Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 00003
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/05/2012
Parcel: 2S102AB01201
Jurisdiction: Tigard
Site address: 9240 SW CENTER ST
Project: CACH Subdivision:RTH TIGARDVILLE ADDITION, AMENC Lot: 64
Project Description: (1) panel and (2) branch circuits.
Contractor: L & K ELECTRIC Owner: CACH FAMILY SMALL PROPERTIES LLC
10122 SE SHADY LN BY REGENCY MANAGEMENT INC
DAMASCUS, OR 97089 12488 SW AUTUMNVIEW ST
TIGARD, OR 97224
PHONE: 971 - 506 -8351 PHONE:
FAX: 503 - 663 -0343
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 01/05/2012 $100.70
Specifics: amps or less
2 crt Branch Circuits w /Purchase 01/05/2012 $14.84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 01/05/2012 $13.86
Electrical
Type of Const:
Occupancy Grp:
Total $129.40
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 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/� _ �_ ��� 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.
JAN -04 -2012 06:14 PM L &K EL E VIC 5036630343 P -0
Electrical p sins A 1C8t10 '64k00- l•t)u 0" 1.1(1. t �F ONI.\
I O
\, ,t Received
City of Tigard �,�\ � w \ " Ddte/B : I 1 / Permit No • -
• 13125 SW Hall Blvd., Tigard, 4' 23 Plan Review Other permit
Phone: 503.718.2439 Pax: 503.598. ( 0 y Date/9 ; ®gce Page 2 toe
Inspection Line: 503.639,4175 ��, Aate Ready /ay'. 9dpplementa) Information
1 11. t. i i Notified/Method:
Internet: www.tigard- oY,gov „
.• -...� 0 PLAN REVIEW
TYPE OF', , ,
Please check all that apply (su I sets of plans w /sterna chocked below),
❑ New construction ® Addition /alfMKn replacement
❑ Service or feeder 400 amps or more 0 Building over three stories,
❑ Demolition ❑ Other: whero the available fault current ❑ Marinas and boatyards.
.. CA TEGORY, OF CONSTIRUCTION • exceeds 10,000 amps at i SO volts or p Floating buildings.
leas to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations, buildings.
❑ Multi-familz ❑ Master builder ❑ Other: -- Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND i CATION [a Addition of new motor load of 0 "A" "E" "1.2" "1 -3 ",
I00HP or more, occupancy.
Job no.: Job site address: 9240 SW Center St ❑ Six or more residential units. ❑ Recreational vehicle parks.
❑ Health -care facilities. ❑ Supply voltage for more than
City /State /ZIP: Tigard, OR 97223 0 Hazardous locations 600 volts nominal.
Suite/b no.: Proj nam ( C� 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: n l sty, B ee. ' 1 Tote1 I
New residential single- or multi - family dwelling unit.
Includes attached garage,
Subdivision: Lot no.: 1,000 5g. ft, or less 168,54 m _ 4
Ea, add'/ 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: _ Limited energy, residential
(wi above sq, ftJ 75.00 2
DESCRIPTION OF WORK
• Limited energy, multifamily 75,00 2
200A panel with 2 circuits for construction residential (with above so, ft.)
Services or feeders Installation, alteration, and/or relocation
200 amps or less 1 100.70 100.70 12
11 PROPERTY OWNER - I • 0 TE 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: Chris Cach
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552,26 2
Temporary services or feeders installation, alteration, and /o
City /State /ZIP: relocation
Phone: ( ) 1 Fax: ( ) 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
401 amps to 599 amps 168,54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with I
APPLICANT I CONTACT PERSON above service or feeder fee, 2
7,42 14,84 2
each branch circuit
Business name: B, Pee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Ben Braun branch circuit
Each add'/ branch circuit 7.42 _ 2
Address: Miscellaneous (service or feeder not Included)
Each manufactured or modular 67.84 2
• City/State /ZIP: I dwells &service and/or feeder
Phone: (503) 804 - 2445 1 Fax:: ( ) Reconnect only 67,84 2
ll 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: L &K Electric, Inc panel, alteration, or extension. page 2 2
-- Each additional inspection over allowable in any of the it'd.
Address: 10122 SE Shady Lane Additional inspection (1 hr min) 66,25/ hr
City/State/ZIP: Damascus, OR 97089 lnveatigation (1 hr min) 66,25 / hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (971) 506 - 8311 Fax: (503) 663 - 0343 Inspection's for which no fee is 40,00 / hr
soec� i tally listed ('f hr mn)
CCS Lie.: 157326 to/ I Electrical Lc.: 26 -11800 Suprv. Lie.: 4975S to /In . ELECTRICAL PERMIT FEES
7 t ti u Subtotal 115.54
Suprv. Electrician signature, required:
Plan review (25% of permit fee):
Print name: Larry Peterson yam Date: 1/04/12 State surcharge (12% of permit fee): 13.86
� TOTAL PERMIT FEE: 129,40
Authorized signatur • ,. y , „ "� This permit application expires if a permit is not obtained within 180
(�
Print name: r�'a r d •• , ,... Date: 1/04/12
tom” 1 s Maya after k has been accepted as eomplete.
Number of inspeeotiona allowed per permit.
E.
C\ 8uildine 'Permiu\C- POrnlltAPP•doe 07/01/10 / 410.46I5T(11/05,COM/Wkn