Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 00496
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/14/2010
Parcel: 2S112AA00500
Jurisdiction: Tigard
Site address: 14344 SW 72ND AVE
Subdivision: NELSON BUSINESS CENTER Lot: 0
Project: Leifs Auto Collision Repair
Project Description: (5) branch circuits for exit lighting.
Owner: FEES
WALTON CWOR NELSON 13 LLC Quantity Description Date Amount
BY TTA/EPROPERTYTAX DEPT 735, PO BOX
4900 5 crt Branch Circuits 09/14/2010 $85.86
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/14/2010 $10.30
Electrical
Contractor:
MOUNTAIN F ENTERPRISES INC
25973 S MOEHNKE LN
BEAVERCREEK, OR 97004
PHONE: 503 - 313 -0761
FAX: 503 - 632 -5521
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $96.16
Required Items and Reports (Conditions)
This permit • : • • • - - to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don n accordance with app , ed plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
day ATTENTION: Oregon law re:uire •u to follow the rules adopted by the Oregon Utility Notification Center. Those rules a s forth in OAR
95 - 001 -0010 thro . h OAR 952- 001 -01 s.' . You - y • •tai a copy of the rules or direct questions to OUNC by calling 503.246.66 or 1.800.3 4.
1 - ued By: (C/X 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:
1 CONTRAC C/
ST , IION ONLY
SIGNATURE OF SUPR. ELEC' / &4,2 ( ( `—' 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.
Electrical Permit Application Fo it t ) i i c i; Hsi: t) N L, Y
City of Tigard Date /B : 4. y /Q Permit No.: &vt el -
114
go 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C ' Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
`r I C ,\ It t, Inspection Line: 503.639.4175 Date Ready/By: luris: ® 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 a sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: 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 ", "I - ", "l -
Job no.: Job site address: r g IOOHP or more. occupancy.
l Ul`� 0 or more residential units. ❑ Recreational vehicle parks. for
City/State /ZIP: '' hh ' �7 l'1, ❑ Health-care facilities. ❑ 600v nome al. more than
V «T ❑ Hazardous locations.
Suite/bldg. /apt. no.: Project name: e t o ( l ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qtr. 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 I
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
T l t- KY.- (T— Lc 131 tO u residential (with above sq. ft.) _
-
f Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER 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
City/State/ZIP: Temporary services or feeders installat ion, alteration, and/or
ty 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 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
Branch circuits - new, alteration, or extension, per panel _
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56.18 G4,1, i t 2
Contact name: branch circuit
Each add'I branch circuit 4. 7.42 2
Address: Miscellaneous (service or feeder not inc luded)
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 n - . A'1N c Eta. 'j'', yo 'AA A .., R- - Rec
panel, alteration, or extension. Page 2 2
a1J To Each additional inspection over allowable in any of the above
Address: - e'- -actiq.5 S, vtualk 1uQA L-r Additional inspection (l hr min) 66.25/ hr
A , (� Investigation (1 hr min) 66.25/ hr
City/State /ZIP: �' 4s ficeisi�t p- b".... -L�b Lt Industrial plant (1 hr min) 78.18 / hr
Phone: �•
�$ S, ( ) ) Fax: �? SZ S Inspections for which no fee is
specifically listed (%A hr min) 90.00 / hr
CCB Lic.:(SGtST 1`' \T Electrical ic.: 3- 2 - j bl -G Suprv. Lic.: s -Z ELECTRICAL PERMIT FEES
1 , ?(t ill / i //2 Subtotal: f9 . 91# Suprv. Electrician signature, required: -F`� / Plan review (25% of permit fee):
"`fff ��� . F::-7-:---t
Print name: ,1 \, 1 Date: q _ t-5 ' b State surcharge (12% of permit fee): D. rj o
TOTAL PERMIT FEE: 6. i f s
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: I Date: • Number of inspections allowed per permit.
1:\ Building \Permits\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:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ 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
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permiu\ELC- PermitApp.doc 07/01/10