Permit CITY OF TIGARD ELECTRICAL PERMIT
m COMMUNITY DEVELOPMENT Permit #: ELC2012 -00220
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/18/2012
Parcel: 2S113AB00101
Jurisdiction: Tigard
Site address: 16101 SW 72ND AVE 200
Project: Perlo Constrution Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Electrical for TI.
Contractor: HUGHES ELECTRICAL CONTRACTORS INC Owner: PACIFIC REALTY ASSOCIATES LP
10490 NW JACKSON QUARRY RD ATTN: N PIVEN
HILLSBORO, OR 97124 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 -647 -2221 PHONE: 503 - 624 -6300
FAX: 503 - 647 -7754
FEES
Quantity Description Date Amount
10 crt Branch Circuits wo /Purchase 04/18/2012 $122.96
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/18/2012 $14.76
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $137.72
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 rule- uestions to OUNC by calling 503.232.1987 or 1.800.332.2344. A
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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.
From: • , 1 y /13/62 04/19/2012 05:41 #070 P.002/002
*Or, 0) lei t i e.c.€
Electrical Permit Applicati ; __ ' _p FOR OF icE USE orLy
City of Tigard � PR T. 20 �� Received j
C 13125 SW Hall Blvd., Tigard, OR 972 PIen 1, Other permit „r " _•
' � Phone: 503.7182439 Fax: 503.598. 960 Date/ :: 4j7.t / , `I I ,
Line: 503.639.4175 .. 5 04 io `� i. "
71(; A It I)
Inspection rtl -9u "' . c '.. (.. �� Date ed/MeBy: BI See Pate 2 for
Internet: www.tigard or.gov ,� ,lp - - f, ,a •;. - ,��1 Notified/Method: r Supplemental Information
... . ... . .... . ..: :•;'r`., g;i.. .., : ... s:. -rt. ::t•�'.b °..:T- .aa'� -t _r: " ✓ - nr :<f•;?, ; �•. - .'k "'c o � "
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..�:' �� .:::.a.'.z::.I..�u' ..l:::tY.k, ^',,::.: n'�� j'f n`i'•��rv��..,. tv. �....Y ��r�rx 'W �'S41'.�ii'i :... -. :s...k:..�. �. .a .ti r
❑ New construction ∎_1 Addition /alteration/replacemen Please check all that apply (submit F sets of plans w /hems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
Di Demolition
❑ Other: where the available fault current ❑ Marinas and boatyards.
r :'+;' '�_ '' '" " " <: `<' s. exce 10,000 amps at 150 volts or ❑ Floating buildings.
_ ' :TrE' �•=p 11 O ;,;� , .';; ;.3�' Ps g orp•
GA GUi( F '_E A CT i `. `. '''
;:; . °` ���': � .. . , �;- �� '; , 'z�- ,- „�- ,w.�.;y�,._..,_ _,Yr.d��.: - _ . .�- :�, , � ..... _;z3< less to gmun4 orexttMsI4.000 ❑ Commercial sgriculmral
❑ 1- and 2- family dwelling E Commercial/industrial ~ ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
�l 2
••E
:� • x n,n•_ �� :' , : n`,: ; ::- : },•; =;s ❑ Emergency system larger separately derived system.
"::r ; 3 r! :)<, . S m - )tNp ..7� a .�,.+t1,1��N ��. :t Addition of motor load of ••A •• •• •
...:.:A:..3' ?�i..��f... �..a.. -. . ... .�.. ,. �<.`� . .a.r. ..:. ... _.: dam., .+?,sc .._.- ..,.a_ n -.r �r � ..'J?r .; ..., ., a'�, _ .tn3 M':l� ❑ AddlhO O now m010 08 O ❑
Job no.: I a Ace �W� Job site address: 1 6 k S W - lan e. Ave.. is or or more.
m occu eation
(� ❑ Six or more residential unite. ❑ Recreational vehicle parks.
City / State/ZIP: 1' o,r1.1 op, C I cl ❑ Health -care facilities. ❑ Supply voltage for more than
((�� ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 4C)0 Project name: Per i 0 Qrl ( Ire T 1 ❑ Service or feeder 600 amps or more.
