Permit CITY OF TIGARD ELECTRICAL PERMIT
a • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00663
T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/20/2012
Parcel: 1 S 136AD06505
Jurisdiction: Tigard
Site address: 10998 SW 68TH PKWY
Project: Bailey - Golsan Building Subdivision: WAY LEE Lot: B
Project Description: (6) branch circuits for TI office - new partition walls
Contractor: ALL PRO ELECTRIC INC Owner: KEN GOLSAN
6327 SW CAPITOL HWY STE C #280 BAILEY GOLSAN LLC
PORTLAND, OR 97239 10998 SW 68TH PARKWAY
TIGARD, OR 97223
PHONE: 503 - 246 -0361 PHONE: 503 - 244 -0297
FAX: 503 - 246 -0406
FEES
Quantity Description • Date Amount
6 crt Branch Circuits wo /Purchase 11/20/2012 $93.28
Specifics: • Service or Feeder
1 ea 12 %State Surcharge - 11/20/2012 $11.19
Type of Use: COM • Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
•
Total $104.47
•
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 OA 5 -001 -0 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Qd � Permittee Signature: v /�' 4 PPL' C -4770
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 503.839.4175 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.
Nov 20 12 10:15a All Pro Electric 503.246.0406 p.1
Electrical Permit Application RECEIVE r FOR i)[FIC I: 1:SE ONLY
City of Tigard 201 D , l y 9'r Permit No.: - LFi�I�. -004,
11. ° 13125 SW Half-Blvd., Tigard, OR 97223- NOV 2 Q P1211 Review
a ' Phone: 503.718.2439 Fax: 503.598.1960 � i nn DateJB : Other Permit �I' JO IA.... �'31
TIC. R D inspection Line: 503.639.4175 CITY � TIGAARD Date Ready/BY ® See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVI I TOlifiedltethod: MI Supplemental Information
TYPE OF WORK �l] LJl V �7 PLAN REVIEW
❑ New construction i] Addition /alteration /replacement Please check alt that apply (submit a sets of plans w/itcros checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fads 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
❑ 1 - and 2- family dwelling lil Cortunercial/industrial ❑ Accessory building amps for all o her installations. buildings.
❑ Multi- family D Master builder ❑ Other: ❑Fire pump. ❑ installation of 75 KVAor
. JOB SITE INFORMATION AND LOCATION . ❑ Emergency o ucw system. larger separately derived system.
El Addition of trey motor b li"
ad of � "A ". ", "1 -2 ", "1-3",
Job no.: A Job site address: f� ( Jy ( � 4' 1 r (� 3 t(� �, m or mo more. occupancy.
�.�, t V� 1 V so) V /J , C R.4 � • ❑Six or more residential units. ❑ Recreational vehicle patios.
City /State/ZIP: ll t1l t V1 L "I t 2'2 ✓ ❑ Health-care locations. ❑ Supply voltage for more than
P J /� ❑ }t�q 600 volts nominal.
Suite/bldg.iapt.no.: rojectname: 1 /Il�LIJ� 1 6DI 9.)0 ❑ Serviceor feeder 600 amps or more.
L 7 l.,1 FEE SCHEDULE
• Cross street/directions to job site: Derertptloa 1 city, I Fee. i That I •
New residential single- or tualti- family dwelling unit.
Includes attached garage -
Subdivision: I 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, •
gy residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft)
Limited energy, multi - family 75 2
— 1 1 ctt — 'rli.t�' - i CN) mils. 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 13336 2
401 maps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
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
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 ex tension, 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: B. Fee for branch circuits without
service or feeder fee, first i 56.I8J t7 2
Contact name: branch circuit
Each add', branch circuit - . 7.42 37 Ur 2
Address: Miscellaneous (service or feeder not included)
Cit Stale/Z1P: Each manufactured or modular 67.84 2
Y dwelling, service and/or feeder
1 .
Phone: ( ) I Fax: : ( )
R econnect only 67.84 1 2
Pump or irrigation circle 67.84 I 2
E -mail:
Sign or outline lighting 67.84 2
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CONTRACTOR i Signal circuit(s) or limited -energ .
p�y ii rr f , panel, alteration, or extension. Page 2 I
Business name: m L� mil/ 1 (-e' -, Each additional inspection over allowable in any of the above 2
,,� rr1� ( ona (I hr min
Address: ii W�'�( 1 J1�r � �1L�i � � �� :?�' t l . � t% Additional inspection ) 66.25/ hr
City/State/ZIP: StatelZlP: y am,{ r+ �^ .� Investigation (I hr min) 66.25/ hr
T l4 . U ` C Industrial plant (1 lrr min) 78.18/ hr
Plume: �) �� U
( �) h Fax: (1 5) ) iJ 4 0 I 7 1 Inspetximis for which no fee is 90.00/ hr
` `' z, specifically listed (z hr min)
CCB Lic.: I�}�i (� �) I Electrical Lic i (/� I Lfiei L i Suprv. Lic.: t:..te; "�) S ELECTRICAL PERMIT FEES
S Electrician signature, required: SSubtotal: I 9�'�
fie' 1 ....... . , / Plan review (25% of permit fee):
Print name: K.b r il7 Plif!i D ate: i I 1 f C t J! �-
/t State surcharge (12% of permit fee): li. 1
TOTAL PERMIi' FEE: /04 • "f
Authorized signature: � This permit application expires If a permit is not obtained within 180
Print name: I Date: • days after it has been accepted as complete.
Number of inspections allowed per permit.
1: 1BuildmRlPermits .ELC- PermitApp.doc 07/01/10 440- 46151111/05/COMMEB