Permit IL, a CITY OF TIGARD ELECTRICAL PERMIT
° COMMUNITY DEVELOPMENT Permit #: ELC2009 -00344
.T i U ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/16/2009
Parcel: 2S113AB01201
Jurisdiction: TIGARD
Site address: 16505 SW 72ND AVE
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Liberty Mutual
Project Description: Install /alter (10) branch circuits for TI.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY
#300 10 crt Branch Circuits 07/16/2009 $106.70
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 07/16/2009 $12.80
Electrical
Contractor:
FIVE STAR ELECTRIC, INC.
PO BOX 555
BANKS, OR 97106
PHONE: 503 - 324 -0948
FAX: 503- 324 -0973
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $119.50
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 accord - , 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. ATTE• ON: Oregon -w r-•uires you to follow the nrles adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0• 0 through OAR 952 -0' • - 010 0. Y ay obtain a copy of the rules or direct questions to OUNC by- 503.246.6699 or 1.800.332.2344.
�^ � / / ()--------- Iss ed By: t _ � � (1� J� !/ 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.
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.
'F >" ` 07/13/2009 13:40 #693 P.002/002
.. E CEI J ED
Electrical Permit Appllcahc� OFFICE. usr ON1I
City of Tigard JUL 13 2009 Received
,_ Date/By: Permit No.� tC.ZC� oa34y-
a 13125 SW Hall Blvd.. Tigard. OR 97223 P lan Review ` ��( I
Phone: 503.639.4171 Fax: 503.5 I OF TIGAR Date/By: Other Permit: e t QZ co U 2_
Da1e'By: 4 , l
T I c A u D Inspection Line: 503.639.4) 75 pI Dale Ready/By: ea LB See Page for
Internet: www.tigard - ocgov BUILDING Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition /alteration /replacement Please check all that apply (submit 2 sets of plans wiiteins checked below):
❑ Service or feeder 400 amps or mole ❑ 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 agricultural
❑ I- 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
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION
❑ Addition of new motor load of ❑ °A" ••�" "I - �" "I - �",
Job no.: FS1502 Job site address: 16505 SW 72 Avenue IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97224 ❑ Health -care facilities. ❑ Supply voltage rot more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: Liberty Mutual ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total ---
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less 145.15 4
Tax map /parcel no.: - Ea. add'I.500 sq. It. or portion 33.40 I
Limited energy. residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
10 branch circuits Limited energy, multi - fancily
residential (with above sq. ft.) 75.00 2
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/Z•1P: 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 l0 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 ex tension, per panel
Owner signature: _ Date: ___ A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: 13. Fce for branch circuits
without service or feeder fee. 1 46.85
Contact name: first branch circuit 46.85 2
Address: Each add•I branch circuit 9 6.65 59.85 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
1 dwelling, service and /or feeder 90.90
Phone: ( ) Fax::( )
I Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: Five Star Electric, Inc. energy panel, alteration, or
Address: PO Box 555 extension. Describe: Page 2 2
City /State /L1P: Banks, OR 97106 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 324 -0948 Fax: (503) 324 -0973
Investigation per hour (I hr mint 62.50
CCB Lic.: 158231 Electrical Lic.: 34 -665C J Suprv. Lic 4622S Industrial plant per hour 73.75 •
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required , ^��j Subtotal: 106.70
Print name: Royal Stearns Date: 7/7!2009 -
Plan review (25% of permit fee):
State surcharge (12% of permit fee): 12.80
Authorized signature: TO'T'AL PERMIT FEE: 119.50
This permit application expires if a permit is not obtained within ISO
Print name: -- Date: _ days after it has been accepted as complete.
• ' Number of inspections allowed per permit.
I .\auitdinu\Pcrmin\ELC•PcrmitApp due 05/23/06 440 - 4e 1 5T( I Ii0S/COM/\VE13