Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 00667
Tigard OR 97223 503.718.2439
13125 SW H all Blvd., Ti Date Issued: 11/30/2010
T.i:�'r ARFy g
Parcel: 2S102AD01203
Jurisdiction: Tigard
Site address: 8800 SW COMMERCIAL ST
Project: MAGNO - HUMPHRIES Subdivision: Lot: 0
Project Description: (2) branch circuits for lighting retrofit.
Contractor: TEAM ELECTRIC Owner: MAGNO LLC
9400 SE CLACKAMAS RD. BY MAGNO - HUMPHRIES INC
CLACKAMAS, OR 97015 PO BOX 230626
TIGARD, OR 97281
PHONE: 503 - 557 -7180 PHONE:
FAX: 503 - 557 -8201
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 11/30/2010 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/30/2010 $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 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_• 2- 001 -0090. You- may -ebta - • • • • the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. S
1
Issued By. _-' /' Permittee Signature: _�( L_IL_ -
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.
11-30-10; 07: 38 ;Team ElectrIc ;503.557.8201 # 1/ 1
Electrical Permit Application 0 FOR 01 l E ONLY
City of Tigard
0 Received � Permit Na.: a _ )
• B l v d OR 'we ��� p: /B
�*
6 '' Phone: 503.639.4171 Fax: 503.59: • 60 J �0 M� , - ; Other Permit:
T1 G A R D inspection Line: 503.639.4175 \O � �S i �r�t9 Date Ready/By: ;arts: �,.� 1 See Page 2 for
Internet: www.ttgard or.gov \ Off{ t1\ Notified/Method: Supplemental Information
I TYRE`OF WORK �� .Q�� .. RLAN;REVIEW.',.:.
❑ New construction ® Addition/alteration/r,• L t: ment 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.
• : •: r_.. . : 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 pump. ❑ Other: P P 0 Installation of 75 KVA or
JOB SITE 'INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑Addition of uew motor load of ❑ °A ", "E ", "1 -2 ", "1 -3 ",
Job no.: 4789 Job site address: .8800 SW Commercial St
10011P or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: Tigard Or. 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Magno Humphries ❑ Service or feeder 600 amps or more.
TEE. SCHEDULE':
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1
e e gy, a
Limited n r , residential
67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family
Lighting Retrofit residential (with above sq. ft) 67.84 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
PROPERTY 'OWNER 1 ❑ TENANT 201 amps to 400 amps 133.56 2
Name: • 401 amps to 600 amps 200.34 2
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 installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
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 above service or feeder fee,
each branch circuit 7.42 2
Business name:
B. Fee for branch circuits
• Contact name: without service or feeder fee, 1 56 18 56.18 2
first branch circuit
Address: Each add'I branch circuit 1 . , 7.42 7.42 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR • Sign or outline lighting 67.84 2
•
Business name: Team Electric Company Signal circuit(s) or limited -
energy panel, alteration, or
Address: 9400 SE Clackamas Rd extension. Describe: Page 2 2
CitylState/ZIP: Clackamas Or. 97015 Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: (503) 557 -7180 Fax: (503) 557 -8201 Investigation per hour (I hr min) 66.25
CCB Lic.: 173043 Electrical Lic.: 3 -225C Suprv. Lic.: 4416 S Industrial plant per hour 78.18
% _ ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 4 ��� A _ �_ // _..,_-_, Subtotal: 63.60
Print name: Mike Trusheim Date: 11/30/10
Plan review (25% of permit fee):
_ / _ State surcharge (12% of permit fee): 7.64 /
Authorized signature: 7 /� / � TOTAL PERMIT FEE: 71■2 7)
- ��l� -�Y ---"'"
This permit application expires if a permit is not obtaiuedwithin 180
Print name: Mike Trusheim Date: 11/30/10 days after it has been accepted as complete.