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Permit CITY OF TIGARD ELECTRICAL PERMIT 71 COMMUNITY DEVELOPMENT Permit #: ELC2010 00002 :TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/05/2010 Parcel: 2S101 BC00201 Jurisdiction: Tigard Site address: 8255 SW HUNZIKER RD 203 Subdivision: Lot: 0 Project: Raven Construction Project Description: (2) branch circuits for TI Owner: FEES JOHANSON TRANSPORTATION SERVICE Quantity Description Date Amount 5583 E OLIVE AVE FRESNO, CA 93727 2 crt Branch Circuits 01/05/2010 $63.60 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 01/05/2010 $7.63 Electrical Contractor: RELIANT ELECTRIC OF OREGON LLC 20200 SE OLDENBURG LN SANDY, OR 97055 PHONE: 503 - 701 -4562 FAX: 503 - 668 -4190 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $71.23 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 obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. 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 503.839.4175 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. „ ; Electrical Permit Application , . A , , r t�lz Ic wi� ° _ „ ` Received ” City of Tigard E��i DateBy: / S yO —': .77 PermitNo.:£ Cc20IO OL2� ° 13125 SW Hall Blvd., Tigard, OR 9722 ® ® ®® Plan Review C Ph one: 503.639.4171 Fax: 503.598.1960 Date/BY: Other Permit2�OO/3ieOc2y Inspection Line: 503.639.4175 JAN — 5 2010 � Date Ready /By: Juris: ® See Page 2 for !` 1,1 : i \ K f) Notified/Method: Supplemental Information Internet: www.tigard- or.gov CITY OF TICARC� PP TYPE OF W PLAN REVIEW Li LDIN DI IS�* Please check all that apply (submit 2 sets of plans w /items checked below): ❑ New cons truction.@ddition /alteration /replacement ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling .Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor Toad of ❑ "A ", "E ", "I - 2 ", "I - 3 ", 100HP or more. occupancy. Job no.: Job site address: is d -03 } A (J t,, A y F -t'A ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: —1-16\ a ra__ Z ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Zap Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description 1 Qty. 1 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 Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1 Limited energy, residential 67.84 2 DESCRIPTION OF WORK (with above sq. ft.) L'-' () Q Limited energy, dential (with th above b o a sq . i 67.84 2 G y �/� �y�,B- t�..,� �t-- r � residential bove sq. e.) 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 City/State/ZIP: Temporary services or feeders installation, alteration, and /or 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, per panel Owner signature: Date: A. Fee for branch circuits with APPLICANT ❑ CONTACT PERSON : above service or feeder fee, 7.42 2 • ^ t La �� ., Q �n Fee h branch n circuit Business name: 1�f� �S, LC� t B. Fee for branch circuits Contact name: i �I `t"—f-"/X. 4 OA without it bra service or feeder fee, ` 56.18 2 L first branch circuit ` Address: Each add'I branch circuit 11 7.42 2 Miscellaneous (service or feeder not included) City /State /ZIP: Each manufactured or modular dwelling, service and/or feeder 67.84 2 Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 E -mail: Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name: (a �• Q . ve , L�� Signal panel, or limited - �� \ energy panel, alteration, or Address: -0 � 0 C F ,--t extension. Describe: Page 2 2 Cit /State /ZIP: ea`� ". �L ©�j -� J Each additional inspection over allowable in any of the above 0 1 �f 5 t. .-z__ Fax:( f 5 ( 16 g /Nit I i Per inspection 66.25 Phone: Investigation per hour (1 hr min) 66.25 CCB Lic.: I UUU Electrical Lic.� -Supry ic.:e-f (1 � s Industrial plant per hour 78.18 • d re ELECTRICAL PERMIT FEES - fr Suprv. Electrician slg ture �Q J� /� Subtotal: , 3 , 4 ' b Plan review (25% of permit fee): Print gp t..corlr j - Q State surcharge (12% of permit fee): 2 , (o___3 Authorized signature: TOTAL PERMIT FEE: 2/, Z3 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. I:\ Building \Permits\ELC- PermitApp.doc 0 /01/ 9 � � s - G 4, F. , V/ 90 440- 4615T(I1 /05 /COMJWEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined $67.84 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm n Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* n Vacuum Systems* n Other: COMMERCIAL WORK ONLY: . Fee for each commercial $67.84 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: n Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems n Data Telecommunication Installation n Fire Alarm Installation n HVAC n Instrumentation n Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical n Nurse Calls n Outdoor Landscape Lighting* n Protective Signaling n Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1' \ Building \Permits\ELC- PermitApp.doc 10/01/09