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Permit (10) CITY OF TIGARD ELECTRICAL PERMIT III II • COMMUNITY DEVELOPMENT Permit # ELC2011 -00597 Date Issued 10/25/2011 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 2S115BA02500 Jurisdiction Tigard Site address 16200 SW PACIFIC HWY 0 Project T Mobile Subdivision 2004 -015 PARTITION PLAT Lot 1 Project Description 21 branch circuits and limited energy Contractor MATES ELECTRIC Owner SN PROPERTIES PARTNERSHIP 11124 NE HALSEY 1121 SW SALMON ST PORTLAND, OR 97220 PORTLAND, OR 97205 PHONE 503 -516 -4142 PHONE FAX 503- 695 -6263 FEES Quantity Description Date Amount 1 ea Limited Energy 1 012 512 01 1 $75 Do Specifics. 21 crt Branch Circuits wo /Purchase 10/25/2011 $204 58 Service or Feeder Type of Use COM 1 ea 12% Slate Surcharge - 10/25/2011 $33 55 Class of Work ALT Electrical Type of Const Occupancy Grp B Total $31313 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 are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503 32 1987 or 1 800 3332 344 AV Issued By I I' 1V 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 �� - FOR OFFICE USE ONLY Received p City of Tigard �O 4� Date/By Permit N ELLd JI ( _ (Z 7S C I ° 13125 SW flail Blvd , Tigard, UK 9722‘ 0 Phone 503 718 2439 Fax 50 1960 e n' I C\ Date/By Other Permit TIGARD Inspection Line 503 639 4175 ` c� �f Date Ready /By Sims El See Page 2 for L. Internet www hgard - gov Z V � O Notified/Method Supplemental Information TYPE OF WORK O'..'fl\i \SVVi PLAN REVIEW •t 0,r1( rep la Ce ment Please check all that apply (submit 2 sets of plans w /Hems checked below) ❑ New construction ❑ Addition /alterat \i"... ❑ Service or feeder 400 amps or more ❑ Building over three stones ['Demolition ID Other V where the available fault current ❑ Mannas and boatyards CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings less to ground, or exceeds 14 ❑ Commercial -use agricultural ❑ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations buildings ❑ Multi -family ❑ Master builder 0 Other ❑ Fire pump ❑ Installation of 75 KVA or JOB SFfE INFORMATION AND LOCATION ❑ Emergency system larger separately denved system , D »'t0,/ ❑ Six ❑ Addition of new motor load of ❑ "A" "B" "1 2" 1 3" Job no Job site address 6 2. Oo 51(1 P cete I aney /,y ( r Six o or more residential units ❑ Recreational esational vehicle parks City /State /ZIP (f U' c' - -/ 722 6 - ❑ Health -care facilities ❑ Supply voltage for more than ❑ Hazardous locations 600 volts nominal Suite /bldg /apt no (, Project name T /7706 /Z E ❑ Service or feeder 600 amps or more FEE SCHEDULE Cross street /directions to Job site Description I Qn I Fee I Total I - New residential single- or multi - fatally dwelling unit Includes attached garage. Subdivision Lot no 1,000 sq ft or less 16854 4 Fax map/parcel n0 Ea add'l 500 sq ft or portion 33 92 I Limited energy, residential DESCRIPTION OF WORK (with above sq ft) 75 00 2 Limited energy, multi -family 75 00 2 residential (with above sq ft ) Services or feeders installation, alteration, and/or relocation 200 amps or less 100 70 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133 56 2 Name 401 amps to 600 amps 200 34 2 601 amps to 1,000 amps 301 04 2 Address Over 1,000 amps or volts 552 26 2 Q[ /State /ZIP Temporary services or feeders installation, alteration, and /or City/State/ZIP relocation Phone ( ) Fax ( ) 200 amps or less 5936 I Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125 OS 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701 401 amps to 599 amps 168 54 2 Branch circuits — new, alteration, or extension, per panel Owner signature Date A Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 20 7 42 mg '(0 2 each branch circuit Business name B Fee for branch circuits without service or feeder fee, first p Contact name branch circuit 56 18 5 • �p 2 Each add'I branch circuit 7 42 2 Address Miscellaneous (service or feeder nut included) City/State/ZIP manufactured or modular 6784 2 dwelling, service and/or feeder Phone ( ) Fax ( ) Reconnect only 67 84 2 Pump or irrigation circle 67 84 2 E Sign or outline lighting 67 84 2 CONTRACTOR Signal circutt(s) or limited- energy / v� 'N C panel, alteration, or extension ( Page 2 7.- 2 Business name fl Each additional inspection over allowable In any of the above Address I! / Ly /Vic Rol Sr y Pm 6 6 7 9 Additional inspection (1 hr mm) 66 25/ hr City/State /ZIP p4 U Invesugauan (I hr mm) 66251 hr X 2 �7 2 L Industrial plant (1 hr nun) 78 18/ hr Phone ( 70) ) 546 4A /4‘Z Fax ( 5}73) 61 91 1 -4 - Inspections for which no fee is 90 00/ hr • specifically listed (' /z hr min) I CCB Lie i q 33 7/ Electrical Lie 26 p°& Supry Lie 3T92_ j ELECTRICAL PERMIT FEES Subtotal 2 eI, ' Supry Electrician signature, required J© Plan review (25% of permit fee) _ _ _ Print name 441/2 47,4 Date /0 2 r —Zog State su rcharge (12% of permit fee) Authorized signature A — Bus TOTAL PERMIT FEE { -� 1 J J - - / `--r 'is permit application expires if a permit is not obtaainejwithin 180 Print name Date /0 — days after it has been accepted as complete S e o I/ Number o inspections allowed per permit I\Bmlding \Permits\LLC- PermitApp Sec 07/01/10 440 -4615T( I Ii05 /COSI/'En Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* n Burglar Alarm n Garage Door Opener* n Heating, Ventilation and Air Conditioning System* n Vacuum Systems* ❑ Other COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918 309 - 0000) Check Type of Work Involved: n Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems Er -Qata Telecommunication Installation Fl F ire Alarm Installation n HVAC n I • nstrumentation n Intercom and Paging Systems n L • andscape Irrigation Control* n Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* n Protective Signahng ❑ Other Total number of commercial systems *No licenses are required. Licenses are required for all other installations 1 \Budding\Penm¢ \PLC- PennitApp dcc 07,01/10