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Permit (117) CITY OF TIGARD ELECTRICAL PERMIT 1111 COMMUNITY DEVELOPMENT Permit#: ELC2017-00874 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/27/2017 Parcel: 2S102AC00700 Jurisdiction: Tigard Site address: 12550 SW MAIN ST 120 Project: Stumptown Escape Games Subdivision: None Lot: None Project Description: (2)branch circuits for TI. Contractor: PHOENIX ELECTRIC CO Owner: DOLAN&CO LLC PO BOX 14037 BY FLORENCE T DOLAN PORTLAND, OR 97293 4523 NE DAVIS ST PORTLAND, OR 97213 PHONE: 503-231-8006 PHONE: FAX: 503-235-4300 FEES Quantity Description Date Amount 2 crt Branch Circuits wo/Purchase 11/27/2017 $63.60 Specifics: Service or Feeder 1 ea 12%State Surcharge- 11/27/2017 $7.63 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $71.23 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules and s- forth in OAR 952-001-0010 through OAR 952-001-0090. you may obtai ules or direct questions to OUNC by calling 503.232.198.800.332.2344. Issued By: ��` � �—^ Permittee Signature: _ OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale,lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Electrical Permit Application y roR OFrlcr t sl:()NIA • City of Tigard Date/By:Receiv /1 rA7 17 , Permit#: ,7''''(:,X? i/ 13125 SW Hall Blvd.,Tigard,OR 9 Plan Review l ) w,C Related Permit#: t' �77 Phone: 503.718.2439 Fax: 503.59 (Al Date/By: C /,2) 7 ( j 8' Inspection Line: 503.639.4175 l` t),' Ready Date/By: Jas ® See Page 2 for T I(,ARD Internet: www.tigard-or.gov \Q V Notified/Method: AP Supplemental Information ; , 'U OF�WO; 04' '� � i - R ❑New construction ®Addition/alterati0 Please check all that apply(submit 2 sets of plans w/items checked): �� ❑Service or feeder 400 amps or more ❑Building over three stones. ❑Demolition 0 Other: C93where the available fault current 0 Marinas and boatyards. CATf,puRY©.V CO1l$ Jet exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-family dwelling Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder El Other: ['Fire pump. ❑installation of 150 KVA or ',moi slim `I"Ioh{; ;WA" It)1'+i' ❑Emergency system. larger separately derived ❑Addition of new motor load of system. Job#:416 Job site address:12550 SW Main St. 1001-IP or more. ❑"A","E","1-2","1-3", City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. OCC1ancy 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: /1,40 Project name:Stumptown ❑Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: , - PEE, D Description I Qty. f Each I Total I * 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 1 9 � N (1 W(3 : Limited energy,residential (with above sq.ft.) 75.00 2 TI of office space. Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy 0 See Page 2 ' CarkOrbitir Q . .0 »AN ' Services or feeders installation,alteration,and/or 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 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,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 Branch circuits—new,alteration,or extension, i er panel A1'PI;ICAiAIT fi,. ' (' -- A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 each branch circuit Contact name: B.Fee for branch circuits without service or feeder fee,first 1 56.18 56.18 2 Address: branch circuit City/State/ZIP: Each add'1 branch circuit 1 7.42 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax::( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: Reconnect only 67.84 2 >EQ [ !E Pump or irrigation circle 67.84 2 Business name:Phoenix Electric Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address:PO Box 14037 0 See Page 2 2 panel,alteration,or extension. City/State/ZIP:Portland,OR 97293 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(503)231-8006 Fax:( ) Investigation(1 hr min) 90.00/hr Email:terryk@phoenixpdx.com Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: 162753 1(141114 Electrical Lic.: C89 7/1 l• Suprv.Lic.: 5169S specifically listed(%4 hr min) Suprv.Electrician signature,requiredntSubtotal: 63.60 Print name: Terry Koch Date: 11-22-17 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): 7.63 Authorized signature: TOTAL PERMIT FEE: 71.23 This permit application expires if a permit is not obtained within 180 Print name: Terry KOC (447 Date: 11-22-17 days after it has been accepted as complete. * Number of inspections allowed per permit. 1:\Building\Permits\ELC PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB