Permit I I y CITY OF TIGARD ELECTRICAL PERMIT ti
II = COMMUNITY DEVELOPMENT Permit #: ELC2013 -00294
Date Issued: 05/28/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
Parcel: 1 S 135DA03500
Jurisdiction: Tigard
Site address: 11481 SW HALL BLVD 200
Project: Serenity Subdivision: METZGER ACRE TRACTS Lot: 19
Project Description: (5) branch circuits for TI
Contractor: HI DEF ELECTRIC Owner: BECKAL LLC
1110 NE 19TH CT 7100 SW GABLE PKWY
CANBY, OR 97013 PORTLAND, OR 97225
PHONE: 503 - 891 -2231 PHONE:
FAX: 503 - 212 -5516
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo /Purchase 05/28/2013 $85.86
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/28/2013 $10.30
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $96.16
Required Items and Reports (Conditions)
This permit is issu sub'ect 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 rdance with - 'proved 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. AT NTION: Oregon la , - • ire ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 010 through OAR 952 -r 1 -009 r
il l ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1. 0.332.2344
--
Issu d By: -I�--IL I Ia -d-f- i Permittee Signature: ic •
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' �1•, e _ 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.
1
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard
Kecei■ed
6 / /� ,.! Permit No.: t eiz a`� .�� o a9
M 13125 SW Hall Blvd., Tigard, OR 97223 Date /B Plan Review
III
s Phone: 503.718.2439 Fax: 503.598.1960 Date /B : Other Permit: ,A6 /6 -'pp / , 5 •
I t v A K t> Inspection Line: 503.639.4175 Date Ready /By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov Notified /Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction [,g Addition /alteration /replacement
❑ 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 li Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑Fire pump. ❑ Installation of ISO KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3",
Job no.: Job site address: // y r 5 (.t) H 4 L 6 I OOHP or more. occupancy.
Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: T/O 0 rdt ❑ Health -care facilities.
❑ Hazardous locations. ❑ Supply voltage for more than
600 volts nominal.
Suite /bldg. /apt. no.: t oe) Project name: (t1� / i y ❑ 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 I
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy. multi- family 75.00 2
r� C. I r c_ v.) t -Co • L V ' c 1 0 ( residential (with above sq. ft.)
_ Renewable Energy ❑ See Page 2
P r ►.vr 1r`� . ► ✓ t l -i A.,„4 1 Services or feeders installation, alteration, and/or relocation
❑ PROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1.000 amps 301.04 2
Over 1.000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name:
each branch circuit
B. Fee for branch circuits without /
Contact name: service or feeder fee, first 1 56.18 5 .-- 6. 1 2
branch circuit
Address: Each add'I branch circuit 4/ 7.42 ,g. 4;6 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: t l / — ' 7e - ' t . / c . ^ � r I C Sig circuit(s) or limited- energy See ,
panel, alteration, or extension. Page 2
Address: 1 / / (,J /V e _ / d C '7-- Each additional inspection over allowable in any of the above
Additional inspection (I hr min) 66.25/ hr
City /State /ZIP: 0pip) � 1 - J y 0 q 70 (3 Investigation (I hr min) 66.25/ hr
Phone: ($ , j ) 6"9 / - D. 2. 3 1 I Fax: (S'c3 ) .. 12 _ s-- r i 6 Industrial plant (1 hr min) 78.18 / hr
Inspections for which no fee is
CCB Lie.: /'7 6 6)_ 3 I Electrical Lie.: C.3o 8 I Suprv. Lic.: 2 L/ / S specifically listed (t/ hr min) 90.00 / hr
ELECTRICAL PERMIT FEES // __
Suprv. Electrician signature, required: �.. Subtotal: 74. g tf�
Print name: C t 0 re h c- C— 1--c- i--7 Date: S — 4 / — /3 Plan review (25% of permit fee): �—
5 L J _ State surcharge (1 of permit fee): _ 3 0 Authorized signature: / TOTAL PERMIT FEE: 96:". j 62
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 permit.
I:\ I) uilding\ I' ermits\ 1' .I.C_I'ermitApp_lil.K_I'.RE.dos Rev 115/21 /20(3 4411 4615T(11 /115 /Ct)M/WI:11
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
11481 SW HALL BLVD 200, TIGARD, OR, 97223
Commercial - Electrical
120 Electrical rough-in
05/30/2013 00:00
ELC2013-00294
PASS
Violation Summary:
Inspector Contractor