Permit CITY OF TIGARD ELECTRICAL PERMIT
'`1 a COMMUNITY DEVELOPMENT Permit #: ELC2013 -00090
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/06/2013
Parcel: 2S110DCO2300
Jurisdiction: Tigard
Site address: 11535 SW DURHAM RD C -3
Project: Beltone Hearing Subdivision: 1998 -128 PARTITION PLAT Lot: 1
Project Description: (2) branch circuits to run MC and install new J -box for outlets and switches
Contractor: TESLA ELECTRIC CO Owner: HIP WILLOWBROOK LLC
2850 SW CEDAR HILLS BVLD #250 BY HARSCH INVESTMENT CORP
BEAVERTON, OR 97005 PO BOX 2708
PORTLAND, OR 97208
PHONE: 503 - 724 -1175 PHONE:
FAX: 503- 646 -3498
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 02/06/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/06/2013 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 n may obtain a copy of the rules or direct questions to OUNC by calling 503.232,1%. .:00.332.2344.
Issued By: UY' Lta 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 503.639.4176 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 RECEIVED Folz oFFicu: 1;s1''. oNI.VV
City of Tigard Received Date/By. 2-I 40 (/ 3 Permit No.: e(__e_ 3o4 3 ... ovo 5
° 13125 SW Hall Blvd., Tigard, OR 97223 2 013 Plan Review
el ' Phone: 503.718.2439 Fax: 503.598.1960 r H 3 6 Date/By: Other Permit:
Fl G A R D Inspection Line: g 03.63 ..417 TIG D � Date Ready/By: luris: see Page 2 for
Internet: www.ti ardor. ov t11 Notified/Method: 'T / (1 Supplemental Information
TYPE of w1LDINQD 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 AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: Job site address: 11535 SW Durham Rd. IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: C -3 Project name: .11 - 471`4� (`K.CkC'v_C. ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qn, 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
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 7500 2
Run MC and install new J -box for outlets and switches 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
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 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
ty 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 extension, per 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: Tesla Electric Co. B. Fee for branch circuits without
service or feeder fee, first X 1
56.18 2
Contact name: Igor Zelen branch circuit
Each add'l branch circuit X 7.42 1 2
Address: 2850 SW Cedar Hills Blvd #250 Miscellaneous (service or feeder not included)
City/State /ZIP: Beaverton, OR 97005 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 7241175 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: Tesla Electric Co. panel, alteration, or extension. _ Page 2 2
Each additional inspection over allowable in any of the above
Address: 2850 SW Cedar Hills Blvd #250 Additional inspection (I hr min) 66.25/ hr
City/State /ZIP: Beaverton, OR 97005 Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 7241175 1 1 Fax: ( I ) Inspections for which no fee is 90.00 / hr
- specifically listed (% hr min) _
CCB Lic.: 189699 0.- .. Electrical Lic.:(,599 '1 ∎ 1 I Suprv. Lic.: 4697S ELECTRICAL PERMIT FEES
r Jl� ( / v/ t r13 o Subtotal: 63.60
Suprv. Electrician signature, required: (it/rii,r
Plan review (25% of permit fee): •
Print name: wj (j 0IAA W14 I Yom/ Date' 2/6/13 State surcharge (12% of permit fee): 6.96
TOTAL PERMIT FEE: 70.56
Authorized signature: c //i,•— � ` This permit application expires if a permit is not obtained within 180
Print name: T /' Ze IX �/ Date: 2�6 // days after it has been accepted as complete.
✓ • N um b er of inspections allowed per permit.
I:\Building\Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(11 /05 /COMM'EB 7 /, .c..3
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11535 SW DURHAM RD C-3, TIGARD, OR,
97224
Commercial - Electrical
199 Electrical final
04/23/2013 00:00
ELC2013-00090
PASS - No C of O
Violation Summary:
Inspector Contractor