Permit ; CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00033
T1GAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/07/2012
Parcel: 1S136DCO2504
Jurisdiction: Tigard
Site address: 7275 SW DARTMOUTH ST
Project: Dartmouth Shell Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: New service for future tenant spaces. 5) 200 amp & 1) 100 amp & 1) 1,200 amp AIC 31,730 amps.
Contractor: HILLSBORO ELECTRIC LLC Owner: AMERICAN INDUSTRIES INC
21185 NW EVERGREEN PKWY #110 JOHN DEMPSEY
HILLSBORO, OR 97124 1750 NW FRONT AVE STE #106
PORTLAND, OR 97209
P
PHONE: 503 - 222 -0060
PHONE: 503 - 439 -9666
FAX: 503 - 601 -3680
FEES
Quantity Description Date Amount
5 ea Services or Feeders - 200 02/07/2012 $503.50
Specifics: amps or less
1 ea Services or Feeders - Over 02/07/2012 $552.26
Type of Use: COM 1000 amps or volts
Class of Work: ALT 1 ea Plan Review Electricial 01/19/2012 $263.94
Type of Const: 5 crt Branch Circuits w /Purchase 02/07/2012 $37.10
Service or Feeder
Occupancy Grp: 1 ea 12% State Surcharge - 02/07/2012 $131.14
Electrical
0 ea Plan Review Electricial 02/07/2012 $9.28
Total $1,497.22
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.
Electrical Permit Application RECEIVED Received FOR OFFICE USE ONLY
ill Ci ty of Tigard ,r Permit No.: ��� D
tY g Date/By: / / /7 �A C o? /� - 1 33
2' • 13125 SW Hall Blvd., Tigard, OR 97 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 JAN 17. 2012 Date f � Other Permit:
T I GARD Inspection Line: 503.639.4175 Date ReadyBy� ^ ^ \ luris:
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: 6i See Page 2 for
1 W 1 � 4- 3 1 Supplemental Information
TYPE OF WdilltILINNUDWISION 1, /P) /A 1 . / w,' LAN.REVIEw -
❑ New construction ® Addition /alteration /replacement { `" Please cheek all that apply t[bmit 2 sets of plans w /items checked below):
D Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas 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 ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings. n
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
['Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ",
Job no.: 7938 • I Job site address: 7275 SW Dartmouth AVE IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard OR 97113 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: I Project name: Dartmouth Hollywood Shell ❑ Service 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 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
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
New service to the building for future tenant spaces residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 5 100.70 503.50 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 1 552.26 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation
Phone: ( ) 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
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
❑ APPLICANT
I ❑ CONTACT PERSON above service or feeder fee, 5 7.42 37.
each branch circuit 7. 2
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
n dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
. _ , CONTRACTOR Si gnal circuit(s) or limited - energy
Business name: Hillsboro Electric LLC panel, alteration, or extension. Page 2 2 •
Each additional inspection over allowable in any of the above
Address: 21185 NW Evergreen Pkwy #110 Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: Hillsboro OR 97124 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 439 - 9666 Fax: (503) 601 - 3680 Inspections for which no fee is 90.00/ hr
specifically listed (% hr min)
CCB Lic.: 134481 Electrical Lic.: 34 -499c Suprv. Lie.: 4941S ELECTRICAL PERMIT FEES ' i , .` �
�` � c�L/ 10Z-71 �� Subtotal: J CA j
Suprv. Electrician signature, required: � ^^� Plan review (25% of permit fee): l ' —
Print name: Joey Vitacco � Date: 1 -16 -12 State surcharge (12% of permit fee): 1 ��/ --
3
TOTAL PERMIT FEE:
Authorized signature: • � 1 ' 7.?
This permit application expires if a permit is not obtain • , . • ■ in 180
Print name: Date: days after it has been accepted as c, plete.
Number of inspections allowed per permit. t ' r r j ;� a ,f _ ■\ ,
! d`) dl. (��
I: \Building \Permits \ELC- PermitApp.doc 07/01/10 440- 4615T(I 1 /05 /COM /WEB