Permit (5) CITY OF TIGARD ELECTRICAL PERMIT
''-. COMMUNITY DEVELOPMENT7,1
Permit#: ELC2019 00660
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/02/2019
Parcel: 2S 110AD08700
Jurisdiction: Tigard
Site address: 10775 SW MURDOCK LN 1
Project: Hudson Apartments, Building G Subdivision: None Lot: None
Project Description: (12)branch circuits for water heater monitoring upgrade for building G units 1-12.
Contractor: TICE ELECTRIC Owner: S&P PACIFIC CREST LLC
5405 N LAGOON AVE. 10695 SW MURDOCK LLC
PORTLAND, OR 97217 ATTN SHARKANSKY, MAX
700 N SAN VICENTE BLVD STE G460
WEST HOLLYWOOD, CA 90069
PHONE: 503-872-8230 PHONE:
FAX: 971-230-3330
FEES
Quantity Description Date Amount
12 crt Branch Circuits wo/Purchase 10/02/2019 $137.80
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/02/2019 $16.54
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $154.34
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 503.232.1987 or 1.800.332.2344.
Issued By: , .--r._�+s x,,,,-(;
____ ,,,,,,,,,,_-_3.,,-... ,,,e,,,...--
,,e- 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 $,-it
i ,
PP -° ,. a,- ,. ,,-Amt, FOR OFFICE USE OIY Y � Y
2t. City of Tigard Received
Permit!t:
W 13125 SW Hall Blvd.,Tigard,OR 97223 �C 1. 21' Date/By: `�V/ (sl /jT' �� y,7`y, 3��
-.101Plan Review �`
Phone: 503.718.2439 Fax: 503.598.1960 Related Permit k:
Inspection Line: 503.639.4175 'Jr Ready Date/By:GAARD I I 1 Ready Date/By: furls El See Page 2 for
, .�,, ,.. Internet: www.tigard-or.gov rel i!l F¢ /'" ',j.` Notified/Method: fs- Supplemental Information
TYPE OF WORIZ, PLAN REVIEW
0 New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition ❑Other: 0 Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION 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.
0 Multi-family 0 Master builder 0 Other:
❑Fire pump. ❑installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job 4: Job site address: _ _ ❑Addition of new motor load of system.
%� 1 IO-)('S� 10 Jt;4/• OOHP or more. ❑:.A„..E..::I 2„..I;„
City/State/ZIP: _1 -U six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: f—( , I Project name: J' --" � 1,9€4,60,....A
7 - I 1.� ,Q�, , fl 0 Hazardous locations. 0 Supply voltage for more than
' 17. ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. i Each I Total I '
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: includes attached garage.
Tax map/parcel 4: 1,000 sq.R.or less 168.54 4
Ea.add'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
/ (with above sq.ft.) 75.00 2
6-/i)�Jl 69....4.4 4';`,`' �"7/ 1,...74,- why,/'-, Limited energy,multi-family
�// 1 J residential(with above sq.ft.) 75.00 2
G-_g�r c `4,s' k'+,Gxl4g
j� PROPERTY OWNER �` Renewable Energy ❑ See Page 2
❑ TENANT 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:( ) I 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 i
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
0 APPLICANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits~Pith
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56 18 rG 2
branch circuit G
City/State/ZIP: Each add'l branch circuit a// 7.42 V,61 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email:
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Tice Electric Company Sign or outline lighting 67.84 2
-energy
Address: 5405 N Lagoon Ave panel,alteration orlimiteext nsion.
❑ See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP: Portland, OR 97217
Additional inspection(1 hr min) 66.25/hr
Phone:(503)233-8801 Fax:(503) 231-3372 Investigation(1 hr min) 90.00/hr
Email: adamc@ticeelec.com Industrial plant(I hr min) 78.18/hr
inspections for which no fee is
90 00/hr
CCB Lie.: 166 Electrical Lic.26-126C Suprv,Lie.: 3940S specifically listed(%hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,require , ,„ t.g?i195 Subtotal: /3 ?. ye I
Print name: j':�a44, 4thier&F",7 DaYe: �r�je/�/7 0 Plan Review Required(25%of permit fee):
�/ State surcharge(12%of permit fee): 5' 9'
Authorized signature: TOTAL PERMIT FEE: J--y, 3 y
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
t:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB