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Permit
NAI a CITY OF TIGARD ELECTRICAL PERMIT ° COMMUNITY DEVELOPMENT Permit #: ELC2010 -00420 T tGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/17/2010 Parcel: 2S101 BB01400 Jurisdiction: TIGARD Site address: 12172 SW GARDEN PL, BLDG# 3 Subdivision: PARK 217 Lot: 0 Project: Harris Office Works Project Description: Installation of subpanel and (6) branch circuits. Owner: FEES WALTON CWOR PARK BC 8 LLC Quantity Description Date Amount BY TTA/EPROPERTYTAX DEPT 325, PO BOX 4900 1 ea Services or Feeders - 200 08/17/2010 $100.70 amps or less PHONE: 6 crt Branch Circuits w /Purchase 08/17/2010 $44.52 Service or Feeder 1 ea 12% State Surcharge - 08/17/2010 $17.43 Contractor: Electrical SALAR ELECTRIC 19645 SE WOODED HILLS DR DAMASCUS, OR 97089 PHONE: 503 - 351 -3730 FAX: 503 - 665 -2817 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $162.65 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 rice 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. ENTION: Ore. =. la - quires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 95 001 -0010 through OAR 95- r01 -0 10. u may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. I sued By: 4 Perm ittee Signature -f-_:L.. . 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' , . ` ✓� •---%---7 Date: 'Air 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. Electrical Permit Application RECEIVED , _l FOR OFFICE Ic I ILSE (i ` •1 . Ci of Ti g and /o Permit No.: E4..610/4/1, 00 9.0./0 a 13125 SW Hall Blvd., Tigard, OR 97223 I llig ® Phone: 503.639.4171 Fax: 503.598.1960 AUG 17 2010 Date/ PlDate /B an R : : eview / Other Permit: r l i l> Inspection Line: 503.639.4175 Date Ready/By: Juris: el See Page 2 for Internet: www.tigard or.gov _ CITY OF TIGARD Notified/Method: Supplemental Information . TYPE OF woRigiLDING ply iS ON PLAN REVIEW ❑ New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ' f J �¢ ❑ Service or feeder 400 amps or more ❑ Building over three stories. � ❑ Demolition [ Other: iv /�tK ({� S � j� 11JiJt1 W5 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 ", "1 -2 ", "1 -3 ", I OOHP or more. occupancy. Job no.: Job site address: 2,1 7-Z S id P.� pot_ ❑ Six or more residential units. P ❑ Recreational vehicle parks. City/State /ZIP: `:1 6A_ 9( 7-7_2-3 ❑ Health-care za Hazardous facilities. ❑ Supply voltage for more than Got_ ` ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description 1 Qty. 1 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 sq. 75.00 2 DESCRIPTION OF WORK ( with above q• ft. ) Limited energy, multi - family 75.00 2 Q 8 k 10-0 /k- vu ') .S; Y - C /aa (y t ,I._ ? I ` _, ,� residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation CC_ A - 5 ZQ /4 y1 e6 - 200 amps or less l 100.70 2 ❑ PROPERTY OWNER r I ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 - Address: - -- - - -- - - Over 1,000 amps or volts 552.26 2 - Temporary services or feeders installation, alteration, and /or City/State /ZIP: relocation Phone: ( ) Fax: ( ) 200 amps or less 0 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 1 ❑. CONTACT PERSON above service or feeder fee, 6 7 42 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, first ' 56.18 2 Contact name: branch circuit Each add'I branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 67.84 2 ty dwelling, service and/or feeder 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: 54- a ( ( L ' ��2t'C panel, alteration, or extension. Page 2 2 '� 1 Each additional inspection over allowable in any of the above Address: (' 6 i 5 W ©o 4 QA (.-.1 Lt I 1 i 5 f / Additional inspection (1 hr min) 66.25/ hr City/State /ZIP: (. .4_ 1 ,_.. t4 5 G vs O. l 0/7_0 U a, Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18 / hr Phone: (rte 3 3 ( -3 3 --) O Fax: ( ) Inspections for which no fee is 90.00 / hr /. specifically listed (V :: hr min) CCB Lic.: /60 2�W Electrical Lic.: C (ly uprv. Lic.: 4 6 ti S ELECTRICAL PERMIT :FEES, _ Suprv. Electrician signature, required: Subtotal: /%/ Plan review (25% of permit fee): — Print name: 4 /� 60 S /� I Q Date: - I �' State surcharge (12% of permit fee): /7 7'3 T 7 L TOTAL PERMIT FEE: Authorized signature: This permit application expires if a permit is not obtai withi Print name: Date: * days after it has been accepted as complete. Number of inspections allowed per permit. I:\ BuildinePermits \ELC- PermitApp.doc 07/01 /10 440- 4615T(11/05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined $75.00 Check Type of Work Involved: Fl Audio and Stereo Systems* n Burglar Alarm n Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* n Vacuum Systems* n 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 n Clock Systems n Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation n Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical • ❑ Nurse Calls ❑ Outdoor Landscape Lighting* n Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1: \ Building \Permits\ELC- PermitApp.doc 07/01/10