Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 00591
Date Issued: 10/21/2011
T t G p D 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel: 1 S126CA00100
Jurisdiction: Tigard
Site address: 9225 SW HALL BLVD H
Project: Tan Republic Subdivision:VASHINGTON SQUARE ESTATES NO Lot: 108
Project Description: TI Low voltage for data telecommunications system.
Contractor: SUBLIME ELECTRIC INC Owner: GREENBURG CORNERS LLC
224 NE CREST ST BY MENASHE, R BARRY
SUBLIMITY, OR 97385 621 SW ALDER, SUITE 605
PORTLAND, OR 97205
PHONE 503 - 580 -4917 PHONE
FAX' 503 - 769 -8983
FEES
Quantity Description Date Amount
2 ea Services or Feeders - 200 10/21/2011 $201 40
Specifics: amps or less
16 crt Branch Circuits w /Purchase 10/21/2011 $118.72
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea Signal circuit or Limited 10/21/2011 $75.00
Energy Panel
Type of Const: 1 ea 12% State Surcharge - 10/21/2011 $47.41
Occupancy Grp: Electrical
Total $442.53
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will
be done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules 'et forth in OAR
952- 001 -0010 through OAR • -101 -0090 You may obtain a copy of the rules estions to OUNC by calla 3 232 or 1 800 332 234'
Issued By: . Permittee Signature: / V
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application � FOR OFFICE USE ONLY
g
CI Of Tigard � !€iew PerrmtNo 7 ! 1315 SW Hll vdTigard, OR 972 t✓
Phone: 503 718 2439 Fax 503.5' 11. ice/ rt \\ DateIBy- Other Permit
%/ a� • a ,
T I G,A AR D Inspection Line: 503.639.4175 0 , Date Ready/By El Page 2 for
Inter www.tigard - or.gov C� D 4r t� ♦ O ,�Notified/Method Supplemental Information
V Wit'
1
'�".' T- 1',P.E =OE ORK: : �'�` L 0;': ,.
LL - ❑ New construction 0 Addition/alteration. Please check all that apply (submit 2 sets of plans w /items checked below)
❑ Service or feeder 400 amps or more El Building over three stones
El Demolition CI Other: 0..0 where the available fault current ❑ Mannas and boatyards
',$ -- ?' ;, ^' ": Y ' > 4 i - ` -`, "' ' exceeds 10,000 amps at 150 volts or Floating buildings
. • t: -" = ,- ' CA T EG O RY, OF CO '' - RU CTION.`µ :,! ` A a - P ❑ g g
� '� ��• less to ground, or exceeds 14,000 0 Commercial-use agricultural
❑ 1- and 2- family dwelling ® Commercial/industrial CI 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
'`JO „ � ~ �N �N� � C
D� �ATION ''�„
'� B SIT1��I FOI2iVIATIO .. LO
°- ' - _- •__.,--.__-._�. ___ti �___ .:_. - -, _..,.� .� -,_- U Addition of new motor load of ❑ "A "E" •'L2° "L3
Job no.: Job site address: 9225 SW Hall Blvd. 100HP or more occupancy
❑ Six or more residential units ❑ Recreational vehicle parks
City/State/ZIP Tigard, OR 97223 ❑ Health -care facilities- El Supply voltage for more than
El Hazardous locations. 600 volts nominal
Suite/bldg. /apt. no.. Suite H Project name Gr urg Corners p_,, ❑ Service or feeder 600 amps or more
F' a.; ; :1'_;::::��`-•;..;FEE`SC$En IE
U = �
Cross street/directions to job site Greenburg Road Description I Qty I Fee. I Total 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. ft. or portion 33.92 1
Tax map /parcel no.:
Limited energy, residential
_ zr•,. 75.00 2
"r= (with above s . ft.)
I)ESCRIP ION�-OF. ORK' :'� "<
.T n -�� Y -F = q
i -n:. ": '• ° " : ,, �4 .� " .':; f�> . _ . • . �-` ., .. .; ._ ?-•'
Limited energy, multi - family 75.00 2
Install new 200 amp Service. Install new 100 amp panel. Install 16 branch residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
circuits for lighting, power, and tanning beds. Install Low Voltage. 200 amps or less 2 100.70 201.40 2
= c - i '' '.=ss <c =' 3 a ` 201 amps to 400 amps 133.56 2
r❑ _
�PROP _T;It1Y OWNER; ,':',- - °.. . _ - _ , ,. ,, - VT .. _
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 30104 2
Address: Over 1,000 amps or volts 552.26 2
City /StatelZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125 M8 2
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
: above service or feeder fee, 16 118.72
..APPLICANT .. ®'CClN1?A -!',* RSQN - 7.42 2
- i�`a� =` °,. F_ �.,,. _. sc.���'k�51`_ -,.. ,. _._. _ _ - -. �_ - -= .r_ >
, ,.., = - each branch circuit
Business name. Sublime Electric, Inc. B. Fee for branch circuits without
service or feeder fee, first
Contact name: Morris Chappell branch circuit 56.18 2
Each add'l branch circuit 7.42 2
Address: 224 NE Crest St. Miscellaneous (service or feeder not included)
City/State/ZIP: Sublimity, OR 97385 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 580 - 4917 Fax. : (503) 769 - 8983 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail' sublime @wvi.com
Sign or outline lighting 67.84 2
• � - '_ _ y:. - , .� .zs,F�' -, C ,:__ -, - � • `,:. __. -_ _ -. _ - - -_ � _ ._. ; _ S circuit(s) or limited- energy
Business name. Sublime Electric, Inc. panel, alteration, or extension. 1 Page 2 75.00 2
Each additional inspection over allowable in any of the above
Address: 224 NE Crest St. Additional inspection (1 hr min) 66.25/ hr
- Investigation (1 hr min) 66.25/ hr
City /State/ZIP: Sublimity Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 580 - 4917 Fax: (50 ' - : ' 83 NW
/ Inspections for which no fee is
_.....11111■.. 90.00/ hr
specifically listed ('h hr mm)
CCB Lie.: 157657 ! E l ectrical ic. Su 1��: 7 6 :z; "" ''` '
j 'x`�`�' _1;LEGTRICAIs „,PERIVII7'.� ^FEES °”' °;�;1: "' „- :�'w;-'
� Subtotal: 395.12
Suprv. Electrician signature, required: , , , L%� � /
o
�-rl Plan review (25% of permit fee):
Print name: Morris Chappell ■ ■e e: 10 - 2011 State surcharge (12% of permit fee): 47.41
gn �� � /' TOTAL PERMIT FEE: 442.53
Authorized signature: � -%� /�
` / `= This permit application expires if a permit is not obtained within 180
Pnnt name Moms Chappell Date: 10-21 -2011 days after it has been accepted as complete.
Number of inspections allowed per permit
1 \Building\Pemuts\ELC- PetnutApp doe 07/01 /10 440- 4615T(1l/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
,RESIDEN'TIAI WORic, ONL_Y:W . -
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
C 21:141 I_ERCIAti WORK ONI Y: ;,<.�_..:.. , -. -:,
,.,- -�.... a.._ ...- -_`_ - _. - .__ . ...... .... .... .. .... ... � _ -... .." {. �`��. ~~'����� ..,. ",emu °f`:.
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alann Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
I- \Building\Pemuts\ELC- PemutApp doc 07/01/10