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Permit Electrical Perm, p.i"-~ ati n � t - - s) i� 2 0 -, 57- 14:- 'l / ,a ..r«'° 4!' , ; '.FOR.oFFcE usE oNLY ` ° _ ;;0 • �. y 9 ` � ' 1 Received ~ � City of Ti and T Permit No - Date /B 1 -• Aw . � /i c `,4 111 a 1 3125 SW Hall Blvd., Tigard, OR 972.1 ®�® Plan R eview 1. II Phone: 503.639.4171 Fax: 503.598. l' i Date /By: Other Permit: T F I G /V D Inspection Line: 503.639 t;�) 1 gate Ready /By: luris' Si See Page 2 for K N. P % 't,: Internet: www.tigard- or.gov It ;`,.tified/Method: 69 Supplemental Information OV x) `' - TYPE. OF"WORK;j .. PLAN REVIEW • SeNew construction ❑ Addition /alterationG tent Please check all that apply (submit 2 sets of plans w /items checked below): t ❑ 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 load of ❑ "A ", "E ", "I -2 ", "I -3 ", / �3 Job site address: 11 ?0 S � IDOHP or more. occupancy. Job no.: to 8 � (�wtti Ave Recreational p (J ❑ Six o r more residential units. ❑ ecr vehicle parks. City /State /Z[P: 1",‘4,,,n ❑ Health -care facilities. ❑ Supply voltage for more than , / �� ❑ Hazardous locations. 600 volts nominal. Suite/bldg./apt. no.: Project name: M P 3 tfC 5iar Y ❑ Service or feeder 600 amps or more. f t �l FEE SCHEDULE. . Cross street/directions to job site: µv Y ci '— 3.,sf tr,esf o p a 7 Description 1 Qty. I Fee. 1 Total I • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Ea. add'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: ' Limited energy, residential - : ' DESCRII'TION OF WORK (with above sq. ft.) 75.00 2 Limited energy, multi - family 75.00 2 /kCcc.S eerfkal CC J ✓) �� r-y ( residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER . ❑ ' TENANT : 201 amps to 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: ( ) Fax: ( ) 200 amps or less 66.85 I Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 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, 6.65 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'l branch circuit 6.65 2 Miscellaneous (service or feeder not included) City /State /ZIP: Each manufactured or modular 90.90 2 dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 CONTRACTOR • • ` Sign or outline lighting 53.40 2 Business name: Signal circuit(s) or limited- cn't2..n i l e, ,9A'h . FS energy panel, alteration, or •'" t? , extension. Describe: Page 2 995` 2 Address: 1 cid) E. F ni, 5 sup D City /State /ZIP: fan lo J ✓e2 LA/ rf' X66 Each additional inspection over allowable in any of the above t Per inspection 62.50 Phone: (Svc ) Z b)k _ 2 s-fj Fax: ( .r60 ) c l ." ° 41 fig I nvestigation per hour (1 hr min) 62.50 Suprv. Lic.: CCB Lic.: /7 )6 Electrical Lic.: CLE 1 k(d p j.iaS L£$ Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, require iZ% Subtotal: .„„1_ -5' 9 P Date: Plan review (25% of permit fee): Print name: Ca g y M dd2£ �- « '`J� State surcharge(12 %ofpermitfee): o 217 . . v Authorized signature: TOTAL PERMIT FEE: �C 5-0, w 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. 1:\Building\Permits\ELC- PermitApp.doc 05/23/06 440- 46t5T(11/05 /COM/WEB Electrical Permit Application - FOR OFFICE USE ONLY r tf4 • • City of Tigard . �� Date/B d / / 0, eJ(� ' Gj � Permit No.: t—/ _ 13125 SW Hall Blvd., Tigard, OR 972 aa Plan Review l• C ' Phone: 503.639.4171 Fax: 503.598.1' . 1 ® v� Date/By: Other Permit: TI G A R D Inspection Line: 503.639.4175 r7 t1 ate Ready/By: Ions: HI See Page 2 for Internet: www.tigard- or.gov �• �'' q i tified/Method: �iC, Supplemental Information O �. �� TYPE OF WOR K PLAN REVIEW ArNew construction ID Addition/alteration /04eent P leaze check all that apply (submit 2 sets of plans w /items checked below): D'' ❑ 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 ,CommerciaUindustrial ❑ 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. A ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", ' /� I OOHP or more. occupancy. Job no.: /- �{ 3 Job site address: 70 S sly i�u.21,t2 / 7 V e. ❑ Six or more residential units. ❑ Recreational vehicle parks. City / State/ZIP: r• ❑ Health -care facilities. ❑ Supply voltage for more than t yt4/r � ( Z 0 Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name. M < !