Permit ... ........... .
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• CITY OF TIGARD ELECTRICAL PERMIT
• •- COMMUNITY DEVELOPMENT Permit #: ELC2010 00674
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/07/2010
T1G Parcel: 2S104BB08000
Jurisdiction: Tigard
Site address: 14250 SW BARROWS RD 001
Project: The Ultimate Tan Subdivision: RUSSELL'S SCHOLLS FERRY Lot: 3
Project Description: (1) branch circuit in demising wall.
Contractor: HILLSBORO ELECTRIC LLC Owner: ALULI REAL ESTATE HOLDINGS LLC
21185 NW EVERGREEN PKWY #110 415 -C ULUNIU ST
HILLSBORO, OR 97124 KAILUA
OAHU, HI 96734
PHONE: 503 - 439 -9666 PHONE.
FAX: 503 -601 -3680
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 12/07/2010 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/07/2010 $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 i ed_subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be do in accordance ` h-- •prov == 'lens. This permit will expire if work is not started within 180 days • ance, or if work is suspended for more the 180
days ATTENTION: Oregon la requi - • • u to follow the rules adopted by the Ord -, ' •• • •' ication Center. Those rules are set forth in OAR
952 001 -0010 through OAR 95 1111 i •0911 may obtain a ••pyt f the rules or direct questions to OUNC by calling 50 ' i 27 or 1.800.332.23 4.
/
Iss d By: �_ / .�� �I P erm - _
_r d ! 0, ( [ L
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:
_CTOR INSTALLATON ONLY
SIGNATURE OF SUPR. ELEC' .� ���r Date: `Aff
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.
From:Hillsboro Electric,LLC 5036013680 12/07/2010 02:50 #956 P.001/002
Electrical Permit Application P pplication � I.OR OI HI (F I 'S!' O\
City of Tigard D 7 2010 Received / 7 /40 / n 0 . 4 7
II 13125 SW Hall Blvd., Tigard to ._ 223 Plan Review h
Other No (�
Phone. 503.639 4171 Fax air x ter Permu. /j ^
l j '�i D ate B 4 / ) o70/0� eVO(�
t ( A I:I) Inspection Permit
503.639 41 w rr>l ; t li ' Date Ready/By: )uric: ® See Page 2 for
Internet: www.t or.gov t Notified./Method: Supplemental information
TYPE OF WORK PLAN REVIEW
❑ New construction � Addition/alteration/replacement Please check all that apply (submit a sets of plans w /items checked below)
❑ Service or feeder 400 amps or more ❑ Building ov er 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 RI Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 K VA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of
Job no.: "TO SI Job site address V r � -j j� `j��. � 100HP or more. occupancy.
T j-1`'�-;t'� -' a ❑Six or more residential units. ❑ Recreational vehicle parks.
1
City/State /ZIP: l \ . �', i , 1 7 g 3 ! ❑ Health -care facilities. ID 600 volts voltage for more than
�'�}�� 1 1 t. Ccc- 't�r� , ❑ Hazardous locations- 600 volts nominal.
7 � 'e ldg. /apt. no.: Project name: - J ❑ Service or feeder 600 amps or more.
i FEE SCHEDULE Cross street/directions to job site: I 4 1. wri Description 1 Q ty. Fee 1 To� tal i
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less _ _ 168.54 4
Tax map /parcel no.: Ea add'l 500 sq. ft. or portion 33.92 1
Limited energy, residential 75 00 2 —
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family 75.00 2
5
N /4' _� r y� T residential (with above sq. ft )
�J l 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
City /State /ZIP:
Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) 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 1 own which is not
intended for sale, lease, rent or exchange according to ORS 447, 449, 670, and 701. aot amps to 599 amps 168. z
Branch circuits - new, alteration, or extension, r er panel
Owner signature. Date: - _ _ _ A . Fee for branch circuits with
— ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: 13. Fee for branch circuits wirhovr
service or feeder fee, first �^
Contact name: branch circuit
56.18 J We �� 2
- Each add'l branch circuit 7,42 2
Address: _Miscellaneous (service or • feeder not included)
City /State /ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Far:: ( ) Reconnect only 67.84 2
— . Pump or irrigation circle 67.84 2
E Sign or outline lighting 67.84 2
CONTRACTOR Signal circuits) or limited - energy
panel, alteration, or extension. Page 2 2
Business name: Hillsboro Electric, LLC
Each additional inspection over allowable in any of the above
Address: 21185 NW Evergreen Pkwy #110 Additional inspection (1 hr min) 66.25/ hr
invest
City /State /ZIP: Hillsboro / OR J 97124 Industrial plant hr min) 66.25/ hr
.�._ al plant (I hr min) 78.18/ hr
Phone: ( 503 4 3 9 - 9 6 6 6 Fax: 603 ) 601-3680 Inspections for which no fee is 90.00 / he
-- specifically listed eh hr min) _
CCB Lic.: 134481 Electrical Lic.: 34-499C Suprv. Lic.: 4 0 G Z 5 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: rP 71 , (®/. ( /l? Su L
Plan review (25% of permit it fee fee ) ): �.--
Print name: 1 0.- A • E(,-(r/ g Date: State surcharge (12% of permit fee): (p t'7 y ,
TOTAL PERMIT FE1 j la
Authorized signature: This permit application expires if a permit is not obtained within 180 /
days after it has been accepted as complete.
Print name: Date: . Number of inspections allowed per permit.
1 /Buildi ng\Permits/ELC- Permit App doc 07/01/10 449- 4615T01 /05,COMAVEB