Permit '1' i rt CITY OF TIGARD
ELECTRICAL PERMIT
; c , ' COMMUNITY DEVELOPMENT Permit #: ELC2009-00640
F Date Issued: 12/02/2009
iT t GAKp' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S114AA00200
Jurisdiction: Tigard
Site address: 16285 SW 85TH AVE 301
Subdivision: DURHAM HALL BUSINESS PARK Lot: 0
Project: Quality Counts
Project Description: Reconnect.
Owner: FEES
SHIPMAN, W H LIMITED Quantity Description Date Amount
BY NORRIS & STEVENS INC, 621 SW
MORRISON STE #800 1 ea Reconnect Only 12/02/2009 $67.84
1 ea 12% State Surcharge - 12/02/2009 $8.14
PHONE: Electrical
Contractor:
DYNALECTRIC
5711 SW HOOD AVE
PORTLAND, OR 97239
PHONE: 503 - 226 -6771
FAX: 503 - 226 -7720
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $75.98
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 t gh 0 • 952-*: • 010*. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
/ `
Issued By. . • / O .La J— I _ , Permittee Signature: tee U'-
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' w- 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.
Electrical Permit ApplicatioRECEIVED roa Orrlc'E uSt :.O•il,v.
Received
CI of Tigard 0EC 0-1.200 44 Permit No CCU
■ City g Date/6y; � t1 .
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598. '-' 11 Date/By! — Other Permit:
Inspco Lino: 503 " OF TIGARD Dere Ready /By: 1 ris: 67 See Page 2 for
Internet: www.ti and -Ar. OV
F' '. BUILDING DIVISION Notified/Method: 1
Su 1
plemrntat Information
•
I:L•L :::::.:...:. ... ',41 I" t 1 h, :::l:t,..•I - : "t' ', ; r,l , �t '' it:�i, I,1•.:: i , t14 ft ,`,t ,:,.t•: s,l',•, r t, <,I :,1. • r i,;' ", ., • r).:
f, t!�I I t S y ,l,t,. 1, r� ? I1f''l1Ai ; la
r`I i ` 1ii'lip i i S f. (,1 , i hl1,: ° lit , l , i ,1iY':, ": = i 14iii i ( ','r ( ' ; ,' ' i i ; i ,ri . r 1,` 1'" : r ,i' ill. ,
Ti 1114i�tr. •, 1 :,:•, l l 11r i ice � 1 �.. O lh is I , , :. 11,,. :, s; -t i ` ! i 'iiG; ,,,,
! 1 ,::; :: i U , Y' 4 �,1 :,,. I '' ' '� t „i , 1 , 11,1 , ,1d l l l! {1tP! 1 ! ! f b It.1 4 u, 1 r, 4 :,:
g r
9 � r !(11II { � � �� � � � �� � • ...... i i '`� Please check all that apptY (Submit 2 set.; of plan ` � ; � ,.l�i � ..w.,,..
... ik .�_� •,,,. „vuv:iuJ��. I r!.:li ��:�� :i , ::::: , : � k i.f .l ' 1P . 4.J.;.
❑ New construction la Addition /alteration /rcplacement wvitems checked below)
❑ service or feeder 400 amps or more ❑ i3 111 dine over three stones.
❑ Demolition ❑ Other. where the available fault current ❑ Ma inas and boatyards,
iltl;tPtdY .Nt'tlfi;iii .4fli + . .......... gilt ... + .' i {iaj ,, i ,,.
d ,j,� "l` '" 1 p o ❑ Flo .tin buildings.
!( t 1 1 �,, { ,i �i ;k 1 t �� R .� G � t , r i , q h q ,t, : , 1 ., r 1 ! 111 i� . r,.:ulr ,13 ii,; exceeds I �e amps at 1$0 volts or � g
( I ...,., .' I,, t v1 . ...., ∎: dal: t:; m t a�t ll '4,11}$ii11lC Ai,111.>_:;'P1 ,11iElll„,1,,,,,, hi
L 1 w less t0 around, or exceeds 14,000 ❑ Co inertial -use agricultural
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building amps lot all other installations. but dings.
❑ Multi- family ❑ Master builder ❑ Other: Fire pump
c v v r nn 4 ! - i 7r:, ,,, i , • •, - ..,.. r:r,l y i , i;l'? I .�1 ";, " t i „,, ❑ Emergency system. lari sr separately derived system.
❑ Ins Illation of 75 KVA or
rill i;11i .,,, : , I ` , R .i ' 0 ri �. I { . :i l : ; 1
ail `i� i c , (:'i .. t., ltd la it l i'tk':�. -;ia Ir fe:;: t , 1.: t.,,.r.;1;,; }} ,:,
�� y � 1y � /�y[9 {� � �� . i1, j i ;;liiiy::�i;,�l (,� I!J uiiiirii:*r.
, ❑Addition of new motor load of ❑ "A "L" ''1 - 2" "I - ",
`/6Q Sv c -� 85544,424/4-. 100HP or mire. ucc Ipancy.
' ' Job site addres
❑ Six or more residential units. ❑ Rer reationat vehicle parks.
