Permit CITY OF TIGARD ELECTRICAL PERMIT
■ . COMMUNITY DEVELOPMENT Permit #: ELC2012 -00357
T I GA R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/07/2012
Parcel: 1 S126BC01506
Jurisdiction: TIGARD
Site address: 9020 SW WASHINGTON SQUARE RD 450
Project: Tzell Travel Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: (1) branch circuit for RTU
Contractor: ATLAS ELECTRICAL CONTRACTORS Owner: WSCO REAL ESTATE EQUITY FUND I
4403 SE ROETHE RD 1501 SW TAYLOR ST STE 100
MILWAUKIE, OR 96267 PORTLAND, OR 97205
PHONE: 503 - 659 -2212 PHONE:
FAX: 503 - 659 -4944
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 06/07/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/07/2012 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 0 52 -001- 90. You m obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.3
32. . 2 2344..
Issued By: Permittee Signature: 0 a -1 e' ' 70' I
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.
Jun. 6. 2012 3:36PM Atlas Electrical Contractors Inc No. 0476 P. 3
Electrical Permit ApplicatiFtPC !J.,. pi ED FOR OF ICl: USE °NE I'
City of Tigard 6 i w , .1 _ Permit N.. ,03
111 a 13125 SW HaII Dlvd., Tigard, OR 972�1I II Paso Review
II . Phono: 503.718.2439 Fax: 503.598.1966 N 6 2 0 2 Date/E1 , Other Peanit:
T I G A It ll Inspection Line: 503.639.4175 Date Ready/By. LEM ET See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information
Tf/PE o> e nNlSIO _ • " • PLAN REVIEW • .
❑ New construction ® Addit ion /alteration/replacement Please cheat all that apply (submit 2 sets of plans w /items checked below):
El ❑ Service or feeder 400 amps or more 0 Building over three stories.
U Demolition ❑ Other: wire the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 Grohs or []Frosting buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
(♦ ►1 commeiciavindustrial r Accessory building amps for all other itWallations. buildings.
D Multi-family 0 Master builder 0 Other: ❑ Fire pump. ❑ Installation of 73 KVA or
❑ Emergency system. larger separately derived system
JOB SITE I ' 1 1 AND LOCATION ❑ Addition of new motor load of Q "A ",'B ", "1.2 ", "1-3",
I Job site address: , 9020 SW WASH SQ RD, 4 FLR I0oHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
1 OR 97223 ❑Health -care Deilities. ❑ Supply voltage for more than
['Hazardous locations. 600 volts nominal. Project name: • 21350-TZELL TRAVEL El service or feeder 600 amps or more. -
1 FEE SCHEDULE .
Cross - aetedptIon I Ow. I Pea 1 'row 1•
New residential single- or multi- family dwelling unit.
includes attached garage.
1,000 sq. R. or less 168.54 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.92 1
Tax rnap/parcel ' Li mited en ergy, residential 75.00 2
DESCRIPTION, OF 1 ' (with above sq. R.)
Limited energy, multi- family 15.00 2
CONNECT NEW RTU residential (with above sq. IL)
Services or feeders installation alteration, and/or relocation
' 200 amps or less I 100.70 2
PROPERTY 1 201 amps to 400 amps I 133,56 2
401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 _ 2
• , , Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) I 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, der 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: ATLAS ELECTRICAL S. Pee for branch circuits without
service or feeder fee, first 1 56.18 56.18 2
Contact name: CATHY MUNSON branch circuit
Each add'I branch circuit 7.42 2
Address: 4403 SE ROETHE RD Miscellancons (service or feeder not Included)
OR Each manufactured or modular 67.84 2
City/State/ZIP: MILWAUICIE, dwain : , service and/or feeder
n (503) 659-4944 Reconnect only 67.84 2
Pump or irrigation circle 6734 2
E- moil: cathym@atlaselectrical.com Signor outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: ATLAS ELECTRICAL CONTRACTORS panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
4403 sERoEME ' 1 Additional inspection (I hr min) 66.25/ hr .
OIL ,
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: MILWAUK1E, Industrial plant (I hr min) 78.18/ hr
(503)659-2212 Fax: I Inspections for which no fee is 90.001 Iir
specifically listed ('A hr min)
e 5009S ' ELECTRICAL PERMIT FEES
Subtotal: 56.18
' r " �� I , L Plan review (25% of permit fce):
! 1� State surcharge (12% of permit fee): 6.74
TOTAL PERMIT FEE: 62.92
Authorized signature: 'Phis permit application eitd es If a permit is not obtained within 180
�, ...
�
in�
days has d been accepted as compacts
1
Print name: TY N SHEPERSKY / Number umbero of inspections allowed pe r petmit.
r :vawtding mi orrou,o 40- 4615T(