`kr l e ScfF Sieryi C ❑ Service or feeder 600 F a or more. mps SCHEDULE Cross street/directions to job site: µif Y y j west op a l7 Description I Qty. I Pee. I Total I • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Ea. add'I 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) /� Limited energy, multi - family 75.00 2 /9CCc5S l o -ko CCTV ) d y l r4� residen (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 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: ( ) Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 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 circuit _ 6.65 2 Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular 90.90 2 dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Business name: Signal circuit(s) or limited - A f a , i t ' LI JA ' h +ta -J energy panel, alteration, or ''� extension. Describe: "- Page 2 `-v- 2 Address: i Y ,),1 F. ADA .5-4. Stri'f e - D City/State/ZIP: v (a J viz ( A 5 0`66 I Each additional inspection over allowable in any of the above t Per inspection 62.50 Phone: (so. ) Z gx _ 2 S-,jj Fax: ( ?6o ) c2-Ye — T ill'? Investigation per hour (I hr min) 62.50 CCB Lie.: `7 4) 6S Electrical Lie.: CLE j Lib Suprv. Lic.: a).2 LEE. Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required;_� Subtotal: 0 /..„.1.57 , ... xc1.9.�� o.� Print name: Date: Plan review (25% of permit fee): w Ca.2.( Md u2 f — 16 ` J� State surcharge (12% of permit fee): 7... Authorized signature: TOTAL PERMIT FEE: r,,C tea. w 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 \Pcrmits\ELC- PermitApp.doc 05/23/06 440.4615T(ll/05 /COM/WEB (ir` 4 Community Devel - ment ty R . — )n ':T'[GARD', —" TO: CITY OF TIGARD � ,_ A , / 4` - r Building Division Ser, 13125 SW Hall Blvd., Tiga Phone: 503.718.2430 F. www.tigard- or.gov FROM: [11 Owner El Applicant ❑ Contractor City Staff (check one) REFUND OR Name: 1 � ' INVOICE TO: (Business or Individual) L/1!_L Ge l-S Mailing Address: (/ c i Q V1 Cit /Zip: qNe� vC (i. 7, / � 1 /0/D� B .. e i� Phone No.: 6 - v3) °�0 3 — X33 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): CANCEL PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach receipt, if available). ❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). �; /� � Permit #: PW S CO )- 7 7 -- i ds/ _ .m. et /lam C'4 Site Address or Parcel #: / / 7c) a- 5,u. �cI r/Ve r- A Project Name: /r, 9 /Y)fN S7 ' Subdivision Name: .q 7-1.c-f--3 4 a, Lot #: — EXPLANATION: ' -,' j , C • - - - tN Cvvvy; / /C,0E - --( - Y Curt S /39.-c_e_e( 5 r) rte / re ct' /grrn ,oJ s (A7 r ✓ e 3 -6/►'0 d. �= IL.. • L • ,♦�� i MI L Q C/lii - t f YM � � was • - /e v,'G✓s/ ad a/ 75 c vvA, 5- r�'Y1 St-. M - - tit/ , -* /-/°5 76 r ret/i e it / _ - D ate: 7 /' 5 /c) Sr ,�a ridiutc. t te _ r' Print Name: QraVd rA 'Gk. gGlei r - f – Refund Policy t � 1. The Director or Building Official may authorize the refund of: a) any fee which was erroneously paid or collected. b) not more than 800/0 of the land use application fee when an application is withdrawn or canceled before any review effort has been expended. c) not more than 80% of the land use application fee for issued permits. d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended. c) not more than 80% of the building permit fee for issued permits prior to any inspection requests. 2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds. v t v ° I s : , FOR OFFICE USE ONLI r - WW,,A Rte to S , s Admin: Date o A B 1i Rte to B1d_ Admin: Date /170V B (ail Refund Processed: Date A ,9- B , Invoice Processed: Date By Permit Canceled: Date /0 2 ©.& B_./ Parcel Tat Added: Date B r Recei e t # Date Method Amount $ 1: \ Building \Forms \RegPermitAction.doc Rev (17/26/07 Electrical Permit Application - City of Tigard '' Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: `RESIDENTIAL ' ONLY:' • Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* n Heating, Ventilation and Air Conditioning System* • ❑ Vacuum Systems* ❑ Other: COMMERCIAL: WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation n HVAC T I Instrumentation • Intercom and Paging Systems ❑ Landscape Irrigation Control* n Medical ❑ Nurse Calls n Outdoor Landscape Lighting* ❑ Protective Signaling IQ Other CUV 3 }r AcCr Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\ Building \Permits\ELC- PermitApp.doc 03/23/06