Permit � n CITY OF TIGARD • ELECTRICAL PERMIT
'' 1 COMMUNITY DEVELOPMENT Permit#: ELC2009 -00399
Date Issued: 08/04/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 parcel: 2S101AA08700
Jurisdiction: Tigard
Site address: 12511 SW 68TH AVE
Subdivision: WEST PORTLAND HEIGHTS Lot: 29 •
Project: HP NW
Project Description: (2) branch circuits for breakroom.
Owner: FEES
BEVELAND BUILDING LLC Quantity Description Date Amount
4740 SW LOWELL CT
PORTLAND, OR 97221 2 crt Branch Circuits 08/04/2009 $53.50
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 08/04/2009 $6.42
Electrical
Contractor:
CANBY ELECTRIC INC
790 S IVY ST
CANBY, OR 97013
PHONE: 503 - 266 -7878
FAX: 503 - 266 -5543
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.92
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: # .2 Permittee Signature: fr" e_4 A/
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 603.639.4176 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.' ECEIVED
• Received + � �� I p / YJ
City of Tigard Dale/BY: / i/ Q G nv
Pctt N C a _ _____ _3> 9
13125 SW 1:Iall Blvd.. Tigard, OR 97223 3 1 2009 Plart.Reyiew / 7 -.. —..
ti • Phone: 503.639.4171 Fax: 503.598.1960 D �gy 011,o, I ,:mil •
T t (; n I - n : inspection line: 503.639.4175 , Date•RcadyBY; i ® seNee Pnge 2 for . .
Internet: www.tigard- or.gov .: , • OF TIGARD Notified/Method: S uppremental'tnforlwdon •
TYPE U . . . .. . • PLAN REVIEW.
• ❑ New Construction Addit /alteration/replacement Please tale& all that apply (auhmil 2 sets of pima vdiicm chec0icd.below):•
❑ Service or feeder 401) amps in mac ❑ Building over three stories. •
• ❑ Demolition ❑ Other. . • where the available taut) eunent ❑ Marinas and boatyards.
Y
CATEGORY OF G01
Rit1 ; ; ; : = . : ` . :; : ' " exceeds (0,000 amps t less to owed, 11 50 vtrhs in ❑ hli sting buildings; I� 1OJ!l ! : : ' or
` � ' - ground, r exceeds 14.000 0 Cununctt:ial- usg ttgricuhuml'
Vt:1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all d. 1 ,naaualions. building,
❑. Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
n.
.. ,.:. : ., - .,• - - Cmerren� a etc t , rl.ta sapu lei derive
JOB SITE INFURMA'1'tnN : \LtT Di;LOCAT10NT ;i: ; > . ` ; c ' ? ' .
: _ ` .. . ❑ AddNion o m uwi load of A t I Y °t •3 d
system.
Job•no. : Job site address: j � ! / 10011p or occupancy.
1 + " " ` `� t ❑ (n Six or more residential ann. Q Itcorcaonnal vehicle parks.
City /Slate / %IP: ❑ Health -carc facilities [ 1 Supply voltage for morc thin •
� � D� �i� 2Z ❑ Flata/douc locations 600 volts nominal.
' ' Stiitc/bidgJapt v no -: 1 Project name: .IA N� • • • ❑ Service or fcedt r 600 :11111/N u, !INN. ff �7�I : e.., .., . , FEE SCHEDULE
Cross street/directions to job site: . tkscriotivn _ - (. Qt1,._1 fir 1 Total . I "
•
M — New residential single- or multi- family dwelling unit.
• Includes attached garage.
Subdivision: L 0 1 no.: 1,000 s q. II. or l ess 145.15 4
u
. Ea. add'l 500 sq. tt. or portion 33 40 .. '1 .
Tax map /parcel no.: Limited energy, residential
( 75 (X)
:,
: y '. '. '� : `i : : ,, (with hoe sq. ft.) _..
bE5CR1P OF• iW
� - -lain v 75 UU Z
• Limitctl energy muhi i1 •
_ c i I N b 1cm residential (with above sot II) L irnton . and/or relocation.'•
200 amps or less 1 (10.30
0P O .
PROPERTY OWNED', .:,:' : : .E���Nl�`>C. "r:
-. `:• „ • '.;: •: ;sas s 201 ( imps (0 400 amps 106
Ob .
l '~" 401 amps to 600 tunes 1 60.60
Name: yJ I J _ 601 amps to 1,(x10 amps 240.60 2
' Address: Over 1,000 amps or volts _ 454.65 .2
. . Temporary services or feeders imaallation, alteration, and /or ..
City /Statc/ZIP: relocation
:Phone: ( 5C/7— _ •
fax. ( ) 200 amps or less — I 66.85
•
installation 1 own which is not
201 amps to 400 amps 100.30
Owner. installation: This installation is being made on property. 401 amps to 599 amps 133 75 •
intended for sale, lease• rent, or exchange. according to ORS 447, 449.670, and 701. eratieh circuits new, altrratin or c :tcasiun, r panel
Owner signature: _ Date: • • — A. Fee for branch circuit, lath
ci
. :. 0014' PERSQA7 6.65
abOVC S
Q APPLICANT Q;;..'... :. :..Fi .:.•..,....:.,. :: `
each brmlch circus
: Business name: H. Fee for branch circuits
.•• •• 'without service or feeder Ice. j Ati KS 4h�
Contact name: first branch circuit • Each add'3 brunch circuit — 1 ) 6.65 _
Address. Miscellaneous (service or feeder nut included) : •
•
City/State/7.{P: each manufactured or moluhu 90. 90 2
dwellin.. service and /or nyticl
Fax: : ( ) Reconnect only 66./15 . 2
Phone :•( ) at 40
s .
. -_ -
E-mail: t .
r ' .._ .. 0
Pump u 'rrigation circl •.
..sas
' S i or outline lightin;
� 5 t.4 2 •
~ Signal circuitts) or limited-
,'B name: C >� l � „Q5 ` a - "iv. C. energy panel. alteration. ut I • 2 •
C y 1 . extension. Desathe: 1 fags 2 •
Address: --1. Ck V C) •• .�.tJ -.d —
,� ^ � Eaeb additional inspccuun over ntlowable in an of the above
City /State, /Ii 1 "t Per inspection — 1 62.50
Phone: d' 1 ax: (SC '9 t0 (ta — y vestl per hour 11 ul uuul ... l .. 62 :50
� . o 3 Indust'ial plant per hour ! ... 73.75 _
CCB Lie.: ' Z• , on t 7 1lcctric 1 .. ic_: —11 t Suprv. Lic.: 2( - 2_, - s ti t.F'c: t'RIC.A1, PEIItMrr i'EE S —
Subtotal'
Sups'. Elel'li lit In }I Iltllllrt', rCgUi tl: 1'I:In icy ltltt I.' ? "„al perms( f ee)'
f
Date
Print name: �� l )r.l f O:-t tlr •.UlClli i;(i • tJ perlr
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