Permit II Y,l CITY OF TIGARD ELECTRICAL PERMIT
, COMMUNITY DEVELOPMENT Permit #: ELC2011 -00556
TIGAR.a 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Date Issued: 10/06/2011
Parcel: 2S 113AB00300
Jurisdiction: Tigard
Site address: 16037 SW UPPER BOONES FERRY RD 200
Project: Oregon State Bar Subdivision: FANNO CREEK ACRE TRACTS Lot: 38
Project Description: (20) branch circuits for TI.
Contractor: ACCURATE ELECTRIC UNLIMITED INC Owner: OREGON STATE BAR, THE
PO BOX 871866 16037 SW UPPER BOONES FERRY RD
VANCOUVER, WA 98687 TIGARD, OR 97224
P
PHONE' 503 - 620 -0222
PHONE: 360- 567 -3330
FAX 360- 567 -3320
FEES
Quantity Description Date Amount
20 crt Branch Circuits wo /Purchase 10/06/2011 $197 16
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/06/2011 $23.66
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $220 82
Required Items and Reports (Conditions)
This permit issued subject t• the re•ulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law All work will
be don in accordance with app •v= • pia , 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 require. you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952- 01 -0010 th .ugh OAR 952-1,i 0090 ou ay obtain a copy of the rules or direct questions to OUNC by ca st _ nrA 9 32 1987 or 1 800 332 2344 t
0 0
Is ued By: Permittee Signatur "t'.. 4' ._ .
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' 1 / 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.
OCT -06 -2011 09:47 Accurate Electric, Inc. 3609947013 P.001
Electrical Permit Application Received FOR OFFICE USE ON LY ' 0 II al City of Tigard DateB : /4 G 67,---- /i 6j Permit No.: c s,(C —De"55 .
13125 SW Hall Blvd., Tigard, t,' ) O' 1 Plan Review ��/
a ' Phone: 503.718.2439 Fax: 50 t 0 r1. Other Permit
t! Date /B . 1 , 0 II -- -0Q 11
T I G A RD Ins Line: 503.639.4175 �� O v n�Q Date Ready /By: !d See Page 2 for
Internet: www.tigard- or.gov O ��,�rCJ�®� Notifed/Method: Supplemental Information
T Y P E .OF WQ } 0 1/4 . ' • • -. • P t A 1 N RE I.EW
❑ New construction ® Addition /alters tint Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ID Building over three stories.
❑ Demolition ❑ Other:
where the available fault current ❑Marinas and boatyards.
- CA TE G ORY O "CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings,
less to ground, or exceeds I4,000 ❑ 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
JO$ S1TE_'ITIFORMATLON ,AND IAGATiON CI Emergency system larger separately derived system.
" ['Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: 10 -1289 I Job site address: 16037 SW Upper Boones Ferry Rd IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks,
City /State/ZIP: Tigard, OR (11221 oet 60A 5 n t 4 -ire ❑ Health facilities ❑ Supply voltage for more than
6 4 rG... ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: t V 1 Project name: ❑ Service or feeder 600 amps or more.
_ ,FED S�REDULE '
Cross street/directions to job site: Description I Ott. F Fee. I Total I .
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
DESCRII'I "1PI OF iVORIC; ,, , (with above sq. ft.) 75.00 2
/" y Limited energy, multi - family 75.00 2
Renovate suite 165 & 200 , - MA) C'' y sci /( - r goo residential (with above sq. ft.)
services or feeders installation, alteration, and/or relocation
BUP2011 - 00198 and BUP2011 - 00197 p Db WO 4 / • 200 amps or less 100.70 2
C1 PROPERTX' OWNER ' I 1 ' . 0 TRNANT t:,. ' J( 201 amps to 400 amps 133.56 2
Name: .ril, �c� i d ) amps to 600 amps 200.34 2
C '601 amps to 1,000 amps 301.04 2
Address: „ r ^„tv"" �v e '4 Over 1,000 amps or volts 552.26 2
City / State/ZIP:
( J� p (\v �� (ig/ Temporary services or feeders installation, alteration, and/or
(J`r" .e''Nrib‘ relocation
Phone: ( ) Fax: ( ) n , ( o k 1 1 200 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
APl'I ICANT ; I above service or feeder fee,
, 17J •CONTACT:. PERSON each branch circuit 7.42 2
Business name \ ' B. Fee for branch circuits wit /rout
service or feeder fee, first I 56.18
56.18 2
Contact nam . ti ;� ` - branch circuit
E ach add'I branch circuit /21 i 7.42 ,Ld1'1 2
Address: _ = . Miscellaneous (service or feeder not included) _ I kW,/
' Each manufactured or modular
City / State/ZIP: � �� . dwelling, service and/or feeder 67.84 r2
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: Accurate Electric Unlimited, Inc. panel, alteration, or extension- Page 2 2
Each additional inspection over allowable in any of the above
Address: P.O. Box 871866 Additional inspection (I hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City/State /ZIP: Vancouver, WA 98687
Industrial plant (1 hr min) 78.18 / hr
Phone: (360) 567 - 3330 I Fax: (360) 567 - 3320 Inspections for which no fee is 90.00 / hr
specifically listed (' /A hr min)
CCB Lie.: 191346 1 Electrical Lie.: C638_ Suprv. Lie.: 5590S S ' - E1,ECTRICAL PERMIT PEES
Suprv. Electrician signature, required:1 &WM, a Subtotal: G�'�. j`
U 1 Plan review (25% of permit fee):
Print name: Bill Dixon Date: 10 - 6 - 11 Slate surcharge (12% of permit fee): 3.64
TOTAL PERMIT FEE: - 2 1 J 6a
Authorized signature: JJ(' This permit application expires if a permit is not ained within 180
�� J days after it has been accepted as complete.
Print name: Debi Watts Date: 10 -6 -11 * Number of inspections allowed per permit.
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