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Permit
CITY OF TIGARD ELECTRICAL PERMIT v e <'.: COMMUNITY DEVELOPMENT Permit #: ELC2010 -00421 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/17/2010 • Parcel: 2S113AB01201 Jurisdiction: TIGARD Site address: 16535 SW 72ND AVE Subdivision: PACTRUST BUSINESS CENTER Lot: 0 Project: Oce Imagistics Project Description: (2) branch circuits in production area. Owner: FEES PACIFIC REALTY ASSOCIATES Quantity Description Date Amount 15350 SW SEQUOIA PKWY #300 PORTLAND, OR 97224 2 crt Branch Circuits 08/17/2010 $63.60 wo /Purchase Service or PHONE: 503 - 624 -6300 Feeder 1 ea 12% State Surcharge - 08/17/2010 $7.63 Electrical Contractor: TICE ELECTRIC 5405 N. LAGOON AVE. PORTLAND, OR 97217 PHONE: 503 - 233 -8801 FAX: 503 - 872 -8290 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 •irect questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By �: ._=� Permittee Signature: 9 . 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 503.639.4175 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. 08/11/2010 11:50 503 - 231 -3372 TICE ELECTRIC PAGE 02/02 Electrical Permit Application FOR OrlAcE usu. ONLY City of Tigard , . ' ?� mo i yi Permit No.: - " 13125 SW Hall Blvd., Tigard, OR 97223 ' \ � '� '' Plan Review Other Permit: I Phone: 503.639.4171 Fax: 503.598.1960 � ? � ` _ T 1 L_, A ii n inspection Line: 503,639.4175 a Ready/By. luris: 0 Sec Page 2for Internet www.tigard-or.gov Not/lied/Method: . LVJ Supplemental Information TYPE . Op' WORK N. y , ,,. ., '; .. ? PLAN ,3REVIEW [] New construction ; ,_ / Addition /alterAUO3Vrepiltcetl�ieltt ' -•` � ` J. C , ' Please check alt that apply ( submit 2, sets of plans whim= checked below): Q Service or feeder 400 amps or more 'I] Building over truce stories. ❑ Demolition ❑ Other. where the available fault currant ❑ Marinas and boatyards. ,. .: ' ' exceeds 10,000 at 150 volts or ❑ Floatin bui `•- ' ,,:CATE OF C O N S iXt1U .'. ' ' . � din gs. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1 - and 2 family dwelling Vommercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family 0 Master builder ❑ Other: ❑ Fire pump. ❑ ittst:dlation of 75 KVA or JOB . S1TE 11VPORMATION: ANA LOCe1TION . ; 0 Emergency system- larger separately derived system, ' ❑ Addition anew motor load Of ❑ Job no.: f ?'0 .§1 $i Job site address: 1 frS 3 S 5W 7 e e,/ e, Six or or mars. occupancy. ❑ ❑ Six or more residential amts. Recreational vehicle pares, City /State /ZIP: 1j c g Cie q - 1).J1- Cl Health -care facilities. D supply voitage for more than y °Hazardousbcations, 600 volts nominal. r _ ! L g ln- ] 0C1 C � (n�C( 1 iA c.. © Service or feeder 6OD amps or more. Suite/bld /a no_: Project name: 5 Cross street/directions to job site: neterlrumn 1 Qty. 1 Fee 1 Total 1 New residential single- or multi - family dwelling unit. Includes attached garage. _ Subdivision: I 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 l P Limited energy, residential DESCRIPTIQN OF .WORK; (with above sq. ft.) 2 PrO "` OA D� 1. { _ 1 _ Limited energy, (with above sq . i 'r l 611 � � �j residential (waft above sq. a) 67.84 2 Services or feeders instaliation and/or relocatio 200 amps or less 100.70 2 '❑ :PROPERTY OWNER : : . 0 TENANT ; 201 amps to 400 amps 133.56 2 Name: 401 am 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 1, 59.36 1 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 - Owner signature: Date: Branch circuits— new alteration, or extension, per panel _ $n A Fee for branch circuits with ;,::. ..', :: „' ❑. APPLICANT' :.':'. �' PERSON: ' above service or feeder fee, 7,42 2 each branch circuit Business name: B. Fee for branch circuits ii Contact name: without service or feeder the, 1 56.18 5c e,l 2 first branch circuit Address: Each add'l branch circuit k 7.42 7. 2 - Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone: ( ) I Pax : ( ) Reconnect only 67.84 2 E - mail: Pump or irrigation circle 67.84 ` 2 , .... . ,....:, ,' :.:.:: !„ .::: ; i :.: CON1CItA4T0R: ?' ....: .:., ' ; :: ::.. .:. ' , . Sign or the lighting 67.84 2 out] Tice Electric Company Signal p alter limited- 'Business name: p �' encrsy panel, alteration, or _ Address: 5405 N Lagoon Avenue extension Describe: Page 2 2 City/State/ZIP: Portland, Oregon 97217 _ Each additional inspcctinn over allowable in any of the above Per inspection 66.25 Phone: (5 0 3) 233-8801 I Fax: (5 0 3) 872-8290 Investigation pm (i hr min) 66.25 CCB Lic.: 1 6 6 Electrical Lie : 26-126C1 Suprv. Lic.: 3651 S Industrial plant per hour 78.18 rLECTRICAL'.. PERMIT • FEES : ':'. ;: Suprv. Electrician signature, required: cor-...—..-- Subtotal: 1 0'3 (pO — Print name: Doug Johnson I Date: ' ' /11 1 fl , Plan review (25 %ofpermitfee): 7 _ State surcharge (12% of permit fee): o 4 Authorized signature: 1 .. - JA, _ TOTAL PERMIT FEE: 1 I , 71, Date: p I t/ � This permit application expires if a permit n not obtained within 80 D Print name: 0 / 1 1 1 days after it has been accepted as complete. —" • Number of inspections allowed per permit IN 1191dingTetmits \A.e- PEnnitApp.doo 10/01109 440.4615T(11 /O1(CQM/WEB Ma VI/ 60 Ca)