Permit CITY OF TIGARD ELECTRICAL PERMIT
''' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00615
Date Issued: 11/03/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Parcel: 2S101AA00100
Jurisdiction: Tigard
Site address: 12000 SW 66TH AVE
Project: Landmark Ford Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: (2) branch circuits.
Contractor: MR ELECTRIC OF CLARK COUNTY Owner: CORLISS, JAMES L & CORA K
14300 NE 20TH AVE D102 -313 PO BOX 23970
VANCOUVER, WA 98686 TIGARD, OR 97281
PHONE 360- 574 -7200 PHONE
FAX: 360- 546 -2158
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 11/03/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/03/2011 $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 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 OA' '01 -0090 You may obtain a co• of - u es o • -ct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issued By: . Permittee Signature:
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.
Nov. 2. 2011 7:17PM RECEIVED No. 8472 P. 1
Electrical Permit Application FOR OFFICE USE ONLY -
r f V 02 2011 Received
City of Tigard Date/J3 /
`J ,," P erm i t No : r �
11 M ..- ' 1 3125 SW Hall Blvd , Tigard, OR 97 ?2 Y O F T IGARD
Phone: 503.718,2439 Pax, 503.598. Other Permit*
TIC AR
Inspection 503,639.4175 B UILDING DIVISION
E]
P Date Ready/13y. see Page 2 for
Intermit: www tigard or.gov Notified/Method: NM Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration /replacement Please check all that apply (submit 2 acts of plans wluems checked below)'
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other:
where the available fault current ❑ Marinas and boaiyards-
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
El 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: I] Fire pump. ❑ Installation of 75 1CVA or
JOB SITE INFORMATION AND LOCATION ['Emergency system larger separately derived system
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1.3 ",
Job no.; 8480 Job site address' 12000 SW 66 Ave 1ooHp or more occupancy,
❑ Six or mere residential units ❑ Recreational vehicle parks.
City /State/ZIP: Tigard OR 97233 ❑ Health - care feelings. ❑ Supply voltage for more than
El Hazardous locations. 600 volts nominal,
Suite/bldg. /apt. no.: Project namej$4$O " _ 4 • , ✓k ❑ Service or feeder 600 amps or more.
►mil 1 PEE SCHEDULE
Cross street/directions to job site: Dricrlp5on I oty. I Fee, I Toni I
New residential single- or multi- family dwelling unit
Includes attached garage.
Subdivision: Lot no.: 1,000 sq ft. or less 168 54 4
Tax map /parcel no.:
Ea. add'l 500 sq. ft, or portion 33.92 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq ft.) 75.00 2
Limited energy, multi- family
Install of 2 car chargers residential (with above sq 11.) 7500 2
Services or feeders Installation and/or relocation
200 amps or less 100 70 2
® PROPERTY OWNER ❑ TENANT 201 amps to 900 amps 133 56 2
Name: Land Mark Ford 1 Jim Corliss 401 amps to 600 amps 200 34 2
601 amps to 1,000 amps 301.04 2
Address: 12000 SW 66' Ave Over 1,000 amps or volts 552 26 2
Temporary services or feeders installation, alteration, and /or
City /Statt /ZIP: Tigard OR 97223 relocation
Phone: (503)639 -1131 Fax: ( ) 200 amps or less 39.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 101 amps to 599 amps 168 54 2
Branch circuits w new, alteration, or extension, per panel
Owner signature: Date; A. Fee for branch circuits trit/s
® APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: Mr. Electric B. Fee for branch circuits without
service or feeder fee, first 1 56,18 5618 2
Contact name: James Kleiser branch circuit
Each add'1 branch circuit 1 7.42 7.42 2
Address; 14300 NE 20 Ave D102 - 313 Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State /ZIP: Vancouver WA 98686 dwelling, service and/or feeder 67.84 2
Phone; (360) 574 -7200 Fax: : (360) 546 -2158 . Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: esr @mrelectricec.com Sign or outline lighting 67.84 2
CONTRACTOR Signal circuu(s) or limited- energy
Business name. Mr Electric panel, alteration, or extension Page 2 _ 2
Each additional inspection over allowable in any of the above
Address: 14300 NP. 20`h Ave 0102 -313 Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City / State/ZIP: Vancouver WA 98686 Industrial plant (1 hr mm) 78.18/ hr
Phone: (360) 574 -7200 Fax: (360) 546 -2158 Inspections for which no the is 90.00/ hr
specifically listed (h hr min)
CCB Lic.: 168324 Electrical Lie.: c136 Suprv, Lie.; 4588S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal 63.60
Plan review (25% of permit fco)'
Print name: James Kleiser Date: 11 -1 -11 State surcharge (12% of permit fee)' 7.63
TOTAL PERMIT PEE; 71 23
Authorized signature; Phis permit application expires if a permit is not obtained within 180
days after it has been accepted as complete,
Print name: James KI Date: 11 • Number of inspections allowed per permit
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