Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2012 -00420
T [ GAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/17/2012
Parcel: 1 S126DC04400
Jurisdiction: Tigard
Site address: 9430 SW CORAL ST 100
Project: Fluence Subdivision: LEHMANN ACRE TRACT Lot: 7
Project Description: (3) branch circuits for TI
Contractor: TICE ELECTRIC Owner: MARTIN BUILDING LLC
5405 N. LAGOON AVE. BY BOGUMIL HOLZGANG & HARRIS PC
PORTLAND, OR 97217 9430 SW CORAL ST #100
PORTLAND, OR 97223
PHONE: 503 - 233 -8801 PHONE:
FAX: 503 - 872 -8290
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 07/17/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/17/2012 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 -001 090. You m obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: mA, A f /.T L, ( f7Q"+'
' f
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.
0711612012 14:05 Tice Electric C ' ¢AX)5038728275 P.0021003
P
Eleetfrieal Permit Appliesti u- . FOIL OFI I( I I tit' 1) \
City of Tigard JUL 16 2012 vned Z IMIE ParmitNo �' „2/91 - . 0 _ 7J
• 13125 SW Hall Blvd., Tigard, OR 97223
T ply Plan Review OtlierPmmi
Phone. 5031182439 Fax: 503 . 5 -qx ' 17-1 / OF 1I GAIID ��
rt ;:: t Inspection line: .639.4175 QtJ��IlsIVt! ® �V�JIdJPI Datekea /try: 7 d/" See Page ator
Internet www.ligard Q O V 1 i Norlfled/Metbod: V tr/ B1 Supplemental lnformadon
TYPE OF WORK PLAN REVIEW
•
❑ New construction ® Addition /alteration/replacement Haase check all that apply (submit1 sets of plans w /items checked below):
❑ Demolition ❑Other. ❑ Service or feeder 400 amps or more 1:1 Building over three stories.
where the available fault unreal 0 Marinas and boatyard&
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildinga
less to mood, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Piro pump. ❑ Installation of 751rvA or
JOB SITE INFORMATION AND LOCATION la Emergency system. larger separately derived system,
13 Addition of sew motor load of ❑ "A ", "E", "1-2 ", "1.3•0,
•
Job no.: 80.6284 I Job site address: 9430 SW Coral St 1txl11Parmore
occupancy.
13 Six or more residential mita CI Recreational vehicle parka
City / State/ZIP: Portland, OR 97223 ❑ Eealth.ome facilities. 13 Supply voltage for more than
dliaffidous looeticns. 600 volts nominal.
Suite/bidgJapt no.: 100 Project name: Finance ❑ Service or feeder 600 amps or more.
FEE SCHEDOLE
Cross street/directions to job site: Ds,crtpt sn - I Ote. I Fer. I 'tbtst I •
New reddential tingle or multi - family dwelling unit
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. $ or less 168.54 4
Tax map /parcel no.: _ Ea. add'1500 sq. f. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above aq. It.)
Limited energy, multi4bmlly — 75.00 2
Adding 6 new receptacles in different locations residential (with above sq. ft.)
Services or feeders Installation, alteration, and/or relocation
' 200 amps or less 100.70 2
Cl PROPERTY OWNER I ❑ TENANT 201 ampsto 400amps 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 55226 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Pax: ( ) 200 amps or less 59.36 1
Owner Installation: This installation is being made on property that I own which is not 201 amps to 400 125.08 z
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, Qer panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT . . I ❑ CONTACT PERSON shove service or feeder fee, 7.42 2
each branch circuit
Business name: B, Pee for branch circuits without
service or feeder fbe, first l 56.18 S6.f 8 2
Contact name: breach circuit
Each edd'l branch circuit 2 7.42 14.84 2
Address: Miscellaneous (service or feeder not included) '^
Ci / State/ZIP: Each manufactured or modular 67.84 2
h' dwelling, service and/or leader
Phone: ( ) pgx : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: Sign or outline lighting . 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: TICE ELECTRIC COMPANY panel, alteration. or extension. Page 2 2 '
Each additional Inspection over allowable In any of the above
Address: 5405 N LAGOON AVE Additional inspection (1 hr min) 6625/ hr
City/State/ZIP: PORTLAND /OR/97217 Investigation (1 hr min) 66251 hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 8724230 Fax: (971) 230-3330 Inspections for which no fee is 9000/ hr
syecificclly listed (14 hr min
CCB Lic.: 166 I f red: seal Lie.: 26 6C uprv. Lic.: 3304$ ELECTRICAL PERMIT FEES
/ Subtotal: 71.02
Suprv. Electrician signature, required: �G.„..ie., Plan review (25% of permit tea):
Print name: LOWELL ARNO I Date: 7/162012 State surcharge (12% of permit fce): 8.52
TOTAL PERMIT FEE: 79.54
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: I Date: days after it bas been accepted AS complete.
Number of inspections allowed per permit.
0711612012 14:04 Tice Electric Company (F1005038728275 P.0011003
0 3
.
, ELECTRIC COMPANY
5405 N Lagoon Ave Portland, Or 97217
Phone: 503/233/8801
Fax: 971/230/3330
Fax
To: City of Tlaard From: Theresa Jiollan
Pax: 503 -598 -1960 Pages: 3
Phone: Date: 7/16/2012
Re: Electrical Permit Application CC;
Urgent ['For Review ❑ Please Comment ' Please Reply ❑ Please Recycle
Thanks
Theresa
603- 872 -8230