Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit: ELC2012 -00206
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/10/2012
Parcel: 2S110AC01000
Jurisdiction: Tigard
Site address: 11545 SW BEEF BEND RD 1
Project: Wellington Estates Subdivision: 2003 -083 PARTITION PLAT Lot: 2
Project Description: Meter base replacement.
Contractor: ROSE CITY ELECTRIC CO Owner: FERN VALLEY PROPERTIES LLC
PO BOX 10004 BY CAMBRIDGE REAL ESTATE SERVICES
PORTLAND, OR 97296 PO BOX 2968
PORTLAND, OR 97208
PHONE: 503 - 287 -6164 PHONE:
FAX: 503 - 282 -1060
FEES
Quantity Description Date Amount
1 ea 12% State Surcharge - 04/10/2012 $12.08
Specifics: Electrical
1 ea Services or Feeders - 201 to 04/10/2012 $133.56
Type of Use: MF 400 amps
Class of Work: ALT 0 ea 12% State Surcharge - 04/10/2012 $3.95
Electrical
Type of Const:
Occupancy Grp:
Total $149.59
Required Items and Reports (Conditions)
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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 95 -111-0090. You m- • stain a cosy of the rul - . • =ct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By _ _ — �� �� Permittee Signature:
• WNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
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OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.839.4176 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.
04/06/201213:51 FAX (1001
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Electrical Permit Application, REC EIVED FOR OFFICE E USE ONLY
City of Tigard APR 6 2012 R " °`°� q
13125 SW Hall Blvd., Tigard, OR 9722 •1I . 4/ .... � L
Pi on Review
Phone: 503.718.2439 Fax 503.598.1 rx Data Other Permit
TI % < t i Inspection Lim: 503.639.4175 CITY OF'I'IGARD Date Rdy/By; to See Page 2 for
Internet: www.lig:ad- or.gov BUILDING DIVISIO Notified/Method
Supplemental toforrnattart
'TIME OF WORK PLAN REVIEW •
❑ New ooashnction ® Addition /alteration/replacement Please check all that apply (submit 2 sets ofpiea. wiitenn chocked blow):
El Service or feeder 400 amps or morn ❑ Building over three stories.
❑ Demolition ❑Other
where the available fault current 0 and baxttyatds.
. CATEGORY OF 'CONSTRUCTION armed% 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground. or exceeds 14,000 ❑ Commereinl•use atnieultuml
❑ 1- and 2- family dwelling ❑ Commerciallmdusrial ❑ Accessory building amps for all ether insud4aions. buildings.
IR Multi- family ❑ Master builder ❑ Other: ❑ fire pump. ❑ bte1n1lut tun of 75 KvA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency sys larger separately derived system.
❑ Addition of new molar land of 0 A. "E". "1 -2 ". "1-3",
.
Job no.: Job site address: 11545 SW Beef Bend Rd 10OHP or more, occupancy.
O SLV or more residential units. ❑ Recreational vehick parks,
City /Stale,/ZIP: Tigard, OR 97224 ❑ Hcaltbcare facilities. ❑ Supply voltage far mare than
❑ Hazardous locations. 600 volts nominal.
Suitc/bldgJapt no.: Project name: Wellington Estate Apts ❑ Service or feeder 600 amps or mote,
— FEE SCHEDULE
Cross street/directions to job site: ,Jr�, ,a,,, _iso,t_ l tee l cars l •
' Now revidcntsd single- or motet- fam11y dwelling unit.
Includes attached garage.
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Subdivision: Lot no.: 1,000 sq. it or bet 168.54 4
Tax neap /parcel n0.: - Ea. add'I 500 sq. R. or p ortion 33 1
Limited mug, residential
. DESCRIPTION OF WORK (with above sq. ft.) 75.00 1
Limited maw, muhi•famrly
Replace 3 pack meter base. residential (with above sq. ft.) 75.E 2
services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ . PROPERTY OWNER • • . ❑ TENANT • 201 amps to 400 amps I 13330 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 volt J 55226 2
City /StffidZIP: Temporary services or fenders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 1
Owner installation: This installation is being made on property that I own which is n ot tot ;laps to 400 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, r panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT I 0. CONTACT PERSON . • above � �� 7.42 2
Business name: Rose City Electric Co. B. Fee for branch circuit% without
• - service or feeder fee, first 56.18 2
Contact name: Jerry Schlechter branch circuit
Each add'I branch circuit 7.42 2
Address: P.O. Box 10004 Miscellaneous (service or feeder not included)
City /Statc/ZIP: Portland, OR 97296 Each nL9na1GKla OT modular 67.84 2
dwelling, service and/or feeder _
Phone: (503) 297 -6164 Fax: : (503) 282 -1060 Reconnect only 67.84 2
E- mail: Inio@RoseCttyElectricCo.com Pump or irrigation scale 67.84 2
Sign or outline Lighting 67.84 2
. . CONTRACTOR Signal circuil(s) or limited-energy -
Business name: Rose City Electric Co panel. alteration. or extensor. Page 2 2
Each additional inspection over allowable in any of the above
Address: P.O. Box 1 0004 Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: Portland, OR 97296 Iavestigatioa(l tau®) 66.25/h
Industrial plant (1 hr min) 78.18/1u
Phone: (503) 287 -6164 Fax: (503) 282 -1060 Inspersions for which no fee is
' apa. lisial('A la min) 90.00 / la
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CCB Lic.: 193652 1/7/3 Electrical Lie.: C729 7� /ipi Suprv. Lic.: 5058S /J /143 - ELECTRICAL PERMIT FEES •
Su
Suprv. Electrician si a required: bttu�: I a . 5(v
' PLan review (25% of permit fee): `
Print name: John Wilins +, �, Date: 4/6/12 State surcharge (12% of permit fee): /( ,
Authorized signature( e, Z4 TOTAL PERMIT F'Fs>r: _. ]:i3 Mg. C i��: mil' i hispermit ..ithin 80
days after It has been accepted as complete.
Print name: Jerry Schlechter Date: 4/6/12
' Number of inspections allowed per permit
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