Permit (54) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00238
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/27/2009
TIGARD 9 Parcel: 1 S136DD05300
Jurisdiction: TIGARD
Site address: 11850 SW 67TH AVE, STE# 110
Subdivision: TIGARD TRIANGLE COMMONS Lot: 13
Project: Grange Capital
Project Description: Install (1) 200 amp or less panel, and (8) branch circuits.
Owner: FEES
PNWP LLC#2 & Quantity Description Date Amount
PNWP LLC, 6600 SW 105TH AVE #175 1 ea Services or Feeders - 200 05/26/2009 $80.30
BEAVERTON, OR 97008 amps or less
PHONE: 8 crt Branch Circuits w /Purchase 05/26/2009 $53.20
Service or Feeder
Contractor: 1 ea 12% State Surcharge - 05/26/2009 $16.02
LANTIL LLC Electrical
493 NE 3RD AVE STE B200
CANBY, OR 97013
PHONE: 503 - 263 -2558
FAX: 503- 651 -3540
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $149.52
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 acco • . • 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. • ENTION: • ‘grEop.aw requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 - % 0 through OAR 6-00i-0,e0. You may obtain a copy of the rules or direct questions to OUNC by callin. .2 6.6699 or 1.800.332.2344.
Issue By: 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'N /. Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
' ' 9 -05 -22 Q7 � « ? � ectr 7 503 -651 -3 - -- ,as... - : °- -. • _ P 2 2
><ca Per mit pp a CEBCEBTED , t f,; , I, i 1(, i ,, t i ,
City of Tigard Received Datolly Permit No.: E1C1 ( . 10 , 2,e,
13125 SW Hall Blvd., Tigard, OR W ,! 2 2 2009 Plan Review
g Phone: 503.639.4171 Fax: 503,598.1960 p Other Permit
! 1 , it ! r Inspection Line: 503.639.41750, OF TIGARD Data /By: 1 • ® See Page 2 for
Internet: www.tigai 1 -or.go , 1 ■ ► 1 • g ► Notified/Method lc) Supplemental Information
";.,-r.. . :•; :. .:.: . .. .y''1'.'I. r:: "I, ) `m I'! a �•, et , II,
. •rj� ,�,... • z) r .� < '� !'P F 1jlq)gr i t � 9 ,y1 �1 r,� R 'S ,tlK{f ! I� 14046110M, �t wire , „,,,,•)C>! .
., : • r 0; , ,.. fr L .' :.01� - Y t . , c : , d I I i t -(; / {� r ! 0 r � 1 !(r i r ; � y { !:'l i
' r _ l�V i111 lltkl4'1,'�11t1 ! t,Ii r-vt 3n1�s N.,d..{edl fir: ;1 �..l�,Ev:: �Y. YIIV�V7�� ;79'.,".7. < ",'�r�,T�'1�;/7; , •�'.,' .
O New construction . ddition/alteaation/replacement Meese check all that apply (submit E bets of plans w /items checked below).
❑ Service or ter 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other
;,;r■'_'Pr.' ? t. '.. na ltlea j^fQArrt�9au�taa;ctaaslriu , ir1 ? T Cu r where the available fault current ❑ Marinas end boatyards.
^ t'. I.; '� a. m ' ' r '. t,. a a . , ; S � • 1. S !RT-Fi A ngrff!s tilt i, exceeds 10,000 • at 150 volts or ❑ Floating buildings.
i .. Y u ililrrM U v m ra a:e� >n nyyrc ,».;.r. Its S'.: ���:r.•,,sdE' h�E7 ?s %` �a Ni,� Ki; tees to ground. or exceeds 14.000 ❑ Commerdal -eras ag,iculnual
❑ 1 - and 2- family dwelling ommercial/industrial ❑ Accessory building am pa for all other installation& buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or
: :t' ilic.,,l!
ii' 'rr i,1101 ,i ' rva ... t'.. r."s;,'srni:«a><kx.uv.r.;�:,..: 1y! `. o;i� ❑mr
ErBcncy syemm. larger separately derived system.
+1 �l, nn t err. 1�an 7il: ivwtimlrurad u* ..:: r, r.., �tG G U' t?:, c; a. �n l. . ft�
u rr ;.1 � ❑ AddltionofaawafOTOrloadof ❑ »A" "E•• ••l_2•• "1.3”.
no.:' Job site address:1 I�` 13-} IOOtiP or more, occupancy.
I ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP; , I ❑ Health -care facilities. 0 Supply voltage fur mom than
/_'` ♦ M _
SuittJbld / ❑ Herardous locations 600 volts nominal -
g. 1, ' p Project na me: la l 46 �' ❑ arBaer600ampsormore.
