Permit 1111 CITY OF TIGARD ELECTRICAL PERMIT
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2'. COMMUNITY DEVELOPMENT Permit#: ELC2014-00703
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/08/2014
Parcel: 1S136DB02601
Jurisdiction: Tigard
Site address: 11606 SW PACIFIC HWY 200
Project: Greenlight District Subdivision: AZOIC TERRACE Lot: 1
Project Description: (4)branch circuits for lights and receptacles.
Contractor: AMP ELECTRIC Owner: HWY 99 LLC
8152 SW HALL BLVD#325 2655 MARYLHURST DR
BEAVERTON, OR 97008 WEST LINN, OR 97068
PHONE: 360-910-5805 PHONE:
FAX: 503-643-6798
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo/Purchase 12/08/2014 $78.44
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/08/2014 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 952-001-0090. You may obtain a copy of the afCS Otdiract questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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Issued By: ii? nittee 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 503.639.4175 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 Application ; I OR of l i I I .l c)�l
City of Tigard Received
Deem %O Permit No.:
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• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ��^ �
I g Phone: 503.718.2439 Fax: 503.598.1960 , ,„S”-,ik: Date/By: Other Permit: OKJ J K- ,,
i i [.[ Inspection Line: 503.639.4175 ,,`,x�'t 1; Date Ready/By: luris: 65 See Page 2 for
Internet: www.tigard-or.gov ., .- • Notified/Method: Tre Supplemental Information
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TYPE OF WORK ,'`, r K`v► PLAN REVIEW
❑New construction Addition/alteration/replacement Please check all that apply(submit a sets of plans w/items checked below):
Demolition ❑Service or feeder 400 amps or mom ❑Building over three stories.
❑ ❑Other: i'��' a where the available fault current ❑Marinas and boatyards.
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CATEGORY OF CONSTRIj exceeds 10,000 amps at 150 volts or ❑Floating buildings.
* less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ I-and 2-family dwelling gi Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","t-2","1-3",
Job no.: Job site address:1/606 - 1001-EP or more. occupancy.
1 �► ' !1 sw r°s t r� �"��"7/ Zoo
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: T t G VitAd 6k` 212-3 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: 2_00 Project name:Get . /,,'G617" 49/ST, ❑Service or feeder 600 amps or mom.
FEE SCHEDULE
Cross street/directions to job site: Description I Qtr. I Fee. I Total I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot n0.: 1,000 sq.ft.or less 168.54 4
Tax map/parcel no.: Ea.add'I 500 sq.ft.or portion 33.92 1
Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Limited energy,multi-family
/Zt'tit 2- I-/C /,` 7 /ffD4 , ! Z p/�1' Renewablel(with a ve sq.ft.) ❑ SeePgoo 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑ 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:( ) 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
(jl-'APPLiCANT 49--CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
Business name:ii-vyy t' E J x_77 /C /,‘,.//� C each branch circuit 7.42 2
B.Fee for branch circuits without
Contact name: T ev„ ,449 17 /�u Ghr' service or feeder fee,first % 56.18 f ./Q` 2
J` branch circuit
Address: vs-i_ ._<Yis 3ery L� jL 4/z14(3'2__S" Each add'l branch circuit 3 7.42 1-1.-2-3-2
City/State/ZIP:I v67�/,w,,► 9'?(-XP t7 Miscellaneous(service or feeder not included) .ap.`,
�q Each manufactured or modular 67.84 2
Phone:(Sv3 )a /6 - '/ 7 7 Fax: :( S(/3) gy3_�2�� dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: Ail" L L.,z C 7�/e /✓' Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Aniziof .1.... t..--7-A-,c /p C. Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address: ff2 Ste- /j„9 L L L 1,17 It 3 ZS" Each additional inspection over allowable in any of the above
City/State/ZIP: yy,,��,, '� ^� Additional inspection(I hr min) 66.25/hr
(go,/rv�Yt ��'� / DO Investigation(1 hr min) 66.25/hr
Phone:(sf) )ey(.-3 f 7 , Fax:(f ) 6'/f3_6'2 ye- Industrial plant(1 hr min) 78.18/hr
C� inspections for which no fee is 90.00/hr
CCB Lie.:, /,a ei s Electrical Lie.: C/ 7 / Suprv.Lie.:3 e-6 y$' specifically listed('/:hr min)
/ / ELECTRICAL PERMIT FEES
Suprv.Electrici i ttr required:
/111/7 i �Q t t! 6 Subtotal: 7 . 7$ `'
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Plan review(25%of permit fee):
Print name. Date: )
.1 all/ �� State surcharge(12%of permit fee): -�-���.H/
Authorized signature r� ' ` _ TOTAL PERMIT FEE: --- f-7, r)
Print name: Date: �Q� This permit application expires if a permit is not obtained within 180
� �!el Ae pw�. T�,r9G,6�je� 7' y days after it has been accepted as co plete.
• Number of inspections allowed per permit. r_
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