Permit :1 CITY OF TIGARD ELECTRICAL PERMIT
11 • COMMUNITY DEVELOPMENT Permdffi ELC2011 -00596
Date Issued 10/25/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 15126CA00100
Jurisdiction Tigard
Site address 9225 SW HALL BLVD H
Project Tan Republic Subdivision VASHINGTON SQUARE ESTATES NO Lot 108
Project Description (2) branch circuits for RTU
Contractor DOT ELECTRIC Owner GREENBURG CORNERS LLC
1437 SE HENKLE RID BY MENASHE, R BARRY
CORBETT, OR 97019 621 SW ALDER, SUITE 605
PORTLAND, OR 97205
PHONE 503 - 695 -9805 PHONE
FAX 503 - 695 -6225
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 10/25/2011 $63 60
Specifics• Service or Feeder
1 ea 12% State Surcharge - 10/25/2011 $7 63
Type of Use COM Electrical
Class of Work ALT
Type of Const
Occupancy Grp
Total $71 23
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 at other applicable law All work will
be done in accordance with approved plans This permit wit 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 throu•h • •R 952- 001 -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issued By �i�ri!>>�Permlttee Signature
ti /GJ /\ 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 am® Received
FOR OFFICE USE ()NIA
y +
City of Tigard � Date/B t / r yr �
'� C Permit 14o �t — sY •
° 13125 SW Hall Blvd , Ttgard,ORV'( C� '1Q Plan Review
Phone 503 718 2439 Fax 503 528060 G � 1 Date/By Other Permit
'GI GARD Inspection Line 503 639 4175 Q p C1 o Date Ready /By Sans See Page 2 for
w
Internet ww tigard - gov S® Nonfied/Melhod ) ® G Supplemental Information
TYPE OF WORK { Ut�+it-A\ oW PLAN REVIEW
r"c Please check all that apply (submit 2 sets of plans w/nems checked below)
❑ New construction Ni Additnoldaltera(tm
t�j` ❑ Service or feeder 400 amps or more ❑ Building over three stones
❑ Demolition ❑ Other where the wadable fault current ❑ Mannas 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
❑ I- and 2- family dwelling Eli Commercial/industrial ❑ Accessory building amps for all other installations buildings
El Multi-family ❑ Master budder ❑Other ❑ Fire pump ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately denved system
❑ Addition of new motor load of ❑ "A' , "E ", "1 - ^, "I - ",
Job no Job site address 9 ZZ C S i\ St, , I - 1 Six o or more ree occupancy
_ ❑ Six or more residential units ❑Recreational vehicle parks
City/State/ZIP �' 4 Syz� ❑ Health -care facilities ❑ Supply toltage for more than
❑ Hazardous locations 600 volts nominal
Slate /bldg /apt no it Protect name • '2Q r[Q,. (D I r L ❑ 8eoace or feeder 600 amps or more
}�_ FEE SCHEDULE
Cross street/directions to Job site Description I Qty I Fee I total I *
New residential single- or nralti-family dwelling unit.
Includes attached garage.
Subdivision Lot no 1,000 sq ft or less 168 54 4
Tax map/parcel no Ea add'I 500 sq ft or portion 33 92 I
Limited energy, residential
DESCRIPTION OF WORK (with above sq ft) 7500 2
Limited energy, multi- faintly
Mil I rl-F C , / iaC Um 1 , residential (with above sq ft ) 7500 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 100 70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 13356 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 I
Owner installation: This installation Is being made on property that I own which is not 201 amps m400 amps 125 08 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, _cr panel
Owner signature Date A Fee for branch circuits with
❑ CONTACT PERSON
❑ APPLICANT above service or feeder fee, 7 42 2
( each branch circuit
Business name 'n J Q a-7u C - Li., C B Fee for branch circuits without /
service or feeder fee, first
Contact name branch circuit 56 18 j7o . 17 2
Each add'l branch circuit ' 7 42 7 LJ� 2
Address Miscellaneous (servile or feeder not included)
City/State/ZIP Each manufactured or modular 67 84 2
dwelling, service and/or feeder _
Phone ( ) Fax ( ) Reconnect only 67 84 2
Pump or irrigation circle 67 84 2
E
Sign or outline lighting 67 84 2
-
�\ + CONTRACTOR Signal circuit(s) or limited- energy
Business name ( tr�,r -. ti I` J (.\ panel, a or Paget 2
J�> ` r..-r Each additional inspection over allowable in any of the above
Address \ 9 1 cc 4*a _'\c U n a Additional inspection (I hr nun) 66 25/ hr
Investigation (I hr nun) 66 25/ hr
City /State /ZIP ( tt 1. 0 ^ 9 -- ) Q ( S Industrial plant (I hr mm) 78 18/ hr •
Phone (S "} ) 2 _') 18e Fax (S` ) bSS_ b2Zg Inspections for which no fee is 9000/hr
specifically listed (Va hr min)
CCB Lie Iy c -/13, Z Electrical Lic 2'0_ 0 r\ C Supry Lie 4 6 s'SS ELECTRICAL PERMIT FEES
p tTsl n4 t required '7 t / td/t!i n Subtotal 63 r (.s c)
Supry Electricta e, —
1 t
/ Plan review (25% of permit fee)
Print name Pc* �■ 0 Qz011 ■ Date Jo, I s' / State surcharge (12% of permit fee) 7 ,
TOTAL PERMIT FEE 2 /, ,,)
Authorized signature this permit application expires if a permit is not obtained with 180
days after it has been accepted as complete,
Print riaiite Date • Number of inspections allowed per permit
I tBmlding1PermusLLLC- PermitApp doe 07/01/10 440- 4615T(I I /05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined........ $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918
Check Type of Work Involved:
El Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
[1 Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
total number of commercial systems
*No licenses are required. Licenses are required
for all other installations
V3mIding\Pei mns0.i c- PetmuApp dot. 07 /01 /IC