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Permit (28) CITY OF TIGARD ELECTRICAL PERMIT 11. COMMUNITY DEVELOPMENT Permit#: ELC2023-00288 13125 SW Hall Blvd.,Ti Date Issued: 5/22/2023 and OR 97223 503.718.2439 TIGARD 9 Parcel: 1 S 136AD06400 Jurisdiction: Tigard Site address: 11440 SW PACIFIC HWY Project: 76 Service Station Subdivision: None Lot: None Project Description: Plumb and wire fuel renovation to dispensers. Contractor: BOYLES ELECTRIC INC Owner: WEST COAST OREGON GROUP LLC PO BOX 1227 11440 SW PACIFIC HWY BORING, OR 97009 TIGARD, OR 97223 PHONE: 503-663-2628 PHONE: FAX: 503-663-9048 FEES Quantity Description Date Amount 8 crt Branch Circuits wo/Purchase 05/19/2023 $108.12 Specifics: Service or Feeder 1 ea Plan Review Electricial 05/19/2023 $27.03 Type of Use: COM 1 ea 12%State Surcharge- 05/19/2023 $12.97 Class of Work: ALT Electrical Type of Const: Occupancy Grp: Total $148.12 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. Th' permit will e pire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Ore law requ' y u o follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 throuah OAR 01-00 . ouorn b 'n a of the r ect auestions to OUNC by calling 503.2 .1987 or 1.800.332.2344. X/ ��/r�/ Issued By: Permittee Signature: G� /%��'v OWNER INSTALLATION ONLY f' 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'N 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 FOIL I)Pi it ] I ',I'()NI Cityo Tigard Received Y:7, t?f + y. Permit#:61 r 1 -_corac,.III 13125 SW Hall Blvd.,Tigard, Plan Review b^� QI (l CJa Phone: 503.718.2439 Fax: 5 FeEIVED burp $ p" 9 Related Permit#: Inspection Line: 503.639.4175 Ready By. �L i <<1 1> Inspect Internet: www.ti and-or. ov otifud at ethod: 3004s, B See Page 2 for g g l7 tG Supplemental Information TYPE OF fWuRK s' �) t-=1 PLAN REVIEW ❑New construction ®Addition/ t ucement //�Z���lease check all that apply(submit j,sets of plans widens checked): ❑Demolition ❑Other: t"TI A f 1 ❑Service or feeder 400 amps or more 0 Building over three stories. I�U jll�� l�(!71 where the available fault current 0 Marinas and boatyards. CATEGORY OF CO C1rlOI���'N exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to groin or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived Job#:5092 OC I Job site address:11440 SW PACIFIC HW ]OOIIY ❑Addition c of new motor load of system. �more. ❑"A","E" "I-2" "1-3" City/State/ZIP:TI GARD OR 97223 ❑Six or more residential units. occupancy. ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: I Project name:76 STATION ®Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total I • New residential single-or multi-family dwelling unit Subdivision: I Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential PLUMB AND WIRE FUEL RENOVATION TO DISPENSERS (with above sq.ft) 75.00 2 Limited energy,multi-family 75.00 2 residential(with above aq.IL) 0 PROPERTY OWNER ❑ TENANT Renewable Energy ❑ See Page 2 Services or feeders hsstallation,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:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2 Email: Temporary services or feeders installation,alteration,and/or 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 0 APPLICANT I 0 CONTACT PERSON Branch drauits-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 1 56.18 56.18 2 City/State/ZIP: Each add'l blanch circuit 7 7.42 2 I Miscellaneous(service or feeder not included) 5! .et'A Phone:( ) Fax::( ) Each manufactured or modular Email: dwelling,service and/or feeder 67.84 2 Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name:BOYLES ELECTRIC INC Sign or outline lighting 67.84 2 Address:PO BOX 1227 Signal circuit(s)or limited-energy panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP:BORING, OR 97009 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( 503) 663-2628 I Fax:(503 663-9048 Investigation(1 hr min) 90.00/hr Email: byeleca©frontier.com Industrial plant(lltrmin) 78.18/hr Inspections for which no fee is90.00/ hr CCB Lie.:137002 I Electrical Lie.:3-465C I Suprv.Lie.:3404S specifically listed C/z hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: 94- F. Subtotal: 111.12 Print name:John E. Boyles Date:4/24/23 la Plan Review Required(25%of permit fee): 27.78 State surcharge(12%of permit fee): 13.33 Authorized signature: . TOTAL PERMIT FEE: 152.23 This permit application expires If a permit is not obtained within 180 Print name:John E. Boyles Date:4/24/23 days after It has been accepted as complete, * Number of inspections allowed per permit. is\Building\Permits\ELC_PermitApp_ELR BRE.doe Rev 06/17/2015 440-4615T{11/05/COM/WEB