Permit n CITY OF TIGARD ELECTRICAL PERMIT
14 g COMMUNITY DEVELOPMENT Permit #: ELC2012 00701
Date Issued: 12/12/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Parcel: 1S135DD00700
Jurisdiction: Tigard
Site address: 11710 SW WARNER AVE 1
Project: Nelson Apartments Subdivision: HOFFARBER TRACTS Lot: 38
Project Description: Rewire 4 plex, plus common area (1) 400 amp panel and (32) branch circuits
Contractor: CROWN VOLTAGE Owner: NELSON, DAVID
609 SW EATON BLVD 9620 N LOMBARD ST
BATTLE GROUND, WA 98604 PORTLAND, OR 97203
PHONE 360 - 666 -0995 PHONE. 503-804-0262
FAX. 360 - 666 -4673
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 201 to 12/12/2012 $133.56
Specifics: 400 amps
32 crt Branch Circuits w /Purchase 12/12/2012 $237.44
Type of Use: MF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 12/12/2012 $44.52
Electrical
Type of Const:
Occupancy Grp:
Total $415 52
Required Items and Reports (Conditions)
This per s issued subje o the regulations contained in the Tigard Municipal Code. State of OR Specialty Codes and all other applicable law All work will
be d e in accordance with app ved •fans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
day ATTENTION Oregon law . - •uires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
95.- 001 -0010 thro gh OAR 952 -00 090 Y• may obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344,
Is ed By: if / Permittee Signature: �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.
Electrical Permit Applicati FOR OFFICE USEONLY
Cl of Tigard
CE�ED Received //��
g Date /B �� ®�O' Permit No �����.� 70
° 13125 SW Hall Blvd ,Tigard, OR 977.9•• r 1 2 2012 (L C Plan Review
Phone 503 718 2439 Fax 503 598 p a1e /B Other Pei snit
TIGARD Inspection Line 503 639 4175 Date Ready/By Jans ® See Page 2 for
Internet www tigard -or gov CITY OFTIGARD Notified /Method Supplemental information
TYPE (IRWR IVVISIGN 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
❑ 1- 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 ANU LOCATION ❑ Emergency system larger separately derived system
❑ Addition of new motor load of ❑ "A "E ", "I - ", "I - ",
Job no.. R12290 Job site address: 11710 SW WARNER AVE 100HP or more occupancy
❑ Six or more residential units ❑ Recreational vehicle parks
City /State /ZIP. TIGARD, OR 97223 ['Health-care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite /bldg. /apt no. Project name. ❑ Service or feeder 600 amps or more
FEE SCHEDULE Cross street/directions to job site'
J Description I Qty I Fee. 1 Total
New residential single - or multi- family dwelling unit.
Includes attached garage.
Subdivision Lot no • 1,000 sq ft or less 168 54 4
Tax map /parcel no. Ea add'I 500 sq II or portion 33 92 I
Limited energy, residential
DESCRIPTION OF WORK (with above sq R) 75 00 2
Limited energy, multi-family
P residential (with above sq ft) 75 00 2
Remodel 5 plex electrical
Services or feeders installation, alteration, and /or relocation
200 amps or less 100 70 2
® PROPERTY OWNER ❑ "TENANT 201 amps to 400 amps 1 133 56 13 f.542
Name David Nelson
401 amps to 600 amps % "1----- 200 34 349 - 2
601 amps to 1,000 amps 301 04 2
Address 9620 N LOMBARD ST Over 1,000 amps or volts 552 26 2
City/State/ZIP: PORTLAND OR 97203 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (503)804 -0262 Fax: (503)213 - 5875 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, per panel
Owner signature: Date: A Fee for branch circuits with
❑ APPLICANT' ® CONTACT PERSON
above service or feeder fee, 32 7 47 237 44 2
each branch circuit _ _
Business name Crown Voltage, Inc. B Fee for branch circuits without
service or feeder fee, first 56 18
Contact name • Stacy LaCombe branch circuit 2
Each add'I branch circuit 7 42 2
Address. Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State /ZIP. 67 84 2
dwelling, service and /or feeder
Phone: ( ) Fax : ( ) 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: Crown Voltage, Inc. panel, alteration, or extension Page 2 2
Each additional inspection over allowable in any of the above
Address 609 SW Eaton Blvd Additional inspection (I hr min) 66 25/ hr
Investigation (I hr min) 66 25/ hr
City /State /ZIP. Battle Ground WA 98604
Industrial plant (I lir min) 78 18/ hr
Phone (360) 6660995 Fax: (360) 6664673 Inspections for which no fee is 90 00/ hi
specifically listed ('/, hr min)
CCB Lic . 153934 Electrical Lie. 37 -984C Suprv. Lie, 5777S ELECTRICAL PERMIT FEES GD
Suprv. Electrician signature, required: • / / Subtotal *4-9.9-11-' ?J7�
2. ---""
/ Plan review (25% of permit fee)
Print name: Daniel Tucker Date 12/12/12 State surcharge (12 %ofpermit lee) 32 y ' 53 / 1.
TOTAL PERMIT FEE 490 }I y /4 .
Authorized signature —
Gr/J/4 This permit application expires if a permit is not obtained within 180
Print name: Date days after it has been accepted as complete.
* Number of inspections allowed per pennit
I \BuildingPernins`ELC- PermitApp doe 07/01/10 440- 4615T(I I /05 /COM /WEB