Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2010 -00623
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/04/2010
Parcel: 2S 102 DA00600
Jurisdiction: Tigard
Site address: 13500 SW HALL BLVD
Subdivision: Lot: 0
Project: Friends of the Tigard Library
Project Description: Altering (1) branch circuit.
Owner: FEES
CITY OF TIGARD Quantity Description Date Amount
13125 SW HALL BLVD
TIGARD, OR 97223 1 crt Branch Circuits 11/04/2010 $56.18
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 11/04/2010 $6.74
Electrical
Contractor:
GLOBAL ELECTRIC, INC.
PO BOX 162
NORTH PLAINS, OR 97133
PHONE: 503 - 647 -5650
FAX: 503- 647 -5649
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $62.92
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 c .the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. s
Issued By: 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.
From: 11/03/2010 13:43 #684 P.001/002
Electrical Permit Applic , r()R. )1 :E ti . r •
p �� . CI t ,, O I1
City of Tigard vv ` 1 �O�O . _ Permit No: /.� ` .... - 0 ..� "...
� 13125 SW Hall Blvd., Tigard, OR 9723 OV Plan Review e
0 "_ Phone: 503.639.4171 Fax: c03 598 I ) '( Gr .7 �,` Date /B Other PcrmPermit: '.1 l A I •; Inspection Line: 503.639.4175 • 0� `\ \�\C`O \v Date Ready; By: See Page 2 for
- -., , -- nternet: www.tigard -ocgov G � C V N otified /Method. a �3 Supplem ental lnformarion
TYPE OF W 1y PLAN REVIEW
Please check all that apply (submit 2 set: of plans sr /items checked below):
❑ New construction sa Addition /alteration /replacement
❑ 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: 0 Fire pump. 0 Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION O Emergency system. larger separately derived system.
❑ Addition of new :norm load of ❑"A" "E" "1.2" "1-3".
Job no.: Job site address: ( 3 5 t ' S W fiat' S iv Six or or more more. R occupancy. Recreational ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP:
❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 1 • C I 1_ f k i"q f ❑ Service or feeder 600 amps or more.
t x
Cross street/directions to job site: 7 FEE SCHEDULE
J Description 1 Qt). 1 rep. 1 Total 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less 145.15 ' 4
Ea. add'I 500 sq. 11. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. 11.)
Q Limited energy, multi- family
75.00 2
Ex� e .(k e x t S -C e� (7 V C v C c � t residential (with above sq. ft.)
S ervices or feeders installation and/or relocation
200 amps or less 8(1.30 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 l 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, , r panel .
Owner signature: -- Date: _ A. Fee for branch circuits with •
' APPLICANT • ❑ ...... ❑CONTACT PE RSON above service or feeder fee, 6.65 2
each branch circuit
Business name: 13. Fee for branch circuits go t
without service or feeder fee, sr0 - 1 '
Contact name: f or:). 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included) _
City/State /ZIP: Each manufactured or modular 90.90 2
Phone: dwelling, service and/or feeder
( ) 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: G (06,_ G ( Signal circuit(s) or limited -
t? C J C . energy panel, alteration, or
Address: P 0. o X /6 extension. Describe: Page 2 2
City /State.'ZIP: Each additional inspection over allowable in an`of the above
/�Oc �h P �a t �s O ff, ?N33 Per inspection 62.50
Phone: (43 ) 6‘..( 7 - S 6 so Fax: (5-C: ) 6Y 7- $6 y 9 Investigation per hour (1 lu min) 62.50
CCB Lic.: /5 6 g3 8 Electrical Lic.: 35/ 6.‘sC Suprv. Lic.: ,5,;2 /OS industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature. required: ),.,„, �� .---" Subtotal: �( ' - r&. I t" •
h /// / Plan review (25% of permit fee): Print name: J � S � I S � 1 eC t � Date: / o
State surcharge (12% of permit fee): xP ,--j al
Authorized signature: TOTAL PERMIT FEE: � a 4, �).-
l +
Print name: This permit application expires if a permit Is not obtai thin ISO
Date. l days after 11 has been accepted as complete.
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