. 11 rrt f . ' a "^ „ jrt v�,-, ,' m rp l� f �r
Crass street/directions to job Fite: t* F� • 7 ;',(!::�:i+.i4•^' j N]:tl i t! : !.. ",;.::: `.:.�r��'C.7�iit&GSn St1.�8tk*lli•r�•�ii:•);i 4
Dearlpdos 9u. Fee T000 •
' New residential single- or mold -family dwelling unh.
includes attached garage.
Subdivision: Lot no.: I.000 aq• R. or less 145.15 4
Tax map/parcel no.: Ea. add'1500 sq. ft. or portion 33.40 1
'� f lt 1• (1 , t ,. t vw.,wra.wrnew. »f •( a , * a^'. +^ 4 1.1` 7 r, - ' r, t r4
p Limited . residential
r,l ;1) :.. J: 1�{� ! I•!,.•: , ., y ! e7 r e; : �! 1,1111
- ..,w,n1,.� ' 1 �. �Si�.tdi ,.�•�I�i .r•�'.ti! ' ¢c �' ' .} 7.. J . ; k.. � w ..1 +�'d r:'I (with above alt, ft.) 75.00 2
1 1 Limited energy, muiti•fanuiy
L �n 0 f' \ I � \4O AX N. residential (with above sq. R) 75.00 2
Services or feeders insWlation alteration, and/or relocation
' Wfwq f i"1 r �� .P to ''- v:, sin t,,rlr,t� r t on -. (^ ., 200 amps or less 1 80.30 �, 3 2
�i Y y!7 ,j" -7^ M1:;,i. A �' K"1 Af 17, l r�'�yh(1 ���r.^�� '1
s ., 1»�rhr,y7fe -I. A,Gu.n.r1� I,L t 2 01 amps W 400 amps 106,85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: - Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 1 Fax: ( ) 200 amps or lees 66.85 1
Owner installation: This installation is being made on property that 1 own which is not 20! amps to 400 amps 100.30 Z
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 ./ 1
Owner signature:
Branch circuits - new, alteration, or extension, per panel
gnature. « racer. v, won ' Rate A. Fee for branch cileuits with
,'I ' {�{j ri el-.9 ;31:0 a !i l 7t 7r *. t < a
,ice& as S, �.. 4M5-4 1Wtw«i4 1 b V 4l ..re V•,4! �!.la . % a ei:4 t. i .+�. :a l r :i::..,,.:.!,;',1.;,,;!', �r,. ,',j ,1! shove service or feeder fee 6.65 a 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46 85 2
first branch circuit
Address: Each add'I branch circtdt 6.65 2
Miscellaneous (service or feeder not included)
City /State/Z1P: Each manufactured or modular - 2
90.90 dwelling, service and/or feeder
Phone: ( ) I Fax:: ( ) Reconnect only 66.85 2
E -mail:
Pump or irrigation circle 53.40 2
4r l .' l i r 3rr, r , >»�rc,r t t <.., -.- . :r7 ✓ t
r - x -'' .fir a1"� _ ,; ' ��a;'3' ' l ,i •' _ , r ^` w �+; ! t t a •, c b or outline ., . 4„rr�.�.. :F. � . f'.;i <'� 1, :... if .!�,: Sign lighting 53.40 2
Business name: , r / �. Signal cirrcuit(a) or limited.
.1 a • 11 I!..-di - . e
♦ 1 Q r� . energy panel, alteration or
Address; '� A)r 3RD Aye- _60;4e- 8.2041 Oxtension. Describe: Page 2 2
City/State/ZIP: Y D Q G7�I1� ? Each additional inspection over allowable in a !‘ of the above
/ / / `� •7 - Per inspection 62.50
Phone:
«) fro 3 5S•58 ` Fax; (.3 ) C61 5q( investigation per hour (, hr min) 62.50
CCB Lie.: , i Electrical Lk.: 3 - 2C Suprv. Lic.. 9.410 < industrial plant per hour
e ctan signature, required: 1 U , 1 1 f7 F, -gfi ;; 2 4 a'�a *7-75: . r. - ^r i s ro l
S required: ~ : <..,J_: ;.�;..,. 73.75
_ ...- . ..._ :.f ' �' wzt,u a� ,6'.I
#(07 Subtotal: 133 .S
Print name: �, G, In Date:
' Platt review (25% of permit fee): --
State surcharge (12% of permit fee): j 1 e .
Authorized signature: r TOTAL PERMIT FEE:
11��'ca, S
Print name: Date: This permit appnesess expires If a permit is not obtalncd is 180
days after It her been accepted es compiete_
- • Number of inspections allowed per permit
r:T BuildingTermiuTBLC.RrmitApp.doc 0523106 440- 6t57uIPo5/COWNEB