Permit v CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00217
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/27/2011
Parcel: 2S102BD00702
Jurisdiction: Tigard
Site address: 9870 SW MCKENZIE ST 2
Project: McKenzie Street Townhomes Subdivision:RTH TIGARDVILLE ADDITION, AMENC Lot: 7
Project Description: Panel replacement.
Contractor: D & L ELECTRIC INC Owner: MCKENZIE STREET TOWNHOMES LLC
PO BOX 367 BY ERIC RABOSKY
WEST LINN, OR 97068 13325 SW CLEARVIEW WAY
TIGARD, OR 97223
PHONE: 503 - 656 -5623 PHONE:
FAX: 503 -650 -1918
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 04/27/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 04/27/2011 $12.08
Type of Use: MF Electrical
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 0 001 -0090. - • • r - • • • • - rules o direct questions to OUNC by calling 503.232.1987 or 11,800.332.2344.
Issued By. � �'' Permittee Signature:
OWNER INSTALLATION ONLY l/
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.
APR -28 -2011 04:33A FROM:DaL ELECTRIC INC 5036501919 TO: 5035901960 P.1
Electrical Permit Application RE IVE I OIt t )1 I I(I I `NI l )\ I 1
Received
1,4
City of Tigard i a Date/13 : I Permit No.: — -
1
13125 SW Hall Blvd., Tigard, OR 97223 a . + y Plan Review s
Phone: 501718.2439 Fax: 503.598.1960 AP 1 2 4 2 01 Date/B ; Other Permit•.
t , It i Inspection Line: 503.639.4175 Date Ready/By: EgIM RI Sec Page 2 for
Internet: www.tigard- or.gov CITY 0 TIGARD Notified/Method: Supplemental information
TYPE OF WallIELDI.. 1 r ' PLAN REVIEW
Please check all that apply (submit a sets of plans w /items checked below):
❑ New construction ® Addition /alteration/rcphlnincn t
❑ Demolition El Other: I j amps or more
❑ Service or feeder 400 am ❑ Building over three stories.
p where the available fault current ID Marinas and boatyards
CATEGORY OF CONSTRUCT! 4 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
❑ Emergency system larger separately derived system.
JOB SITE INFORMATION AND LO ` ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2", "1 -3 ",
Job no.: Job site address: 9870 SW Mcketiie #2 unit 100HP or mom. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard Oregon 97223 j ❑ Health -care facilities. ❑ Supply voltage for more than
rt ❑ Hasrrdous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 1 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: i nerertatton 1 9rr. I Fee. I Total I
- 1 New residential single- or multi - family dwelling unit.
I Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
1 Ea. add'I 500 sq. ft. or portion 33.92 1 -
Tax map /parcel no.:
L imited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.) _
Limited energy, multi - family 7500 2
up grade electrical panel unit residential (with above sq. ft.)
# 2 unit y Services or feeders installation, alteration, and/or relocation
200 amps or less I 100.70 100.70 2
j i ❑ TENANT 201 amp to 400 amps 133. 2
® PROPERTY OWNER I
t 401 amps to 600 amps 200.34 34 2
Name: Eric Rabosky Town House Propertties 601 amps to 1,000 amps 301.04 2
Address: 13325 SW Clear View Way Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: Tigard Oregon 97223 i relocation
-i 200 amps or less 59.36 1
Phone: (503)314 -3163 Fax: ( ) 1 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on pro b rty that 1 own which is not 401 amps to 599 amps 168.54 2 ,
intended for sale, lease, rent, or exchange, according to OR " ;447, 449, 670, and 701. Branch circuits- new, alteration, or extension, per panel
Owner signature: Date: _ A. Fee for branch circuits with
gn above service or feeder fee, 7.42 2
0 APPLICANT I ❑ li3ONTACT PERSON each branch circuit _
F
B. Fee for branch circuits without
Business name: service or feeder fee, first 56.18 2
branch circuit _
Contact name: + Each add'/ branch circuit 7.42 2
Address: Miscellaneous (service or feeder not Included)
ri Each manufactured or modular 67.84 2
City/State /ZIP: dwelling, service and/or feeder 67.84 2
I Reconnect only
Phone: ( ) Fax: ( '' Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 — 2
CONTRACTOR
' I Signal circuits) or limited - energy
I panel, alteration, or extension. ,, Page 2 2
Business name: D &L ELECTRIC INC. . Each additional inspection over allowable in any of the above
( Additional inspection (I hr min) 66.25/ hr
Address: PO BOX 367 I Investi (1 hr min) 66.25/ hr
City/State/ZIP: WEST LINN OREGON 97068 I Industrial plant (1 hr min) 78.18 / hr
— j Inspections for which no fee is 90.0W hr
Phone: (503) 656 - 5623 Fax: (503) $0 - 1918 specifically listed (t4 hr min)
ELECTRICAL PERMIT FEES
CCB Lic.: 88069 Electrical Lic.: 3 - 161C Suprv. Lie.: 2662S Subtotal:_ 100.70
Suprv. Electrician signature, required: ! Plan review (25% of permit fee):
[Y State surcharge (12% of permit fee): 12.08
Print name: DONALD H LETTENMA1ER j Date: 04 - 2011 TOTAL PERMIT FEE: 112.78
Authorized signature: ' This permit application expires if a permit is not obtained within 180
'' days after it has been accepted as complete.
Print name: ` Da t e: • Number of inspections allowed per permit.
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