Permit CITY OF TIGARD ELECTRICAL PERMIT
2:. _ COMMUNITY DEVELOPMENT Permit #: ELC2009 -00184
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04 /28/2009
Parcel: 2S112AC00100
Jurisdiction: Tigard
Site address: 14529 SW 72ND AVE
Subdivision: Lot: 0
Project: Save On Tires
Project Description: (11) branch circuits.
Owner: FEES
DONNELLY, THOMAS J Quantity Description Date Amount
PO BOX 83192
PORTLAND, OR 97283 11 crt Branch Circuits 04/28/2009 $113.35
wo /Purchase Service or •
PHONE: Feeder
1 ea 12% State Surcharge - 04/28/2009 $13.60
Contractor: Electrical
A BETTER ELECTRICAL COMPANY
16869 SW 65TH AVE STE 373
LAKE OSWEGO, OR 97035
PHONE: 503 - 753 -0836
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $126.95
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 ith 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 day ATTENTION: Ore • aw e• ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
9::: -0010 through OAR 9 • 001-01 ,• •u may obtain a copy of the rules or direct questions to OUNC by call' 503.246.6699 or 1.800.332.23
d By: C �'� %� ` � [ Permittee Signature: /�' V`�°�
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'N �� �r L ' /v �, — t/�___ Date:
r
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 FOR OFFICE: lISE °NIA
City of Tigard DateB� p.55/ t 9 �f , / �• ,
Permit No.:
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C ' Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
l' I G A R D Inspection Line: 503.639.4175 Date Ready/By: lu I ® See Page 2 for
Internet: www.tigard- or.gov Notif/M
edethod: /'' Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ` Addition/alteration /replacement Please check all that apply (submit 2 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 XCommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 K VA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I - ",
Job no.: Job site address: /i s�/ M � v,„. or more. occupancy.
1 7 s �� ❑ Six Six o or r more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: 7/} OI ✓e) ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: •
✓1 d p 0 ) 7 r 145 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 •
H a/ New residential single- or multi - family dwelling unit.
72 - on t Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 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, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, I, 46.85 'f 6,g5 2
first branch circuit
Address: Each add'l branch circuit p 6.65 G / rj
` 0 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
A 13e-f`I'er 0, .4-y- i ( Cr, »n, pa energy panel, alteration, or
Address: 16 8' 69 5 w 6 5 t j Ave "- F . e 373 extension. Describe: Page 2 2
City/State /ZIP: 1.--( k 05‘wejo OR 9 7035' Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (5 p 75, 0 2 3 6 Fax: ( /, b 1) Investigation per hour (1 hr min) 62.50
CCB Lic. :48 4 9 8 Z Electrical Lic.: C. 45' 2 Suprv. Lic.: 3 itt$ S Industrial plant per hour 73.75
/A/3 ( . p /0b I/O ELECTRICAL PERMIT FEES
Suprv. ec 6 1 n signature, required: Subtotal: i . 3 5
Print name: 11 1 ch 4 tQ � k N /S o r% Date: Plan review (25% of permit fee): �—
State surcharge (12% of permit fee): / 2 .
Authorized signature: TOTAL PERMIT FEE: / 2 i S
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \Pennits\ELC- PennitApp.doc 05/23 /06 440- 4615T(11 /05 /COM'WEB