Permit a CITY OF TIGARD ELECTRICAL PERMIT
`` 11 COMMUNITY DEVELOPMENT Permit #: ELC2010 -00157
T t GAR17, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 04/07/2010
Parcel: 2S101DD00400
Jurisdiction: Tigard
Site address: 6825 SW SANDBURG ST
Subdivision: Lot: 0
Project: Vigilant
Project Description: (1) branch circuit for new a /c.
Owner: FEES
TOC MANAGEMENT SERVICES INC Quantity Description Date Amount
6825 SW SANDBERG ST
TIGARD, OR 97223 1 crt Branch Circuits 04/07/2010 $56.18
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 04/07/2010 $6.74
Electrical
Contractor:
ATLAS ELECTRICAL CONTRACTORS
4403 SE ROETHE RD
MILWAUKIE, OR 96267
PHONE: 503 - 659 -2212
FAX: 503 - 659 -4944
Type of Use: COM
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 accorda ce 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. ATTE •N: Orego law requires you to follow the rules adopted by the Oregon Utility • Ica ion Center. Those rules are set forth in OAR
952 - 001 -00 • through OAR 952 10 • 10 ou may obtain a copy of the rules or direct questions to •UNC by calling":F •.• -99 or 1.800.332. 344.
Issued By. . L�ir/ 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 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.
Alit, 2, 2010 2:20` \ Alias Ei= .trica.' Contractors In \c. 7�19
Electrical Permit Application FOR OF1r ICF.. USE ONLY
City of Tigard ,' , Received ����
g I , J �� ' _ i DaletB ,: 7 A /Q in Permit No,: 0 1,010...00/5 2
• 13125 SW Hall Blvd., Tigard, OR'' 97223 i Phone; 503,639 1171 Fax; 5 03.59ti.1960 Plan Review
DaleB OtherPertnil:
T I CIA IL D
Inspection Line: 503,639 Dale Read B : luny: Bi See Page 2 for
hueenet, www.tigord- or.gov APR 0 2 2010 Notified/Method: Supplemenlul Informotlon
-PLAN REyIEW , : ,
D New consinretion ® Addition /ialtcrafion/icplaectrierif'
Please check all that apply (submit a sets of plans wliiems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
CI Demolition ❑ Other:
_ where the available fault current 1: Marinas and boatyards.
CA G RY . Or C s at 150 volts a
❑ 1 and 2-family dwelling ®Commercial/industrial - exceeds 10,000 am 11 ❑ Accessory building p ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑Commercial -use agricultural
wilding amps for all ether I nstallations. buildhrgs,
El Multi - family ❑ Master builder ❑ Other: ❑Pirc pump. ❑ Installation of75 KVA or
^'* ❑ Emerp "eney system. larger separately derived system.
I , JOB S1TE-INFORMOION ASV[) LOCATION: ❑ Addition of new motor load of ❑ "A ", "E ", "1 2 ", '1 3",
Yob no.: 19495 Job site address: 6825 SW SANDBURG STREET 100HP ormore. occupancy,
❑ six or more residential units, ❑ Recreational vehicle parks.
City /State /ZIP: TIGARD, OREGON 97223 ❑ Health -care facilities. ❑ Svpply vohngc for more than
❑ Ha2ardous locations. 600 volts nominal.
Suite/bldg. /apt. Ito.: Project name; VIGILANT ❑ Service or feeder 600 amps or more.
—.— w , FEE. SCHEDULE : ' ,
Cross street/directions to job site: Ducripuan 1 Qtr'. 1 Pre. J Total 1 '
New residential single or m ulti - family dwelling unit,
Includes attacked garage,
Subdivision: Lot no.: 1,000 sq. it. or less 168.54 4
Eu. udd'l 500 sq. 11. or portion 33,92 1
Tax map /parcel no.: Limited energy. residential
67.84
d •
, • ',DESCRIPTION OF WORK (we above sq. 11t)
Limited energy, multi - family
PROVIDE ELECTfi1C AI, TO CONNECT NEW AIR CONDITIONER. 67,84 2
residential (with above s9,11.)
Services or feeders Installallon, alteration, and/or relocation
200 amps or less 100.70 2
. ❑' PROPERTY OWNER - LI 'TENANT ' . 201 imps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 maps or volts 552,26 2
Temporary services or (ceders Installation, alteration, and /or
City /Slate /ZIP: __ _ relocation _
Phone: ( ) Pax; ( ) 200 amps or Tess 59.36 1
201 amps to 400 amps 125.08 2
Owner Installation: "I his 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 am l0 599 am 168.54 2
Branch circuits— new, alteration, or extension, per panel
Owner signature: Dale: A. Fee for branch circuits With
above service or feeder fee,
'�iPPI CANT' ! Q •401V`l'ACI','rPETtSON each branch circuit 7.42 2
Business name; B. Fee for brunch circuits without '
service or feeder fee, first 1 56.18 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not Included)
/State /ZIP: Each manufactured or modular
C►
CY dwelling, service and/or feeder — 67.84 2
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: ATLAS ELECTRICAL CONTRACTORS, INC. panel, altemtiosi, or extension. Page 2 2
Each additional inspeelion over allow hie in any of the above
Address: 4403 SE ILOET[ ROAD Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: MILWAUIUE, OREGON 97267 investigation (1 hr min) 66.25 /hr
Industrial plant (1 hr min)
78 18/ hr
Phone: (503) 659 -2212 Feu;: (503) 659 -4944 Inspections for which no fcc is 90.00/ hr
E specifically listed ( % hr min)
CCB Lic.: 1532 Electrical Lic.: 3 2C S .prv. Lic.: 50095 ELECTRICAL PERMIT. FEES '
Suprv. Electrician signature, required n Subtotal: 56.18 14 v� r` Plan review (25% of permit fee);
Print name: TY SHEPERSKY .e$ s: 4/2/10 Slate surcharge (12%ofpermit fee): 6.74
TOTAL PERMIT FEE: 62.92
Authorized signature: 1 This permit application expfre3If a permit is not obtained within 180
` / days rifler it has been accepted as tomplere-
Print name: TY SHEPERSK — LDate: 4/2/10 • Number of inspection: altowed per petmil,
r: \Duilding\Permits doe 10; ;01/09 6.10- -0615T(11 /05 /COM/VEB