Permit j ELECTRICAL PERMIT
q CITY OF TIGARD
111 • COMMUNITY DEVELOPMENT �� •, ' Permit#: ELC2015-00224
T t G AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/08/2015
Parcel: 2S112AB00600
Jurisdiction: Tigard
Site address: 14101 SW 72ND AVE
Project: Westside Moving and Storage Subdivision: 1992-007 PARTITION PLAT Lot: 2
Project Description: Adding sub-panel and circuits to refeed office power pole.4/8/15,REPRINTED to change signing supervisor to
3940S,Richardson.
Contractor: TICE ELECTRIC Owner: PJT INVESTMENTS LLC
5405 N LAGOON AVE. 4836 SE POWELL BLVD
PORTLAND,OR 97217 PORTLAND,OR 97206
PHONE: 503-872-8230 PHONE:
FAX: 971-230-3330
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 04/08/2015 $100.70
Specifics: amps or less
3 crt Branch Circuits w/Purchase 04/08/2015 $22.26
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 04/08/2015 $14.76
Electrical
Type of Const:
Occupancy Grp:
Total $137.72
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 '• -ccordance wi -•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. •TTENTION: Oregon la, requir- you to follow the rules adopted by the Oregon Utility Notifica r. Those rules are set forth in OAR
95 r01-0010 through OAR 952-00 I--0. yt•• ay obtain a copy of the rules or direct questions to OUNC by 503. • .1987 or 1.800.332,2344.
Issued By: _/ �I ' PermittQ ignature: i��f y
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.
0410812015 09:41 Tice Electric Company (FAX)5038728275 P.001/001
• ; ��vEo
f l.ectrieal Permit AtmlY Hill t►I F'u F t SE 4►N1,N
2�15 Received �R11��r ELC2015-00224
City of Tigard PR S Receiv `,' PermilNo•:
• 13125 SW Hall Blvd.,Tigard,OR 97TH' Plan Review �-
i Phone: 503.718.2439 Fax: 503. 1 tJF TIGARD 13atelsy: Other?emir
1 1 r,•t a tJ Inspection Line: 50.3.639.4175 ad-o g c� ING D VIS►ON t)iteReedyfl3y: Jun. See Page 2 for
Internet: www.ti and-or ov UILD Notiiled/Method: Supplemental Information
TYPE Of WORK PLAN REVIEW
❑New construction gl Addition/altetation/replacement ' rinse check all that apply(submit a sea of plans wilt/MS checked below): I
❑Service or feeder 400 amps or more ❑Building over three stories.
LI Demolition_ ❑Other: where the available fault current ❑Marines and boatyards.
C'\TEGORY OF COYSTRUC l'1Oc exceeds 10,000 amps 51150 volts or ❑Floating buildings.
lass to ground,or exceeds 14,000 0 Commercial-use test-lookout!
E 1-and 2-thirdly dwelling (CommerciaVindustrlel ❑Accessory building amps f rall other installation. buildings.
0 Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installed=of 150 KVA or
❑Emergency system. larger asptuat»ly derived ayuem.
JOB SITE INFORNLYr1ON I ND LOCATION i:Additionofnewmotorloadof 0"A","E",4 l-2"."1-3",
lo
Sob no.: Job site address: 14101 SW 72ND AVE eres. Recreation.
❑Six or more residential units. 0 Recreational vehicle parks,
City/State/ZIP: TI GARD/O R197224 0 Roaltlr-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt,no.: Project name: WESTSI DE MOVING ❑Service or feeder 600 amps or more.
FEE SCLLEA►tiLE
Cross street/directions to job site: n«ar:poen 1 qp••J Pee, 1 Tatar L•
— - New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lotno.: 1.000 sq.Ti.or lass 168.54 I 4
Tax map/parcel rio.: Ea.add'I 500 sq.h.or portion 33.92 1
L Mited error',residential
DESCRIPTION OF WORK (with above sq.ft) 75. _00 2
Limited energy,multi-family 73.00 2
SIGNING SUPERVISOR IS CHANGING. residental(withaboyesq.tt)
Renewable['Iry ❑ Sec Page 2
Services or feeders Installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑ TENANT 1 200 amps or less -1-- 100.70 140,70 2
201 amps to 400 amps 133,56 2
Name: - 401 amps to 600 amps _LL 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
-. Over 1,000 amps or volts 55226 2
City/State/ZIP: Temporary services or feeders Installation,alteration,and/or
Phone:( ) Pax:( ) relocation
200 amps or leas 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: hate: Branch circuits-now,alteration,or extension,per panel
I ❑ APPLIC.t\'1 ❑ CON'TAC'T' PERSON A.Pee for branch circuits with
, above service or ibeder lee, 3 742 °ZG Zl 2
Business name: each branch circuit
D.Fee for branch circuits without
Comsat name: service or feeder fee,first
branch circuit 56.18 2
Address: Each add'!branch circuit 742 I 2
City/State/ZIP: Miacellanedus(service or feeder not Included)
Each manuiltctured or modular 67.84 2
■Phone:( ) FOX::( ) dwelling.service and/or feeder
Reconnect only 67,84 2
E-mail: Pump or irrigation circle , 67.84 2
CONTRACTOR Signor outline lighting 67.84 2
Business name:TICE ELECTRIC COMPA.ISy Signal circuits)or limited-energy sea
panel,alteration,or extension. Pete 2 2
Address:5405 N LAGOON AVE Each additional Inspection over allowable In any of the above
City/State/ZIP:PORTLAND/OR/97217 Additional inspection(1 htttiln) 6666.25/1r 51i
/ Investigation(1 hr min) 66.25/hr
Phone:(503)233-8801 Fax:(911)230,9330 44//4' Industrial plant(1 hr rain) 78.18/hr ilI
Inspections for which no fee Is 90.001 hr i -
CCB Lic.: 166 Electrical Lic.: 26-126C Suprv.Lie.: 39408 spec1Acally listen v.shrmin)
eft;x: _ ELECTRICAL PERMIT FEES
rSuprv.Electrician signature.required: 6 , ,a„___- Subtotal: �2 ,' io
Print name: BOB RICHARDSON Date: 4/8/2015 Plan review(25%of permit fee);
State surcharge(12%of permit fee): /y,76
Authorized Signature: TOTAL PERMIT FEE: 137, ! Z-
This permit application expires if a permit Is not obtained within 180
Print name: Date: day*after it has been accepted as complete
' Number of inspections allowed per permit.
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