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Permit - CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2010 00100 TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/03/2010 Parcel: 1S136DD05300 Jurisdiction: TIGARD Site address: 11850 SW 67TH AVE, STE# 100 Subdivision: TIGARD TRIANGLE COMMONS Lot: 13 Project: Broad River Project Description: Add /alter (8) branch circuits. Owner: FEES PNWP LLC #2 & Quantity Description Date Amount PNWP LLC, 6600 SW 105TH AVE #175 BEAVERTON, OR 97008 8 crt Branch Circuits 03/03/2010 $108.12 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 03/03/2010 $12.97 Electrical Contractor: ALTEC ELECTRIC LLC 6613 NE 166TH AVE VANCOUVER, WA 98682 PHONE: 503- 887 -3018 FAX: Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $121.09 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: q,o, V. `� i..Yl� 9 QnJ 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' - p Date: 1 LICENSE NO. Cali 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 Application 4 ', ,1 l * �i i i " 1N ,4 City of Tigard I! r' et a � �t II 13125 SW Hall Blvd., Tigard, OR 97223 �w t Permit No.: `` 2(�I O .00(00 g Plan Review i' :, . 0' Other Permit: P hone: 503.639.4171 Fax: 503.598.1960 MAR 0 120I(Eate/By: ':1' I (:i A R1) Inspection Line: 503.639.4175 ate Ready /By: C� See Page 2 for - Internet: www.tigard - or.gov r Notified/Method: Supplemental Information CITY .OF TIGARDD TYPE OF WORK n l; min in fl 1/ICI © ❑ New construction Addition /alteration/replacement r.l PLAN REVIEW -'' ` I " Please check all that apply (submit 2 sets of plans w /items checked below): ❑ 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 ❑ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family El 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 ", Job n0.: Job site address: / /850 1 U IOOHP or more. occupancy. U f 6 4 — ow-e 71/� ❑ Six or m ore residential units. p /, t ❑ Recreational vehicle arks. City /State /ZIP: 7 , G4.44) i oa, t t 7/2- (V Ce e COiA a �fl�S ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ` O0 .d e Jk r ❑ Service or feeder 600 amps or more. ►J FEE SCHEDULE Cross street/directions to job site: Description I Qty. I 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 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 67.84 2 Limited energy, multi - family 67.84 2 residential (with above sq. ft.) 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 y relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 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 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, first 1 56.18 1 2 Contact name: branch circuit Each add'I branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) Each City /State /ZIP: dwelling, servmanufactured ce and/or feeder 67.84 2 Phone: ( ) Fax:: ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E -mail: Sign or outline lighting 67.84 2 . CONTRACTOR Signal circuit(s) or limited- energy Business name: , /J az Gir (Oc L t e panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: 05 \3 N lF - ( 6 b `± Ot,UQ._ Additional inspection (1 hr min) 66.25/ hr City /State /ZIP: VA w P.oV J Ql-Q (A.1 A Q'I 6ff) Investigation (I hr min) 66.25/ hr ` Industrial plant (1 hr min) 78.18 / hr Phone: ( 3 2 r- ' Fax: ( 0) c L(L� L)J Inspections for which no fee is 6 - 3 3 �'-� f hih f i 90.00 / hr specifically listed C: hr min) CCB Lic.: (56 72_,o I Electrical Lic.: 3 7- to 3, -c Suprv. Lic.: j (3 - 5 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: _'T _ n tz Subtotal: �^" P lan review (25% of permit fee): Print name: ;ILA Rfl I3 1' 4-/- / o Date: State surcharge (12% of permit fee): TOTAL PERMIT FEE: Authorized signature: _. This permit application expires if a permit is not obtained ! (v`� within 180 days after it has been accepted as complete. Print name: Vi -(PTO r2 G-Q// G rte. Date: g _ / -. f p • Number of inspections allowed per permit. IA Building IO/ /09 440- 4615T(I I/05 /COM/WEB V ( 4.—t L r� It l: sh Lc) J • Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: I. 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* n Heating, Ventilation and Air Conditioning System* H 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 ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems n Landscape Irrigation Control* n Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ P rotective Signaling I O ther Total number of commercial systems: *No licenses are required. Licenses are required for all other installations • I:'Building\Permits\ELC- PermitApp.doc 10/01/09