Permit (4) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2019-00659
Date Issued: 10/02/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110AD08700
Jurisdiction: Tigard
Site address: 10705 SW MURDOCK LN 1
Project: Hudson Apartments, Building F Subdivision: None Lot: None
Project Description: (8)branch circuits for water heater monitoring upgrade for building F units 1-8.
Contractor: TICE ELECTRIC Owner: S&P PACIFIC CREST LLC
5405 N LAGOON AVE. 10695 SW MURDOCK LLC
PORTLAND, OR 97217 ATTN SHARKANSKY, MAX
700 N SAN VICENTE BLVD STE G460
WEST HOLLYWOOD, CA 90069
PHONE: 503-872-8230 PHONE:
FAX: 971-230-3330
FEES
Quantity Description Date Amount
8 crt Branch Circuits wo/Purchase 10/02/2019 $108.12
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/02/2019 $12.97
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $121.09
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 co es or direct questions to OUNC by calling 503.232.1987
or 1.800.332.2344.f�
Issued By: 4if+.��r.. ' 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 503.639.4175 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 Li i-l:€ 1\ ' FOR OFFICE USE 0417 '.4
_ .y �' � �
City of Tigard
a 13125 SW Hall Blvd.,Tigard,OR 97223Vo.
0C 2i
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit I:
Inspection Line: 503.639.4175
ell( +. 1 d' ' ReadyDate/By:
T R, ■ S See Pent 2l nr
�_;��, ,. Internet: w�vw.tigard-or.gov t s ^^�¢�t�`"' '1:; Notified/Method: 111
tb. !R Lam, InformationSupplemental
TYPE OF WORK PLAN REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
El Demolition El Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family 0 Master builder ❑Other: 0 Fire pump, 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: /'' / -4/5— /. �" ❑Addition of new motor load of system.
ji,�� I `u�fJ �(/11 t� Lc L/y, 100HP or more. ❑"A""E""l-2""I-3"
City/State/ZTP: 0 Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: / Project name: ys[ ❑Hazardous locations. 0 Supply voltage for more than
/ — ar efyo 4 84 / ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each 1 Total I
New residential single-or multi-family dwelling unit.
Subdivision: ( Lot#: Includes attached garage.
Tax map/parcel 4: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
*1 e..,� 6 4 { � (with above sq.ft.) 75.00 2
` �•'r iG-, Limited energy,multi-family
/ residential(with above sq.ft.) 75.00 2
d " 11.04,.....,r
Renewable Energy 13 See Page 2 1
PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) ( Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
APPLICANT 0 CONTACT PERSONBranch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first
branch circuit I 56.18 r)-.c.,t 113, 2
City/State/ZIP: Each add'I branch circuit 7 7.42 Si 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email:
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Tice Electric Company Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy 0 See Page 2 2
5405 N Lagoon Ave panel,alteration,or extension.
City/State/ZIP: Portland, OR 97217 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)233-8801 Fax:(503) 231-3372 Investigation(1 hr min) 90.00/hr
Email: adamc@ticeelec.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 166 Electrical Lic.26-126C Suprv,Lic.: 3940S specifically listed(%2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: c3W19 Subtotal: 16 Lj ,{0(
Print name: ,4, /�!t^l�4,-ri_C ),,, Date:-V/�„90/,to/ ❑Plan Review Required(2S%of permit fee)_
State surcharge(12%of permit fee): 42. 1
Authorized signature: TOTAL PERMIT FEE: oaf V
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.
1:\Building\Permits\ELC_PermitApp ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB