Permit 1111 CITY OF TIGARD ELECTRICAL PERMIT
- :' COMMUNITY DEVELOPMENT Permit #: ELC2010 -00664
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/24/2010
Parcel: 2S113B000400
Jurisdiction: Tigard
Site address: 8154 SW DURHAM RD
Project: Zuniga Foods Subdivision: Lot: 0
Project Description: (2) branch circuits for ceiling lights and cooler.
Contractor: OREGON ELECTRICAL REMODELS Owner: DURHAM I LLC
8047 SE 134TH DR 8100 SW DURHAM RD
PORTLAND, OR 97236 TIGARD, OR 97224
PHONE: 503 - 810 -1240 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 11/24/2010 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/24/2010 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspe •:d for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rut= - e set ff..•�k. in OA s.
952- 001 -0010 through OAR 952 -001 -0090. You may obtain a of ul „+* questions to OUNC by calling 503.232.1987 or 1.800.33 ' \
Issued By .—% _ — =_ � � Permittee Signature:
ti
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OFFICE USE ONLY
Ill Cl of Tigard iv 4 1 �� Permit No.: .• _aO y —
City g f ° Receed /
Date : 6 i
® 13125 SW Hal Blvd. Ti OR 9722 �i � a Y Plan Review
i 17 Phone: 503.639.4171 Fax: 503.598.19.0 i �' q 4 Date : Other Permit: , v -
l' I C A R I� inspection Line: 503.639 vl g$ � Date Ready/By: See Page 2 for
Internet: www.tigard- or.gov NO Notified/Method: Supplemental Information
TYPE OF WORK 0 .11 ® \ � 1�` ` 0 �l PLAN REVIEW
1=1 New construction ❑ Addition /alteration /regle�4
� t " ' Please check all that apply (submit 2 sets of plans w /items checked below):
dV 0 Service or feeder 400 amps or more 0 Building over three stones.
❑ 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 ", "1 -2 ", "1 -3 ",
Job no.: q I Job site address: c, s 100HP or more. occupancy.
I �� J �� �� m � � ❑Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: '-+�(`U- c a. c ^ 1 U ❑ Health -care facilities. ❑ Supply voltage for more than
v " /t O� J ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: ,,,,-- Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 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 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
,
i Limited energy, multi - family 75.00 2
p r OP C. t..l l r,iAl i / 1 ' t ' j + C 00 I e p ,,1e+� . residential (with above sq. 11)
Y_ / Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER N] TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: e xvG QA Sbo `\ G i,...., 601 amps to 1,000 amps 301.04 2 '
Address: `/clS� 5, . \ ( t q er ,' ,� 1 � Over 1,000 amps or volts 552.26 2
City/State/ZIP: W F' 1 ` W I Temporary services or feeders installation, alteration, and /or
Y T(Gf,rc. t' q ' 3 L , relocation
Phone: ( ) JJ Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ,i" CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: , 0. B. Fee for branch circuits without
service or feeder fee, first 1 56.18 / k � � 1 j 2
Contact name: l n J c ; c branch circuit
e 1 � r t Each add'I branch circuit 1 7.42 2, I'] 2.- 2
Address: `/` �-0 Sl0 Pv �
GA 4. - t' - 1 i r t ej -- 0,, . . x Miscellaneous (service or feeder not included)
r ""' Each manufactured or modular
City/State/ZIP: c � Oa �� e9,(4.5 e9,(4.5 5 dwelling, service and/or feeder 67.84 2
Phone: ( R l� Fax: : Reconnect only 67.84 2
" ) "` _ �� ( ) Pump or irrigation circle 67.84 2
E - mail: ` . f\'l .C- 5 & y a r C Gyn. Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: �,9r Ec-r. , t REMQ 0-�S panel, alteration, or extension. Page 2 2
�- LE�-T� t �-� t- Each additional inspection over allowable in any of the above
Address: 0 I:. 1.3 y Da . Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /State /ZIP: . pc, , r N i 0g 1 - 7y industrial plant (1 hr min) 78.18 / hr
Phone: ins Inspections for which no fee is
(J) c ( 12.44 r' Fax ( ) 90.00 / hr
specifically listed (% hr min)
CCB Lic.: i J i s j Electrical Lic.: {"....62 Suprv. Lic.: 55 3S ELECTRICAL PERMIT FEES
� • ; S 7 I �- Subtotal: D ; (
Suprv. Electrician siAilt !
r eq
jYr Plan review (25% of permit fee):
Print name: 3—c, H t.4 ri _ a-d doh j ate: 1 I (...3 / s C, State surcharge (12% of permit fee): 7, 63
TOTAL PERMIT FEE: 7 /,_ 2-3
Authorized Signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: *
Number of inspections allowed per permit.
I:\Building\Permils\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:
n Audio and Stereo Systems*
Fl Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
Fl Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
PI Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \ Building \Permits\ELC- PermitApp.doc 07/01/10