Permit v CITY OF TIGARD ELECTRICAL PERMIT
Is:. - COMMUNITY DEVELOPMENT Permit #: ELC2013 00099
'TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/13/2013
Parcel: 2S113AA00700
Jurisdiction: Tigard
Site address: 16436 SW 72ND AVE B5
Project: Tesla Motors Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: (2) branch circuits to install 2 receptacles for battery charging stations
Contractor: TICE ELECTRIC Owner: PACIFIC REALTY TRUST
5405 N. LAGOON AVE. ATTN: N PIVEN
PORTLAND, OR 97217 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
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PHONE: 503 - 233 -8801 PHONE:
FAX: 503 - 872 -8290
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 02/13/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/13/2013 $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 OA 9 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: L /Lh? l d7.4 kt Permittee Signature: Oki A l C D KI
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.
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02/1212013 14:38 Tice Electric Company fA)Q503272 275 P.002/005
RECEIVE
Electr Permit Ap� litaahon t "()f; i►r ru l: I til i1,.11
Ii . ,.. City of Tiga D , : i 3 / If . PflffatNc. X 091.1' 3 -e0 F'
st 13129 SW Flail Blvd., Tigard, Olt 97223 F F 8 1 2 2 013 PlaaRevIeW n
' • • Phone: 503.718.2439 Fax: 503.598.1960
In eetion Line: 503.639.4175 t p RI} A ate Rotor
Other tB Soo age a for
t ; r, i t l) I n � net www.tigard- or.gov CITY OF TIGA NOldfed/Method: sapplameatal tororm.eoo
TYPE OF I DIVISION PLAN REVIE
❑ New construction n Addition/alteration/replacement Please check all thetapply Isubmit 2 sets of plans w /items checked below):
❑Demolition 0Other: Q w o lheavaillabablefw current D M eaaborir
CATEGORY OF CONSTRUCTION =ads 10,000 amps at 150 volts or D Floating buildings.
less to ground, or exceeds 14,000 0 Comtnereial- me agricultural
❑ 1 - and 2-family dwelling El Commercial/industrial ❑ Accessory building am,os tbr an other lattatbntites. buildings.
❑ Multi- family ❑ Master builder ❑ Other: D tie tip. 0 Installation of75 KVA or
0Em
JOB SITE INFORMATION AND LOCATION eraowysystem. larger awettoly derived system.
❑Additioaoenewmotorloadof D "A ","E ", "12';w3 »,
lob no.: 80,0487 Job site address: 16438 SW 72nd I00EIP m egged. occ
D Six or mate residential unite. E7 Recreational vehicle paths,
City /State/ZIP: TIGARD /OR/97224 ❑ Heise+ - tare Rests , ❑ Supply voltage for more then
. . . D Haaardoue looatione 600 velar nominal.
Suite/bldg./apt no.: 1 Projectuatlte: TESLA CAR CHARGERS 0 Swirls dr&Oder600 amps ormore.
Cross street/directions to job site: , .wetrtaaon FEE SCHEDULE eel I just I •
New residential single- or multi - family dwelling unit
incindna attached garage,
Subdivision: 1 Lot no.: 1,000 sq. ft. alma I 168.54 — 17
Fa. add'1500 sq. ft. or portion 33.92 l
TeX map /parcel no.: Limited energy, residential 73A0 2
DESCRIPTION OP WORK (with above eq. ft.)
Limited energy, multi - family
75.00 2
INSTALLING 2 RECEPTACLES FOR BATTERY CHARGING STATIONS residential (with above sq.$.)
Services or feederaJmtallation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I Ca 'IENAIYI' 201 amps to 400 amps 133.56: 2
Name:
401 amps to 600 amps 200.34 2
601 ampa to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
/State/ - Temporary s or feeders lnatariadon, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or legs 5936 1
Owner Installation: This installation is being made on property that I own whlCh is not 201 amps to 400 amp 125.08 Z
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 16854 2
Branch dreoits- new, alteration, or extension, per panel
Owner signature: Date: - A Fee ibr branch circuits with
❑ AP'PL ICANT - 1 gi CONTACT PERSON above service or teedar fee,
each brand+ clroult 7 2
Busimeas name; TICE ELECTRIC COMPANY B. Fee for brunch circuits without —
service or teeder the, first 1 56.18 86,18 2
Contact name: THERESA HOLIAN branch circuit _
Each add'! bomch circuit 1 7.42 7.42. 2
AddreSS: 6405 N LAGOON AVE Miscellaneous (tetwice or feeder not Included)
City /shales!!: PORTLAND/OR/97217 Each me s erv e a or nNn r feeder modular 67.84
�J
2 ,
. dw ffeeder
Phone: ( 503 - 8$2 - 8280 j Fax: ( 971 ) 230 - 3330 _dwelling, se vice Reconnect only 67.84 2 •
E - mail: thereaah®ticeeleacom Pump or Irrigation circle 67.84 2
Signor outline lighting 67.84 2
CONTRACTOR Signal c roulr(s) or llnilterlmnergy
Business name: TICE ELECTRIC COMPANY panel, alteration, or extension. Page 2 2
Each additional Inspection over avowable In any of the above
Address: 5405 N LAGOON AVE Additional inspection (I hr min) 6625/ hr .
City /State/ZIP: PORTLAND /OR/972.17 htvatlgetion (1 hr min) 66 25/ hr
industrial plant (lhrmin) 78.16/hr
Phone: (503)872 -8230 _ /?(per Fax: (971) 230-3330 bipediom for which no fits is
specificallylmted l4hr
90,OO/hr
CCB Lia: 166 1 Electrical Lie.: 126C l I Suprv. Lic.: 33045 ••• •• L , TGTRICAI,.pli:R114T Pl• rA
Supry . Electrician signature, required ,� r� -- 2.s.,, � ' Subtotal_ 63.60
Plan review (25% of permit fie):
Print name: LOWELLAiNO I Date: 2/18/2013 State surcharge (12 %ofpermitfee): 7.83
TOTAL PERMIT PEE: 71.29
Authorized signature: .� This permitapplcadon expires if a permit b not obtained while 180
days after It has bean icebpted as complete.
Print name: Dater: 6 Number of Inspections allowed per permit.