Permit .`'q CITY OF TIGAR® ELECTRICAL PERMIT
'. . 116 COMMUNITY DEVELOPMENT Permit #: ELC2009 -00643
,T I G AR'D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/03/2009
Parcel: 2S111 DD00201
Jurisdiction: Tigard
Site address: 15995 SW HALL BLVD
Subdivision: Lot: 0
Project: Plaid Pantry
Project Description: Add /alter (1) branch circuit to extend ceiling fixture.
Owner: FEES
ROSEHILL INVESTMENTS LLC Quantity Description Date Amount
2001 SIXTH AVE STE 2300
SEATTLE, WA 98121 1 crt Branch Circuits 12/03/2009 $56.18
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 12/03/2009 $6.74
Electrical
Contractor:
BECK ELECTRIC INC
15600 SE FOR MOR CT #B
CLACKAMAS, OR 97015
PHONE: 503 - 656 -7396
FAX: 503- 656 -4397
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $62.92
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 -0100. You may o copy of
Q f the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: A (i� L ` \XAAX Perm ittee Signature: Nx
OWNER INSTALLATION ONLY PPP"'
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 503.839.4175 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.
Dec 03 09 10:16a RECEIVED P. z
•
£ictrical Permit Application FOR OFFICE USE ONLY
City of Tigard 3 2fir Receiv
"' DEC 0 JA Permit No : F I ((��n/+�) /'Str 6
'l
D a i v : �G.J eat a.J�J'L VhJ
13125 SW Hall Blvd.. Tigard, OR 97223 ['Ian Review
503.639.4171 Fax: 503.548.196�I' OF TIG(�RD Date /By: Other Permit
TIGARD Inspection Line: 503.639.4175 a ;c Ready /fa s. 0 Sect age 2 for
Internet: www.tigard- or.gov BUILDING DIVISI /Method: Supplemental Informatio
TYPE OF WORK • • PLAN REVIEW
Please check all that apply (submit 2 sets of plm,s ;titems checked below)
❑ New construction -Addition /alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current
❑ Mat inas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings
�- Tess to around, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling 'h+ Commercial /industrial ❑ Accessory building amps for all otlict installation:, buildings
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fit e pump ❑ Installation of 75 KVA or
JOB SCfE INFORMATION AND LOCATION ❑ ttnergency system larger separately derived system
❑ Addition of new motor load of ❑ "A ", '0', '1 -2 ", "I -3 ",
Job Ito.: 15D1 Job site address: C J c' C 4 � 1 tLl ' 1 2 i �'� 100HP or more occupancy.
___ i J � ❑ Six or more residential units. ❑Recreational vehicle parks.
1 C Cx✓t - � L i1,- C 1 zZ-
Cii Y /State /ZIP: x 3 ❑ Health -cane facilities. ❑ Supply voltage for more than
_ � i
❑ Hazalocations. dous locations. 600 Its nominal
Suite /bldg. /apt. no.: Project name: 1 %(ti.A I CA ea,14,4 ❑ Service or feeder MIS amps or more.
FEE SCHEDULE
Cross street/directions to job site: J • Descriptiun P 1 Om. 1 Fee. 1 Total '
New residential single- or multi- fancily dwelling unit.
Includes attached garage.
Subdivision: -- — — Lot no.: —
1,000 sq. ft. or less 168.54 l 4
Ea. add'I 500 sq. I. or portion 33.92 I
- Tax map /parcel no.: Limited energy, residential
67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
•
•
��- Limited energy, multi - fancily
U� },� ,- i')�`� ( -y , ; t --- 'r . ! .,, ✓ e '• residential (with above sq ft) 67.84 2
J 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
Name:
401 amps to 600 amps 200.34 2
601 amps to 1.000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
l City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less . 59.36 I i
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125 08 j 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 maps to 599 amps I 168.54 I I 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: I A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee.
7.42 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name; without service or feeder fee, 56. I S 7 2
first branch circuit
Address: F-ach add'l branch circuit I 7.42 2
Miscellaneous (service or feeder not included) i
City /State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 67'8 84 2
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 I 2
E -mail: Pump or irrigation circle 67.84 l 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: K. 1 Signal circuit(s) or limited-
C�- K L j t ,+y- t t energy panel, alteration, or
Address 1 5 pc) 51,= ,K 6r11C3 f c ,- 5 - �.- _ - extension. Describe: Page 2. 2
City /State /ZIP: c-letcAc G1 3 /4c. G k 9-7C:13— Each additional in over allowable in any of the above
Per inspection 66.25
Phone: ( 5-755 tc.s =' -. / I ` , Fax: ( ) j
1 y Investigation per hour (I lir min) 66.25
CCB Lic.: j Electrical Li,c.: 3--5c.,. Suprv. Lic.: 3C2_' z Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Silprv. Electrician signature, re uired:/
Print name: GI (1. l� c '2� ✓✓ Date: 1 i ' �r j0 Plan review (25 % of permit fee):
�'l' ✓� ttli'11 s ( t 7 State surcharge (12 %of Permit fee):
Authorized signature: / � ' ' ts `�� TOTAL PERMIT FEE: I � ) t
- -._�1 A,�( .r!/ t. >r ,, . r ._
Date: L
This permit application expires if a permit i> not obtained silhin 180
Print name: /' l �C f I Jt� � i I'1 t S 'L' 1 day's after it has been accepted as complete.
vl ar./ • Number of inspections allowed per permit
I tRaildmgTermits \F.l C- PermilApp dnc 10/01;09 440-0,1 5T( i l /05/C1) si /W'Efi