Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2020-00224
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/01l2020
Parcel: 1 S 126CA00100
Jurisdiction: Tigard
Site address: 9225 SW HALL BLVD A
Project: Dancer's Closet Subdivision: None Lot: None
Project Description: (1)branch circuit to reconnect RTU
Contractor: CASCADE WIRE WORKS Owner: GREENBURG CORNERS LLC
PO BOX 821773 621 SW ALDER ST, STE 800
VANCOUVER,WA 98682 PORTLAND, OR 97205
PHONE: 360-904-4412 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 05/01/2020 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 05/01/2020 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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- You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1967 or 1.800.332.2344.
Issued By: ,�r,/l /74/e- Permittee Signature: C�%ter ��/'/ ��' ,('t1.,
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 °- ; ,ll/17:i FOR OFFl(.l t Ft: 011.1
City of Tigard ReceivedS / 7.r/ 2c�
APR Plan Rev .�/� Permit N��C�(J���
Iiiie • 13125 SW Hall Blvd.,Tigard,OR 97223 4� Z�20 plan Review mot'
Phone: 503.718.2439 Fax: 503.598.1960„ __ Dater, rn Related Pevt ft:- Inspection Line: 503.639.4175 V Of- d q_i" T.) Ready Date/By: Juria: See Page 2
for
t I I. A K IIIInternet: www.tigard-or.gov `' Notified/Method: ®Supplemental information
TYPE OF WORK .
0 New construction ►!1 Addition/alteration/replacement Please check all that aIy(submit sets ot'plans w/ircms checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition El Other: where the available fault current 0 Marinas and boatyards.
. , TEGORY OF CO„ _ (N exceeds 10,000 amps at ISo volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,orexceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE': %''I ORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: Job site address: 1 ❑Addition of new motor load of system.
( 22. Sw ls,tl-�l V 0 e- 10014P or more, 0"A","E","1-2, "1-3„
City/State/ZIP:�-\C.t .D (� O`^—t Z2'> ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: A Project name: f9S f'r rgf..t— ❑Hazardous locations. ❑Supply voltage for more than
0 Service or feeder 600 amps or more, 600 volts nominal.
Cross street/directions to job site: S1/4„...... Cc.-12l....1g e--c- `i k WAIF�s 1.V.';r,� z ,
a , '_'FEE SCHEDI]F,$ srl yr ,:..
/� ���-` �, Dennipdon I Qty. I Each I Total '1 +
`'""(i? [r7.t� 2e> c `\ ¢-r, U O 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'I 500 sq.R.or portion 33.92 I
'DESCRIPTION OF WORK r Limited energy,residential 75.00 2
(') ,^ �' (with above sq.ft.)
"`�c.,,""-' e'er -" �`-� Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
TEN ,r Renewable Energy Q See Page 2
0 PROPERTY OWNER ; ,gt ,N Services or feeders installation,alteration,and/or relocation
Name: 't,c>,1--o C t (v r- T 200 amps or less 100.70 2
Address: t%2 5.' �.1,�).1 Q—' �- et•
201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: "7-\t "1'1-'-,--- 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
f&APPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: Cizre:cia,c* 3\p f �S above service or feeder fee, 7.42 2
` each branchbracircuit
Contact name: l J\ 'C}•.,a_"M'' �,�C� B.Fee for branch circuits without
Address: �\"'t"-t,, service orfeeder fa,first . 56.18 rjtp,l`t3 2
branch circuit
City/State/ZIP: \j 'cx ' iCx- k,A341. "Z.— Each add'I branch circuit 7A2 2
Miscellaneous(service or feeder not included)
Phone:(r ( ) (DrL .t-kt),`--2._ Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: ,x 0 C c.-tx t,....3.4QEL''-X f2-'LS (--Cjo---^ Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: e-- Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(I hr min) 90.00/lie
Email: industrial plant(l hr min) 78.18/hr
i Inspections for which no fee is
CCB Lie.:I '� \�7 Electrical Lic.: 2D+C_ Suprv.rv.Lic.: 1 specifically listed(li hr thin) 90.00/hr
r 1 a= . ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: f /{�7Subtotal: rj t,,t�'
Print name: N/(,/ 1���� Date: G//' 7� a� 0Plan Review Required(25%of permit fee):
/ State surcharge(12a/a of permit fee): (p,-l1k-
Authorized signs TOTAL PERMIT FEE: I. Z .q Z
This permit application expires if a permit is not obtained within 180
Print name: Date: �..,` 6`r„--cL days after it has been accepted as complete.
• Number of inspections allowed per permit.
Ltnuilding\Ponnita'ELC PermitApp ELK ERE.doc Rev 06✓172015 44(1-0615T(11/05/COM/WES