Permit y n CITY OF TIGARD ELECTRICAL PERMIT
' "- COMMUNITY DEVELOPMENT Permit #: ELC2012 -00122
T 1 GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/28/2012
Parcel: 1 S136DD01300
Jurisdiction: Tigard
Site address: 6855 SW BAYLOR ST
Project: Tillamook Sales Subdivision: WEST PORTLAND HEIGHTS Lot: 19
Project Description: Install (2) circuits in office /storage room.
Contractor: MILESTONE ELECTRIC Owner: GSP LLC
1281 NE 25TH AVE, STE. T MALCOM & SHARON ESLINGER LLC
HILLSBORO, OR 97124 BY DWIGHT SCHWAB
15450 SW BOONES FERRY RD STE 2
LAKE OSWEGO, OR 97035
PHONE: 503 - 645 -5323 PHONE:
FAX: 503 - 690 -4843
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 02/28/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/28/2012 $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 i ••ect 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 - •prove• 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. A ENTION: Oregon la req ires ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -' 010th ugh OAR 952 :j# 1 -00•0. may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800 .:2.2344.
�• ��
Issued 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:
CONTRACTO INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' A `i 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 1ECE FOR OFFICE US ONLY
City of Tigard ��D DateiBy: I $ /a k , ��?oVog _� lag,
a
Date/By: Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' I Phone: 503.639.4171 Fax: 503.598.1960 FEB �, $ 2 012 Date/By: Other Permit:
T rG n R D Inspection Line: 503.639.4175 Date Ready/By: tug: ® See Page 2 for
Internet: www.tigard -or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE OF o . PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 secs of plans w /items checked below):
❑ 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
❑ 1- and 2- family dwelling MCommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ 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 -2 ", "1 -3 ",
Job no.: 1 2 - 7 0 Job site address: e ir 576'" S 1 ,,,,.) c ,,, 10 tool or more. occupancy. • ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: T ❑ Health -care facilities. ❑ Supply voltage for more than
t g- g-01 / v 9 3 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 4 ! � �`t / / ��:ff g, ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. I Fee. I Total
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
-re S i l c- k -5 cP• ® 1 c e , residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
- re (pf _ keeN , 200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 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 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
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first
Contact name: branch circuit 56.18 S6• a 2
Each add'I branch circuit ' 7.42 7. 4/t 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only , 67.84 2
E - mail: Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Ai, le S T 3YYC
G / tvC panel, alteration or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: t X g- ( N L y S 4,,,, 5 � , e '1— Additional inspection (1 hr min) 66.25/ hr
1 p 61712..1.1 r Investigation (1 hr min) 66.25/ hr
City / State/ZIP: l � i �'S lO 6 t 1� Industrial plant (1 hr min) 78.18/ hr
Phone: (5 c Fax: ( 5-03) [7i q
7 / S v (f/ C �y� Inspections for which no fee is specifically listed (% hr min) 90.00 / hr
CCB Lic.: / S3 C f 9-0 Electrical Lic.: 3 i -6 / i Suprv. Lic.: Sc 63 S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: �'� /Oh, Subtotal: d 3. 6 c
Plan review (25% of permit fee):
Print name: C.-ti ,-1-5 1-7447 Date: y /.. 7r1 Z State surcharge (12% of permit fee): 7. 6 3
Authorized signature:
TOTAL PERMIT FEE: "7 (a 2_3
This permit application expires if a permit is not obtained within 180
Print name: Date: • days after it has been accepted as complete.
• Number of inspections allowed per permit.
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