Permit CITY OF TIGARD ELECTRICAL PERMIT
' ° 7 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00219
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 3
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 OAR • - 001 -0090. You ma • • • • • • the rul=- or • = t questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: _ _ Permittee Signature: _ /I_/ - 4•i�
�� 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.
APR -28 -2011 04:318 FROM :D &L ELECTRIC INC 5036501918 TO:5035991960 P.2
t
Electrical Permit Application I ()R III I It I I ',I t I\ 11
Ci of Ti and Received — � 01 1 - 1�� t
RECE � ��� �r 8-7- V ED
APR 2 2011
E
C OF T I) ARD
4ING DIVISION
1 Phone: S50 Hall .2439 Tigard, Plan Review
B Phone: 503.718.2439 Fate: 50 3.5 9 8 .1960 Date/B :
Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: W see Pa`e 2 f or il
Internet: www.tigard- or.gov Notified/Method: SappkAentolInformation
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition /alteration /replac#rtent Please check all that apply (submit 1 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition 0 Other: 1 where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTI exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground. or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Commercial/indus. ial Accessory building amps for all other installations. buildings.
® Multi- famil ❑ Master builder Other: ❑ Fire pump. ❑ Installation of75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LO TION 0 Addition of new motor lead of 0
100
lob no.: Job site address: 9870 SW Mckeg Q Six or or or more. occupancy.
lt a 03 unit
"I more residential units. 0 Recreational vehicle parks.
City/State /ZIP: Tigard Oregon 97223 " 0 Health -care facilities, ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: Project name: . ❑ Service or render 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: -: j smartestaa I Qtr. I Per. I Twat 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 add'I 500 sq. n. or portion 33.92 1
Tax map/parcel n0.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. R.) 75.00 2
up grade panel Limited energy, multi- family 7500 2
P g P 1 residential (with above sq. ft.)
0 3 unit , Services or feeders installation, alteration, and/or relocation
I 200 amps or less I 100.70 100.70 2
® PROPERTY OWNER I Io TENANT 201 amps to 400 amps 133.56 2
iii 401 amps to 600 amps 200.34 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 ; . relocation
200 amps or less 5936 1
Phone: (503)314 -3163 l Fax: ( h I 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on pro fly that I 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
shove service or feeder fee.
0 APPLICANT 0 i pNTACT PERSON each branch circuit 7.42 2
B. Fee for branch circuits without
Business name: !, service or feeder fee, first
branch circuit 56.18 2
Contact name: Each add'I branch circuit 7.42 2
Address: t Miscellaneous (service or feeder not Included)
Each menu/Ix-aired or modular 67.84 2
City/StateJZIP: dwelling, service and/or feeder
Reconnect only 67.84 2
Phone: ( ) F x : , ( ! Pump or irrigation circle 67.84 2
E -mail: L! Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-energy
∎ ' panel, alteration, or extension. Page 2 2
Business name: D &L ELECTRIC INC. Each additional inspection over allowable In any of the above
Address: PO BOX 367 r Additional inspection (1 hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City/State/ZIP: WEST LINN OREGON 97068 I - Industrial plant (I hr min) 78.18/ hr
Phone: (503) 656 -5623 Fax: (503) 650-1918 Inspections for which no fee is 90.00/ hr
specifically listed (h hr min)
CCB Lic.: 88069 Electrical Lie,: 3 -16IC I Suprv. Lie.: 2662S ELECTRICAL PERMIT FEES
I•:- Subtotal: 100.70
Suprv. Electrician signature, required: tire. J1/#1,: Plan review (25% of permit fee):
Print name: DONALD H LETTENMAIER I Date: 04-27 -2011 State surcharge (12% of permit fee): 12.08
TOTAL. PERMIT FEE: 112.78
Authorized signature: This permit application expires if a permit is not obtained within 180
� days after It an peen accepted as complete
Print name: ^ ,I Date: • Number of inspections allowed per permit.
i ll.