Permit . q CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00045
Date Issued: 01/20/2011
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TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S112AD00900
Jurisdiction: Tigard
Site address: 14800 SW SEQUOIA PKWY
Project: The Home Depot Subdivision: Lot: 0
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Project Description: (2) branch circuits for generator
Contractor: HILLSBORO ELECTRIC LLC Owner: THE HOME DEPOT
21185 NW EVERGREEN PKWY #110 2455 PACES FERRY RD.
HILLSBORO, OR 97124 ATLANTA, GA 30339
PHONE: 503 - 439 -9666 PHONE: 770- 438 -8211
FAX: 503 - 601 -3680
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 01/20/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/20/2011 $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 OA 52 -0' -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B , f �`�- -- Permittee Signature: , - ,D i ` /C/9-- 7 0A l
Y�
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.
From:Hillsboro Electric,LLC 5036013680 01/19/2011 02:31 #024 P.002/002
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Electrical Permit Applic tioP I'OR OH.i is r L Se 0NL
Cl of Tiark If- L f 1, 1E Recav �
' :. • `J p tl Date/B . / vz; // � Permit No / �1.r _n '�n C
1312 Hall Blvd., Tigard, O ��QQ 2 Plan Review L °� /f /! !/V .�7
Phone: 503.639,4171 Fax: 503b001960 2011 DateB Other Permit:
1 i J A 1 6'j Inspection Line: 503.639.4175 r ]n Date Ready/By: Joris 63 See Page 2 for
- Internet: www.tigard- or.gov. CITY OF TIGA 1D Notified/Method: ,, Supplemental Information
TYPII;7 PLAN REVIEW
❑ New construction ?5,1ddition /alteration replacement
Please check all that apply (submit 2 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,
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 yf Commercial /industrial ❑ Accessory building amps for all other Installations buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "lt ", "I -2','y _3 ^,
Job site address: uC��� ,' ' ; Six or or mote. occupancy.
Job no.:
k (] , t lJ�12i� K.W \•-k ❑ Six or more residential units. ❑ Recreational vehicle parks
City /State /ZIP: t I �C, 1 c c ' l - ❑ Health-care facilities ❑ Supply voltage for more than
lCr L... ❑ Hazardous locations 600 Dolts nominal.
Suite/bldg. /apt. no.: Project name: \._viD ticD2 : vv .It, , ' ❑ Service or feeder 600 amps or more
�" FEE SCHEDULE
Cross street/directions t0 job site: Description I Qty. I Fee. 1
T otal
New residential single- or multi- family dwelling unit.
Includes attached garage,
Subdivision: Lot no.: 1,000 sq. ft or less 168.5 4
Ea, add'I 500 sq. ft. or portion 33 92 1
Tax map /parcel no.: Limited energy, -
gy, residential 75 00 3
DESCRIPTION OF WORK (with above sq ft.)
' Limited energy, multi- family 75 00 2
4 I r \�� ____._._ residential (with above sq ft )
Services or feeders installation, alteration, and/or relocation
200 amps or less _ 100,70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552 26 2
Temporary services or feeders installation, alteration, and /or
City /Slate /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59 36 1
400
Owner installation: This installation is being made on property that I own which is not 201 amps to 599 amps 125.08 12
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 I i t 2
Branch circuits - new, alteration, or extension, perpanel
Owner signature: Date: A Fee for branch circuits with
above service or feeder fee
❑ APPLICANT ❑ CONTACT PERSON fee,
7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
— - service or feeder fee, first l 56 I S 5�, 2
I � branch circuit
J
Contact name:
— Each add'! branch circuit I 7.42 1. 49,... 2
Address: 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
- Pump or irrigation circle 67.84 2
E -mail:
�. __ -- Signor outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
panel, alteration, or extension. Page 2 2
Business name: Hillsboro Electric, LLC Each additional inspection over allowable in any of the above
Address' 21185 NW Evergreen Pkwy #110 Additional inspection (I hr min) 66.25/ hr r
City /State /ZIP: Hillsboro / OR 97124 �_ Investigation plant 1 hr 66.25/ hr
__ -_ Industrial plant (1 hr min) 78.18/ hr
Phone:( 503 439 -9666 Fax: (503 /01 -3680 Inspections for which no fee is
V 90.00 / hr
CCB Lie.: 1 3 4 4 81 Electrical Lie.: 34-499C Suprv. Lie.: tic Y /s V i specifically listed (%: hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: ' V / ` _ Subtotl: (o3.(p(� ^
vvviii Plan rertiew (25% of permit fee): / '
Print name: Date: .. \ O , `` State surcharge (12 %ofpermit fee): -1. ,`�
TOTAL PERMIT FEE: '.t .
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 \w m
lding\ernsiELC- PermitApp doe 07/01/10 440 -461 ST(I l /05 /COM/WEB ��� ��
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