/parcel no.: /
First unit over 1,000 Sq.Ft. / 202.46 aOp2 //(l2
DESCRIPTION OF WORK /
C.
Each Additional over 1,000 Sq.Ft. 101.23 3
N�'ce� ��1uC,7 /-�,41v�it'1 gii[Lhi/li(C1 at Half q �� a,S 0-lis
Services or feeders installation,alteration,and/or relocation /
,.•}-- I 200 amps or less Li 100 70 I/ Q ,&J ✓
2
0',PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to600 amps 2(1O 34 '_
Name: 601 amps to 1.000 amps 301 04
z4 •
Address: Over I,000 amps or volts / 552.26 S-5-o2.r'i 2 6/7
#I I "Temporary services or feeders installation,alteration,and/or
lc City/State/ZIP: — relocation
r •1 Phone:( } I Fax:( )
2151 amps or Ices SO 36
201 amps to 40th amps 125 08
Owner installation:This installation is being made on property that I ovn hich is not
_
twri
intended for sale,lease.rent.or exchange,according to ORS 447.449,670.and 701. 401 amps to 599 amps 168 54
11.* wsignature: Branch circuits-new,alteration,or extension,per panel
Owner _ Date: _ _ A Fee for branch circuits with
CI APPLICANT [Q CONTACT PERSON above s ry ice or feeder tee. 7 42MI 2
each branch circuit
jj Business name: B Fee for branch circuits rentor;
0 -- — ------ , service or feeder lex:_first
0 K branch circuit 56 18 ?
Contact name: _
---t Lach add'I branch circuit 7 42
r Address -- Miscellaneous(service or feeder not included) ——
t C.:ih',Statc'LIP: -- — filch manufactured or modular 67 84 -
dwelling.service and/or feeder -
-� — — —Reconnect only 67 84
Phone:( ) I F'ax::( l — ---- — --
Pumporinigationcircle 6784 2
Int1'-mail: Sign or outline lighting 67 84
i 1., i CONTRACTOR — —
_ Signal circuiHs)or limrtcd-energy
Business name: panel.alteration,or extension. Page 2 1
.
LL► t�tc i _H Each additional inspection over allowable in any of the above
Address: Pe g`) Additional utst ctioni t hr min) 66 25!hr
g �� � `� \ Industrial plant hr min) 78.181 hr
— — Investigation(I hr min) 66.25/hr -- —
CityiState-ZlP: 1, / G► / 9(J
Phone:(S)3 )4, --).�sJ Fax:(is ) 6 ,:c.--> ///� � Inspections for which no tee is 90-W1 hr
specifically listed I'' hr min)
CCB Lic.:de9/'3 Electrical Lie.:9l/, c Suprv.Lic.:S(95-9< ELECTRICAL PERMIT FEES
�_ —— -- — Subtotal: ,.. jS
Suprv. Electrician signature,required: ,
i jl -- -----� flan revrcN(25,n of permit fee)`) 5 • •j
7at --- State surcharge(1290 of emit fee): 3 1
Print name: C4/, s?-t! �- S 1
_ L 'Farm.PLRMI f FEE: (y,/6 t �t9J
Authorized signature:
This permit application expires if a permit is not obtained within IMO
— — days after it has been accepted as complete.
Print name: I Date: W Numbet of inspections allowed per pemttt.
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