Permit CITY OF TIGARD ELECTRICAL PERMIT
IN _` a COMMUNITY DEVELOPMENT Permit #: ELC2010 -00214
13125 S W Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/05/2010
T 1 GARD Parcel: 2S110AD08702
Jurisdiction: TIGARD
Site address: 10793 SW MURDOCK CT B10
Subdivision: Lot: 0
Project: Pacific Crest Apartments
Project Description: (1) 100 amp panel replacement
Owner: FEES
TIGARD COLONY LIMITED PARTNERSHI Quantity Description Date Amount
380 UNION ST STE 300
WEST SPRINGFIELD, MA 01089 1 ea Services or Feeders - 200 05/05/2010 $100.70
amps or less
PHONE: 1 ea 12% State Surcharge - 05/05/2010 $12.08
Electrical
Contractor:
PREMIER ELECTRICAL SERVICES INC
4548 SW TAYLORS FERRY RD
PORTLAND, OR 97219
PHONE: 503 - 293 -3060
FAX: 503 - 293 -3061
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $112.78
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 0 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 246.6699 or 1.800.332.2344.
Issued By: _, Permittee Signature: 6A v /9P / 6` �d"../
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 an inspection that business day.
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 Applicati .z 0 I ORt I ICI.-9. 1 h 1 I :� _ , , ECEIVED I .,
illig City of Tigard Received Date/By: S /-S/t) .e Permit No. EGCo2O /O — C/ O at /"
13 125 SW Hall Blvd., Tigard, OR 972 qq — 5 Plan Review
0 Phone: 503.639.4171 Fax: 503.598. fg60Y 2 01 D ateBv: Other Permit:
:T, 1c;,\
• 'R: l')^ Inspection Line: 503.639.4175 Date Ready/By: lurk I ® See Page 2 for
r I Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: 11 Supplemental Information
TYPE 0 R G DIVISION
PLAN..REVIEW
❑ New construction XI Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION . exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND
0 Emergency system. larger separately derived system.
/0 � r ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
•
Job no.: Job site address: �/ 10OHP or more. occupancy.
_S"' �!6//P,QGGf;.8 -77 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: 7—/ 6 A/P p, O/ 9 7 --a `1 ❑ Health -care facilities. 0 Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: f' / Project name: 7'- G � A_�r El Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. 500 or portion 33.92 1
Tax map /parcel / arcel no.: GqS //O/96 a t�0 / Li mited iced energy, residential
idential
DESCRIPTION OF WORK (with sq. ) 67.84 2
with above s ft.
Limited energy, multi - family 67.84 2
pO -4 7e rye V /Pew f ' e..--,7 ¢ residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less / 100.70 /00....t 2
❑ PROPERTY • ❑ TENANT. • 201 amps to 400 amps 133.56 2
,� p 401 amps to 600 amps 200.34 2
Name: / C� .3 /��e �/ /E 2 601 amps to 1,000 amps 301.04 2
Address: / Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: Ls jr 6 39 _ 05.-3 Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
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 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add' I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included) •
City/State/ZIP: /State /ZIP: Each manufactured or modular 67.84 2
Y dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
• CONTRACTOR Signal circuit(s) or limited - energy
Business name: panel, alteration, or extension. Page 2 2
A?_ e r % E/e c /' �G�S r v, cam -.' c , Each additional inspection over allowable in any of the above
Address: ..__ %,,,.•„? ...s To .......c Fe..� �� Additional inspection (I hr min) 66.25/ hr
/ Investigation (1 hr min) 66.25/ hr
City /State /ZIP: .„- of 7 G , � 2....2 y
rr 9 2. / Industrial plant (1 hr min) 78.18/ hr
Phone: ( $03) 1 93_ 3G 6' O Fax: (So7) �, 93 _ .—?p C / Inspections for which no fee is 90.00 / hr
specifically listed (% hr min)
� , , � Lic.: /� 9 I Electrical Lic.: G S 3 Suprv. Lic.:, f y2 S ELECTRICAL PERMIT FEES
�/ Suprv. Electrician sig e, 'quire r /d/V/ 0 Subtotal: l0 0 7
Plan review (25% of permit fee):
Print name: /�-7:. •c ,Va.e V' ,re: p Date /S � / � State surcharge (12% of permit fee): /A • Q
/ TOTAL PERMIT FEE: /72 7e-
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete. ..
N um b er of inspections allowed per permit. �
Print name: Date:
I:\ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 46IST(II /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for Al residential systems combined $67.84
•
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other:
r COMMERCIAL WORK ONLY: • ,
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n A • udio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n D • ata Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ M edical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \ Building \Permits\ELC- PermitApp.doc 10/01/09