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Permit ELECTRICAL PERMIT CITY OF TIGARD ,..� PERMIT #: ELC2005 -00279 DEVELOPMENT SERVICES DATE ISSUED: 4/25/2005 .111 °--" 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171 PARCEL: 25101 BB -00301 SITE ADDRESS: 11834 SW PACIFIC HWY ZONING: C -G SUBDIVISION: TIGARD ROAD GARDENS LOT : 001 JURISDICTION: TIG Project Description: 11 branch circuits. • RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL: MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 10 IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amplvolt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: TEXACO REFINING + MARKETING, INC NORTHWEST PUMP + EQUIPMENT BY EQUIVA SERVICES LLC 2800 NW 31ST PO BOX 4369 . PORTLAND, OR 97210 HOUSTON, TX 77210 Phone: Phone: 503 - 519 - 6056 FEES Reg #: ELE 26 -852C LIP 64567 Description Date Amount SUP 4884S [ELPRMT] ELC Permit 4/25/2005 $113.35 [TAX] 8% State Surcharge 4/25/2005 $9.07 REQUIRED ITEMS AND REPORTS Total $122.42 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these rules or direct questions to OUNC at 503-246-6699 or 1 -89 - 332 -2344. Issued By: C �. ��y�y Permittee Signature: Gr) �.�, Or r� r /1 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'N: 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. • Elettrical Permit Ap I t ' , i_ ► EIVED FOR OFFICE USE ONLY • Received Cht of Tigard Permit No.: c-. CZ; 7 �Z y g 13125 SW APR 2 2 2005 Plan /95/0", 46 SW I tall 131vt1., Tigard. OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 � 1 Date /13y: Other Permit Inspection Line: 503.639.41 75 CITY OF TIGAR 9 �� �, D ate Rea /13y: tune 4 0 See Page 2 for I n ternet: www.ci.tigard.or.us Notified /Method: Supplemental Information Min ntnn nwisloti TYPE OF WORK PLAN REVIEW ❑ New construction .[N Addition /alteration /replacement Please check all that apply: El Demolition ❑Other: ❑Service over 225 amps, comm'I ❑Hazardous location ❑Service over 320 amps — rating ['Bulking over 10,000 sq. ft., CATEGORY OF CONSTRUCTION oil- and 2- family dwellings 4 or more new residential 111 1- and 2 family dwelling Commercial /industrial El Accessory building ['System over 600 volts nominal units in one structure ❑ Building over three stories ['Feeders, 400 amps or more ❑ Multi - family ❑ Master builder El Other: Occupant load over 99 persons EManufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park Job no.: l I•- - (1 Job site address: I I� t.{ . 1 • ID Health-care facility any ['Other: w 4Gt tC, rt t N y Submit 2 sets of laps with an of the above. City /State /ZIP: ..----• ` �'� D P 1 The above are not applicable to temporary construction service. Suite /bldg. /apt. no.: Project name: `/� FEE* SCHEDULE ',-/ e, I Description Qty. Fee. Total Cross street /directions to job site: New residential single- or multi - family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I Limited energy, residential 75.00 2 Tax map /parcel no.: Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular `— /1 dwelling, service and /or feeder 90.90 2 VO44, I� \ t Qvr 3 l �� l_� (/J l L QG� d Services or feeders installation, alteration, and /or relocation v 200 amps or less 80.30 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Namc: 601 amps to 1,000 amps 240.60 " 2 Address: Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 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 600 amps 133.75 2 Owner signature: Date: Branch circuits — new, alteration, or extension, per panel ❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, each branch circuit 1 46.85 q (Ct 1522 2 Address: Each add'I branch circuit 6,65 40)510 2 City /State /ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) Fax::( ) Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or liniited- CONTRACTOR energy panel, alteration, or k ^ c� t ��� ' �� extension. Describe: Paget 2 Business name: A 2 , /AA u je o " 1 ."� 3i Each additional inspection over allowable in any of the above 5 � Address: �© w �� Per inspection 62.50 City /State /ZIP: ofk q,l OR 9"1 1 O Investigation per hour (1 hr min) 62.50 Phone: (62Z) 61q to � / j r �.,f " ��� \ I Fax: (S 7 • iLf t I ndustrial plant per hour 73.75 v ats/ ELECTRICAL PERMIT FE S* CC13 Lic.: Cry fit A Electrical Lic.: -g . A . B rv. Lic.: `f u 31-6 Subtot A J l 136 Suprv. Electrician signature, required) _'��j t` '� Plan review (25 %, of permit fee) s t I�' State surcharge ae (8`%, o permit fee) L f ci £31 Print nam' : tt-11 I-e,4k Date: y _ 1 9 _ 0 t l J G'.0 J TOTAL PERMIT FEE I Z eya Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: * Fee methodology set by Tri- County I3uilding Industry Service Board ** Number of inspections per permit allowed. 1 Building \ Per mitsVELC- PermitApp due 12/03 440 -45I 5T(10 /02/COM /AVEB