Permit (112) , , CITY OF TIGARD ELECTRICAL PERMIT
11111 1 COMMUNITY DEVELOPMENT Permit #: ELC2011 00611
Date Issued: 11/02/2011
T I_QARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 1 S135BD00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST 330
Project: Parsons Subdivision: ASHBROOK FARM Lot: PTS 5 &
Project Description: TI
Contractor: WILLAMETTE ELECTRIC INC Owner: SUN LIFE ASSURANCE CO OF CANADA
PO BOX 230547 BY NORRIS BEGGS & SIMPSON
TIGARD, OR 97281 121 SW MORRISON ST #200
PORTLAND, OR 97204
PHONE: 503 - 624 -3631 PHONE:
FAX: 503 - 624 -2938
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 11/02/2011 $71 02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/02/2011 $8.52
Type of Use: Electrical
Class of Work:
Type of Const:
Occupancy Grp:
Total $79 54
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 • 2- 001 -0090 You may obtain a copy of the : -- oc.•irect questions to OUNC by calling 503 232 1987 or 1 800 332 2344 i
Issued 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' 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.
11/01/2011 TUE 15:05 FAX 5036242938 Willamette Electric V1002/002
.-
Electrical Permit Application F OFFICE USE ONLY
Received
City of Tigard Date/By: , ��rI Permit No.. E! f
" 13125 SW Hall Blvd., Tigard, OR 972
a Q �� '
' Phone: 503.639.4171 Fax: 503.598.1 t0 `1 N. �' P lan Review
Date/By.
® Other Permit. I pf10+1 �
TIGARD'. Inspection Line: 503.639 4175 QV , \Bate Rcady/By lulls' B( See Page 2 for
Internet www.tigard- or.gov -- 0C ,Trio ledlMcthod: �(,' Supplemental information
,�q ...x..- r ...Lav
TYPE OF WORK f ., \ ° 'v s ,,,,` c .q. -4 "' PLAN REVIEW
`j ati`ati P lease check all that apply (submit 2 sets of plans w /items checked below): -
❑ New construction ® Addition /alteration /re ` )
�y : 0 Service or feeder 400 amps or more 0 Building over three stories
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards
'CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 floating buildings
• . • • -. - less to ground, or exceeds 14,000 0 Commercial -use agicutturat
❑ I- and 2- family dwelling 0 Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: 0 Firc pump. 0 Installation of 75 KVA or
JOB SITE I1Vi ORMATIOr AND LOCATION ❑ Emergency system larger separately derived system.
0 Addition of new motor load of 0 "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: /i o j Job site address: 2J, C C) C'J /-(-- Six or or more, occupancy.
(g / (Fj . I 0 Six or more residential units 0 Recreational vehicle parks
Cii /State /ZIP: // 0 Health -care facilities. 0 Supply voltage for more than
y / U"G v�C �� ❑ Hazardous locations. 600 volts nominal
(uit /ap n o.: 3 -. (J Proje na me: 0 Service or feeder 600 amps or more.
�z1� -Scr S FEE SCHEDULE
Cross street /directions to job site: Description i Qt,. I_ Fee. 1 Total 1 »
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168,54 4
Ea. add'I 500 sq ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75 00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family
✓ residential (with above sq fl.) 75.00 2
e\. /--, ' ' J � �- e`--7/ Services or feeders installation, alteration, and /or relocation
200 amps or less 100 70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552 26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: 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
Branch circuits — new, alteration, or extension, I er panel
Owner signature: Date: A Fee for branch circuits with
❑ APPLICANT ❑ 'CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: B. Fee for branch circuits witho
service or feeder fee, first / 56 18 > t � /� 2
Contact name: branch circuit
Each add'l branch circuit ,2"' 7.42 / /_- 2
Address: Miscellaneous (service or feeder not included) _
City/State/ZIP: /State /ZIP: Each manufactured or modular 67 84 2
ty dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67 84 2
Pump or irrigation circle 67,84 2
E-mail:
Sign or outline lighting 67.84 2
CONTRACTOR . Signal circuit(s) or limited - energy
Business name: Willamette Electric Inc. panel, alteration, or extension. Page 2 2 ,
. Each additional inspection over allowable in any of the above
Address: P.O. Box 230547 Additional inspection (1 hr min) 66.25/hr
City/State /ZIP: Tigard, OR 97281 Investigation (1 hr min) 66 25/ hr
Industrial plant (1 hr min) 78.18/hr
Phone: (503) 624 - 3631 Fax: (503) 624 - 2938 Inspections for which no fee is 90 00/ hr
specifically listed S!/, hr min)
CCB Lie.: 75059 Electrical Lie.: 34 -283C Suprv. Lie.: 4226 -S ELECTRICAL PERMIT.FEES
C Subtotal: `7/ c:n'z --
Suprv. Electrician signature, requ' Plan review (25% of permit fee):
Print name: David Fife Date: State surcharge (12% of permit fee): r ,
TOTAL PERMIT FEE: 79 , S
Authorized signature:
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
t,\ Buitdmg \PermitstELC- PcrmitAppdoe 07 /01 /10 440- 4615T0t /05ICOM/WEIO