City /State /GIP ` ❑ Health-care facilities. ❑ sub ply voltage far more than
Suite /blda, /apt. no.! ,3rj / Project name: Service or I ee f der l 100 amps or MK. . al ;: i6, . i
0 ardour locations. 601 volts n0 n,nal
r [ p Ser
y-- _ ,•,# ifiljiill 1i1 -!! itttil 1 . lst a ,� ' i' r ,;.
: .
Cross street/directions to job S ite: 4l i au[ I,,c . 1t, . .� ,r, i! �� t G �S
i'cc, Tolal , h
.. ` ,. tfr pt?(rptl9n - MN t'cc. I ,'� � l
NM residential single- or multi - family t welling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or iris 168.54 4
-- Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: . residential
:,,1 �, t - .,:::.•:::i' +: I .,..... •„ ., ,la• ; �s rte >I !lirEll =� mite energy, 67.84 2
Limited v, reside
a It,t { t,.:,: t!a lfllc' I {;i;. , t IIIIII I i i i r iliiiil. -.. • t r l l,i,', with above R.
ljl Eb�f '! �( 't! : ., I ':;, 1!!! r15 ( w ) __
at t ,. t•, d uk e , epJ
Limited energy, multi- family
67 .84 2
_i z°mnilP -1-4 / / ..,:E_I residential (with above sq. ft.)
Services or feeders installation, alteratit 0, and /or relocation
' ' ''/' AL ' At! `� y 200 amps or less 100.70 2
1 1 i!1 t 1, ;•7i11 i! Ii I 11„ 1 s ^rigl i1„ - -e r 171,, n�•It.i' , I 11ii:Uli ?i'i' - ^r,i
1 ,
t l l i 11 i `-)A& 1i �tA 3t ' t .1, , t . 1 1r1 it 1 :.I.: i 1 {� t1 i i, ik1 1 11 a11,11 -1 201 amps to 400 amps 133.56 2
Name: 401 atnps to 600 amps 200.34 2
..,.. 601 amps to 1 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installati ,n, alteration, and /or
City /State /ZIP: relocation _
Phone: ( ) Fax: ( ) 200 amps or less 59.36 l
Owner installation: This installation is being made on properly 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 exl :nsion, per panel
Owner Signature: - Date:
$ A. Fee. for branch circuits with
;,. t ub t ,1 i i ,I r p� L.Pti ' tr' ! r EI I�{ 1 i;
i �' i I I l' ` f1 E 1 '111 E ft 1 :'lll ' . 18111 1, t( +I ` `° x,1bi ' a „� . rr ? 1 1 ; '' above service or feeder fee; 7,.42 2
dd J ,
14ii,t ., I; -.. ,', 1 . .:. „ i. ,r. u .d , each branch circuit
Business name: 04,/6Viy _ B. Fee for branch circuits
Contact name: 5 S fir st branch service feeder fee
first branch circuiui t X6.18 2
Address: Each add'l branch circuit 7.42 2
. -. - Miscellaneous service or feeder not ins oiled)
Each manufactured
City /StatciZiP: � � or modular
67.84 2
dwelling, service and /or feeder _
Phone: ( ) Fax: : ( ) / 67.84 k7,9,4 2
Reconnect only
E - mail: Pump or irrigation circle 67.84 2
11 15�11 41 11'111'111'11 ' ! 1, 1 1�) I H ' r '`�9t'�4 1. 11111 R , 11;1!1111,11'.11 '1 . tballl l r t t
it:alil tt Y 11 � I i ' 1!� , .... [,•Ill ! i i I °: !stll,i i� !al o Sign or outline lighting 67.84 . ,
•r
tiaw:s
Business name. Al Signal circuit(s) or limited-
. A i _ / energy panel, alteration, or
Address: // [i./ 0 4 �f d _ extension, Describe: Page 2 2
City /State /ZiP: 'y I ,„ /' 9 7 .' each additional inspection over allowal le in any of the above
Per inspection 66.25 1
Phone: ( / .- A, , • / `7� Fax: ` ) . �� � investigation pe hour (I h r ( rvin) ^ 66 - 25
CCI3 Lic.: ).,C,� Electrical Lic.: 4.2 _ Suprv. Lic " : Industrial plant per hour _ 78.18
C-Y r• / 1 ' i l l !' I i °j'til`il j$ ya:a i ,,• II 1 I f
•I �, n r 11 I",��,� NUS 1; , ,., .
` , 1 , yyy M � �
f l jf .m t;rii!iiltti l ll! { {Ii13lj ":;' Wi' n Sut : o t 4f :;i: i:!ii.
Suprv. Electrician signature, required: / 7 $
� s Sut •ntal 7
Print name: egotf )4..., hill Plan review (25% of perms fee):
__=___
�� Rl • n . µ State surcharge (12%ofpermi fee): g j
Authorized Signatu • . 1'U'I AL PERMIT FEE:
4 �� Thi* permit application expires ira permit ■ . not obtained within 180
Print name: 74 days aster it has been accepted tr. complete.
r + �at. �.L .�:II� �fltC:
° Number of i nspection: allos+ per permit•
I:i Building \Peanits\E1.C- PermitApp.dce 10 /0I/D9 eco- 401M1 I/05 /CUM /WEu