Permit 74 .q CITY OF TIGARD ELECTRICAL PERMIT
ffi COMMUNITY DEVELOPMENT Permit #: ELC2010 00433
.T .t G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/20/2010
• Parcel: 2S101DCO3703
Jurisdiction: Tigard
Site address: 13500 SW 72ND AVE 250
Subdivision: BECK BUILDING Lot: 0
Project: Beck Group
Project Description: (2) branch circuits to reconnect RTU's.
Owner: FEES
BECK, TOM L Quantity Description Date Amount
13500 SW 72ND AVE
PORTLAND, OR 97223 2 crt Branch Circuits 08/20/2010 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 08/20/2010 $7.63
Electrical
Contractor:
PRO CIRCUIT ELECTRIC LLC
PO BOX 3948
WILSONVILLE, OR 97070
PHONE: 971 - 563 -8211
FAX: 503 - 266 -1349
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 • 2- 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: L _ _ �_..".._ 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' 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.
" I f" rTry. t '',. 4 7 ' 7.,..
Electrical Permit Application II . i l - ' ''' . '' - 2 --) '*': ' ' ''-' ' ''''''' ''; , 1 012 0 IF lC Cli.SE ON1.1'
, ..
, . City of Tigard AUG 20 Z010 Received .0.- -
gr7-- Permit No.: J.:•-./ J (0-- 0043
, ' 4 13125 Hall Blvd., , OR 97223
II N
SW Tigard
- 2 ,... Phone: 503.639.4171 Fax 503.598.1r IN ,f- -- iii,, , A R D Da Other Permit:
,, Inspixtion Line: 503.6394175
funs: _ lid gee rage 2 For
Internet: WWw.iigard-or.gov BUILDING CAVIS11) 21
T Ve0 Supplemental Information
TYPE OF WORK PLAN REVIEW
Q New construction XAddition/alteration/replacement Please check all that apply (submit 2 sets of plans *items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
' 0 Demolition 0 Other: . where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 vobs or 0 Floating buddimp.
less to grcund, or exceeds 14,000 0 Commercial-use agricultural
El 1- and 2-family dwelling aCcurtmercial/industrial 0 Accessory building amps all other installations. buildings.
0 Multi-family 0 Master builder El Other: 0 Fite pump. 0 Installation of 75 KVA or
0 Emergency system. larger separately derived systen
JOB SITE INFORMATION AND LOCATION
0 Addition of new motor load of 0 "A", "E" "1-2',
Job no.: 1 TOD site address: 135co 5 -72 thoi.e, 100HP or monc.
0Si% OT MOM residential units. occupancy.
0 Recreational vehicle parks.
City/State/ZIP: 0 Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: p_57 Projcct name: 6e k a reni p °Service or feeder 600 amps or MOM.
FEE SCHEDULE
Cross street/directions to job site:
Deserind00 1 o iy. I F,. 1 Total 1 •
t
New residential single- or multi-Eimily dwelling unit.
' Includes attached garage.
Subdivision: 1 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
67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi-famay
'RecorNE Q Pyr The vfc-r 2 - A6ro residential (with above sq. ft.) 67.84 2
Services or feeders installation, attention, and/or relocation
200 amps or less 100.70 2
0 PROPERTY 0%V1 0 TENANT 201 amps 10 400 amps 133.56 2
_
Name:
401 amps 00 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 59.36 I
Owner installation: This installation is being made on property that I own which is not 201 amps 10 400 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
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date:
A. Foc for branch circuits with 1
0 APPLICANT 0 CONTACT PERSON above service or feeder fee' /Ny:‘12,,f.A 2
each branch circuit
Business name: -
B. Fee for branch circuits
without Service or feeder fec, I
1
Contact name:
51,2
first branch cir 56.18 2 cuit
Address:
Each add'l branch circuit I 7.42 — I, a-12- 2
114iscdla aeons (service or /ceder not included)
City/State/ZIP:
Each manufactured or modular ,
67.84 2
dwelling, service and/or fccdcr
Phone: ( ) --- Fax: : ( )
Reconnect only 67.84 2
E-mail:
Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal eircuit(s) or limited-
Business name: p p c c ari E Lp
energy panel, alteration, or
Address: T. 0 s 39 `48 extension. Describe: Page 2 2
City/State/ZIP: 111 i „stifle_ ti 07 0 Each additional inspection over allowable in any of the above
Per inspection
Phone: (91 1) 5 , i I Fax: ( 5155) 24,4 (349
Investigation per hour (1 ltr min) 66.25
CCB Lic.: Electncal Lie.: - ( 0 04 L Suprv. Lic.: 51 07 5 Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, Fzquired: 1
Subtotal: kt -1 ). 60
.,
Print name: 1 A a #;\ (0k, I Date: 12022440,41,.' Plan review (25% of permit fec):
State surcharge (12% of permit fee): 7 • kit
Authorized signature: 8.... tq.._ ( _
TOTAL PERMIT FEE: 7 i •7..,.5
Print name Date I
: This permit application enpires ifa permit is not nb within 130
: I
days after it has been accepted as complete.
• Number of inspections allowed per Permit.
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