Permit CITY OF TIGARD ELECTRICAL PERMIT
111 COMMUNITY DEVELOPMENT Permit #: ELC2010 -00714
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/27/2010
Parcel: 2S101 AD01000
Jurisdiction: Tigard
Site address: 12703 SW 67TH AVE
Project: Open Windows LLC Subdivision: WEST PORTLAND HEIGHTS Lot: 33
Project Description: Electrical for TI.
Contractor: NIXON ELECTRIC CORP Owner: OPEN WINDOWS LLC
PO BOX 68569 4900 SW MEADOWS RD #100
PORTLAND, OR 97268 LAKE OSWEGO, OR 97035
PHONE: 503 - 654 -8841
PHONE: 503 -496 -5790
FAX: 503 - 345 -3503
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 12/27/2010 $63.60
Specifics: Service or Feeder
1 ea Signal circuit or Limited 12/27/2010 $75.00
Type of Use: COM Energy Panel
Class of Work: ALT 1 ea 12% State Surcharge - 12/27/2010 $16.63
Electrical
Type of Const:
Occupancy Grp:
Total $155.23
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. '52- 001 -0090. You may obtain a copy of direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: .� �`�J� Permittee Signature: j
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.
12/23/2010 02:27 5033453403 . CEIVEL) N I XON ELECTRIC #1060 P.002/003
Electrical Permit Applicat tl ) FOR OFFICE I SE ONLY
City of Tigard ee ��
DEC 2 3 2010 P at Rec dB ivd : I r , . �_
13125 SW Hall Blvd., Tigard, OR 972 Plan Review
Phone: 503.718.2439 Fax: 503.598 0 p Other Permit: l h l Q
t i c A RD Inspection Line: 503.639.4175 C ITY OF TIGARD
Date Ready/By: 0 See age 2 for
Internet_ www.tigard- or.gov BUILDING DIVISION Notified/Method: riM Supplemental information
• TYPE OF WORK PLAN REVIEW • •
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets of plans wiitems checked below):
❑ Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
1 - and 2 dwelling less to ground, or exceeds 14.000 ❑ Commercial -use agricultural
} g ® 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 AM) LOCATION ['Emergency system. larger separately derived system_
_ ❑ Addition of new motor load of ❑ "A ", "E". "1.2 ". "1 -3 ",
Job 100111' or more. occupancy.
ob n0.: Job site address:
/ a O sw 646
4{' • ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /Z1P: '7
__ Q in 4 z Z. 3 ❑ Health -care facilities. ❑ Supply voltage for more than
r u 12 Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: P roject name: ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Description l Qty. I Fee. I Total l '
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? SOU sq. R or portion 33.92 1
DESCRIPTION OF WORK Limited energy, �
(with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
SYna ii T' -yam residential (with above sq. ft)
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 /$ta[e/Z1P: 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
201 amps in 400 amps 125.08 2
g property that 1 own which is not
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, r panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ( ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: • B. Fee for branch circuits without
service or feeder fee, first
z
56.18 s6.
Contact name:
branch circuit I �y
Each add'I branch circuit J 7.42 — 4.. Liz, 2
Address: Miscellaneous (service or feeder not included)
City /Stet. /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
Signor outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-energy
CGTt') L panel, alteration, or extension. / Page 2 2
r1 L
Business name: /14 1e O / )
Each additional Inspection over allowable in any of the above
Address: , ,3 bat 657 5 / 9 Pa e ill a n G/ (7 6C q -- z6f j Additional inspection (I hr min) 66.25/ hr 9 ()3 Industrial (1 lr min) 66.25/ br
City/State/ZIP: 11 L. 3
�3
/y/i Industrial plant (t hr min) 78.18 / br
Phone: (30J) GJq -- g 6 i Fax: & p7) 39 - 35 ) Inspections for which no fee is
specifically listed (V5 hr min) 90.00 / hr
CCB Lie.: I q i / Q Q i Electrical Lic.:G /,p // j Suprv. Lic.: 3 / g - S ELECTRICAL PERMIT FEES
Suprv. Electricidn'si afi re, require 7 / �� Subtotal: 3 8.54
Plan review (25% of permit fee):
Print name: C , G ti Date: / I / 1 ! D ,s tate surcharge (12% of permit fee):
•J I TOTAL PERMIT FEE: J S5• a„a
Authorized signature: This rmit
pe application it h as Aires if a permit aaxp is as not obtahred
complete. within 180
y after been
Print name: Date:
• Number of irrs peetions allowed per permit.
1:\ Building \Pamila`E.C- PermirApp.doe 07(01)10 4104615r(11/05/COM/WEB •
12/23/2010 02:27 5033453403 NIXON ELECTRIC #1060 P.003/003
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:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
•
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
V ] Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
L' 1Buildigg ■Permits\ELC- PemNtApp.doc 07101/10