Permit n CITY OF TIGARD ELECTRICAL PERMIT
Is COMMUNITY DEVELOPMENT Permit #: ELC2012 -00559
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/25/2012
Parcel: 1 S136CA01500
Jurisdiction: Tigard
Site address: 7709 SW PFAFFLE ST E85
Project: Jivanjee Subdivision: FAIRVALE Lot: 6
Project Description: Reconnect
Contractor: QUALITY PLUS FRAMING & ELECTRICAL Owner: HAWTHORNE URBAN DEVELOPMENT LLC
16037 SW BOWMEN LN 7705 SW PFAFFLE ST
SHERWOOD, OR 97140 PORTLAND, OR 97223
PHONE: 503 - 799 -1639 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 09/25/2012 $67.84
Specifics:
1 ea 12% State Surcharge - 09/25/2012 $8.14
Electrical
Type of Use: MF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 2 -001 -0 0. You may obtain a py of the rules or direct questions to OUNC by calling 503,x32.1987 or 0.332.2344.
Issued By: 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.
Electrical Permit Application FOR OFFICE USE ONLY ed City of Tigard Date B :
Plan Review 41,2,5 �� Sr— Permit Nn.� " GY�SS
q 13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit:
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: El See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets 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
❑ I - and 2- family dwelling ❑ Commercial/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.: Job site address: 7709 sw phaffle st IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: unit 85 Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description
I Qty. I Fee. I Total I •
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 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
reconnect residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 . 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: jivanjee companies 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: po box 230579. Over 1,000 amps or volts 552.26 2
City/State /ZIP: Portland or 97281 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (503 - 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
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, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: quality plus framing & electtrical B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Don wilson branch circuit
Each add'l branch circuit 7.42 2
Address: 16037 sw bowmen In Miscellaneous (service or feeder not included)
City/ State/ZIP: 97140 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 7991639 Fax: : ( ) Reconnect only I 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: qualityplus framing &electrical panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 16037 sw bowmen In Additional inspection (1 hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City/State/ZIP: sherwood or. 97140 Industrial plant (1 hr min) 78.18 / hr
Phone: (503) 799 1639 Fax: ( ) 4.4.22.1.; for which no fee is 90.00 / hr
specifically listed (V2 hr min)
CCB Lic.: 95163 Electrical Lie. c427 Suprv. Lic.:s ( ELECTRICAL PERMIT FEES
d t `k' Subtotal: 67.84
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: Russ Magnuson ate: 9/25/12 State surcharge (12% of permit fee):
TOTAL PERMIT FEE: Tc 9E?
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Don Wilson Date: 9/25/12 days after it has been accepted as complete.
• Number of inspections allowed per permit.
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