I
Cross street/directions to job site: 5w use C .Y. Y �. ,,,, ' ._. s .,, " ;,, ,
J pp (<� � r•�J' DacAPtba i . .. -> QIY. � . : �� 1
„. .. TWaI
1 1 � C \\ ) 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'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: '
Limited energy, residential 75.00 2
.' .. . p�.RIPiT i,.t o W �,,*p Jam" sor >'�
:! :1 ' ..... v `irV; D]FSt*Itf ** rt:WO,Iii," z ^`,, : ::- 'ii,.. +-stl - 70 i.`x �x t- (with above sq. ll.) , -
Limited energy, multi- family
1n5 -611 New 001 -le k 4 De.m o/ R e i 8 uRil % residential (with above sq. ft.) 75.00 2
Services or feeders installation,alteration, and/or relocation
ExIshR9 DevIee4 200 amps or less 100.70 2
�'': ; _ : 13.6 2
p ;k t ; t = =" ;., , : ar ; 201 amps to 400 amps 3 5
'`:+a�..�.. Y.'. i�'c ,.,. ..: - -:�.c. .. r...v .. .. .: ,.-1;, .. �:n �' dx ... nifr .�3... -.. t_.v.b �'p+..l v.. .. - c ` ^ls
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
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
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 ex tension, per panel
Owner signature: Date: A. Fee for branch circuits with
branch circuit
.� _ 5 ` y ^: ,;f• >r}: -- _ ; ; ,,h ; above i or feeder fee
'• -4,014 :404. . ' , _ f : - .. r.:�6:. a a : 0. s - tf �,rC' :4710.80: _, rz "n ' each branob servce c:cruil 7.42 2
Business name: Hu .E5 Elet4 i col CoR aC rS B. Fee for branch circuits without
c � service or feeder fee, first 56.1 B e
Contact name: S e. Tai Raeeh 1 S(' t 2
Each add'I branch circuit 9 7.42 ( ,-i g 2
Address: 1 0L.4 R Q k!'d Tc s c�a (uQrry RD Miscellaneous (service or feeder not included)
p Each manufactured or modular
City/State/ZIP: Kok 6 op, Cfl % o,L4 dwelling, service and/or feeder 67.84 2
Phone: (803) (p - aa , a , Fax: : (S03)(CA '11 5 1 4
Reconnect only 67.84 2 67.84 2
E PteC.0 hit (�'t 4Q�i e,c, I La (, �fn
Pump or 67.84
.. rin... ' is �:t^.a.:e.:, .:s &� +. ..�':- : :.a -; - �::�. �: ��;:'_-:: �;, r.-„'-; "� ";,.�:- "_���.;��:. i�.'; dti a ate
.,<-r=_ mpo irrigation
Sign or outline lighting ng
- .. r(.
.... ..... - .., �. �.CT `i�. , Signalcircuit(s)orlimited-energy
Business name: uUti�e.e� Elec * s,C . 1, C1oR�r panel, alteration, or extension. Paget 2
t Each additional Inspection over allowable in any of the above
Address: ! 0 L C !.,/ Tp ck 0 R G uo rr.' RD Additional inspection (I hr min) 66.25/ hr ,
Q Investigation (1 hr min) 6625/ hr
.{ L(�
City/ State/ZIP: bQra Q,12, l 7 1 � � Industrial plant (I hr min) 78.18 / hr
Phone: (Y G) �-1 ° p�aj� 1 I Fax: (5 0 3) (M ° i ' , 9 t �f Inspections for which no fee is 90.00 / hr
I specifically listed ('A hr min)
CCB Lic.: 1-1C1 8 �.------SaprV:Lic.:5 3505 t;� = = vu ?;. . 0; :t ; . :,
Subtotal: i ai .,
Suprv. Electrician signature, required: Plan review (25% of permit fee): , ,
Print name :\Th ci v 1,A -- 1 � /� Date: i' 11 / State surcharge (12% of permit fee): 4 Li , 'I 6
rf / `! TOTAL PERMIT FEE: y
Authorized signature: Thts permit application expires if a permit is not obtained v4
days after it has been accepted as complete.
Print name: Date: Q 1
Number of inspections allowed per permit. 13� -7/
1: \Binding \Pennaa\Ei.C- PermoApp.doc 07/0,/1 440-46151111/05/COM/WEB