Permit ;,P,: CITY OF TIGARD
ELECTRICAL PERMIT
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' B': COMMUNITY DEVELOPMENT Permit #: ELC2010 -00296
,x :1 -; Date Issued: 06/16/2010
T j GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S112ACO2100
Jurisdiction: Tigard
Site address: 14865 SW 72ND AVE
Subdivision: FANNO CREEK ACRE TRACTS Lot: 47
Project: I n Bark
Project Description: (3) branch circuits for exit signage.
Owner: FEES
PARRISH- CHURCH, LLC Quantity Description Date Amount
PO BOX 2687
TUALATIN, OR 97062 3 crt Branch Circuits 06/16/2010 $71.02
wo /Purchase Service or
PHONE: 503- 692 -4742 Feeder
1 ea 12% State Surcharge - 06/16/2010 $8.52
Electrical
Contractor:
TEAM ELECTRIC
9400 SE CLACKAMAS RD.
CLACKAMAS, OR 97015
PHONE: 503 - 557 -7180
FAX: 503- 557 -8201
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $79.54
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 rf work is suspended for more the -
days. ELATION: Or - , •n law/lbguires you to follow the rules adopted by the Oregon Utility Notification Center. Th..e rules are set forth ' OAR
952- 1 -0010 through OAR 9' -061-01130. • may obtain a copy of the rules or direct questions to OUNC by calling 503.24. • or 1.80•. ,2.2344.
Is ed By: 1 / t I _,,/ Permittee Signature: 1 / / 4 _ 4 _4_.4 �i_
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.
CaII 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 rink ni t it t I,,1;: O,�I ' '
T
Cl of Tigard .. Received / -
14 g Date/Bv. t.y mi�/' Permit No.: E/ , �a C/O—�9 �p
a 13125 SW Hall Blvd.. Tigard. OR 97223 Plan Review
6 Phone: 503.639.4171 Fax. 503.598.1960 Other Permit:
Datc/Bv:
'l` c'; rS'K i 1 lnspection Line: 503.639.4175 Date Ready/By' tuns ® See Page 2 for
. Internet: www.tigard -or gov Notified/Method Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 sets of plans.vritems checked below):
❑ Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 colts or ❑ Floating buildings.
less to pound, or exceeds 14.000 0 Commercial -use agricultural
❑ 1- and 2-family dwelling x Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: 0 Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system,
Addition of new motor load of
Job no.: Job sitc address: •,a +i ^ /� IOOHP or more. occupancy.
��� S W Of � C ❑ Si! or more residential units. ❑ Recreational vehicle parks.
City; Slate Z1 P: 0 Health-care facilities. 0 Supply voltage for more than
0 locations. T, 11(11 cl o1 1 �� 600 volts nominal.
Suite/bide.: apt. no.: J I Project name: ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description
1 Qty. 1 Foe. ( Toad , •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. R. or less 168.54 4
�Q�+hU r eQ Yj J7�A , .�e Tcac� I + 1 Ea. add'I 500 sq. ft. or portion 33 92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. fl.) 67 84
` p Limited energy. multi- family
add 3 l l Q1 yiT e.A Ev i 5� 9 n S residential (with above sq 11 ) 67.84 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
0 PROPERTY OWNER I , 7 I . TENANT 201 amps to 400 amps 133.56 2
Name: Car l >�� \ Z n y r k 601 amps to 1. 0 amps 200.34 2
` �. .ts✓ Y d , j• 601 amps to 1,000 amps 301.(}1 2
Address: 1 1 *% 6 CW "',atr1 Ve , € Over 1.000 amps or volts 552.26 2
City/State/ZIP: --n. a V ($ � � �1 Temporary services or feeders installation, alteration, and /or ga relocation
Phone: (y5) 5 8q 1 u Fax: ( ) 200 amps or less 59.36 1
.11'' 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 own which is not 401 amps to 599 amps 168.54 2
intended for sale. lease. rent. or exchange. according to ORS 447. 449. 670. and 701.
Branch circuits - new. alteration. or extension. per panel
Owner signature: �__ _ _ Date: A Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee. 7 42
`/ each branch circuit
Busincss name: E I� p� B Fee for branch circuits
—
v " / + ' ('_ ) ` ( _` service or feeder r fee, ee, first I 56 18 S' r Ig
Contact name: elf, branch circuit
Each add'I branch circuit 7 42 14 r$q 2
Address: t /4 Q 5 s 1 ,3 1 a ri d i ie f Miscellaneous (service or feeder not included)
City/State. /IP: 1.1 ( ) e r d 02 ( 9 Each manufactured or modular 67 84 2
ce�� dwelling. service andtor feeder
Phone:) Fax: : Reconnect only 67 84 2
( `a ' ,t_ Pump or irrigation circle 67 84 2
E -mail: ra (` i qbi l iocut. CDC Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or 11m m:1 - energy
Business name: -rp } b L �� C panel, alteration. ore tension Page 2
Each additional Inspection over allowable in any of the above
Address: 94 G CA...AGv yY1(;S Additional tnspectton (1 hr min) 66 25 hr
Investigation (I hr min} 66.25. hr
City /State /"LIP: C LA GK.A mks / O�eGol� 9 --roIS Industnatplant(1hrmin) 78 18 hr
Phone: (Co 3) SS - 1 1' QC_) Fax: ( S0.. ) S$ -Q 2a i Inspections for w hich no fee is 90 00; hr
specifically listed ('.3 hr min)
CCB L 04 3 Electrical I.ic.: 3225 -C Suprv. Lie.: 4.4+j6 S ELECTRICAL PERMIT FEES
Subtotal: 1 1 . 0 2
Suprv. Electrician signature. required: 7'�J� �
' .` ��Y Plan review (25% of permit fee)
Print name: N\ 1 C. t4 h .l- - Taus If Elm Date: G /1( / 1 0 State surcharge (12% of permit fee): '6,S L
Authorized signature:
�.�' �jyr sY TOTAL PERMIT FEE `1 � hin 18 . S 0
This permit application expires it • permit is not obtained with0
days after it has been accepted as complete.
Print name: ml C_4Ati TQU511E) /YI Date: 6 4,,/la • Number of inspections allowed per permit
I Building'Permits'ELC- Perm @App dos 1601(0 440 -40mi 11 -05 COM41'F.B