Permit CITY OF TIGARD ELECTRICAL PERMIT
11111 COMMUNITY DEVELOPMENT Permit #: ELC2010 -00602
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/18/2011
Parcel: 2S112AD00900
Jurisdiction: Tigard
Site address: 14800 SW SEQUOIA PKWY
Project: Home Depot Subdivision: Lot: 0
Project Description: Electrical work associated with replacement of emergency generator.
Contractor: LIN R ROGERS ELECTRICAL CONTRACTORS Owner: THE HOME DEPOT
2050 MARCONI DR SUITE 200 2455 PACES FERRY RD.
ALPHARETTA, GA 30005 ATLANTA, GA 30339
PHONE: 770 - 772 -3400
PHONE: 770- 438 -8211
FAX: 866 - 220 -4646
FEES
Quantity Description Date Amount
1 ea Limited Energy 01/18/2011 $75.00
Specifics:
4 ea Services or Feeders - 200 01/18/2011 $402.80
amps or Tess
Type of Use: COM 1 ea Temp Services or Feeders - 01/18/2011 $59.36
Class of Work: ALT 200 amps or less
Type of Const:
15 crt Branch Circuits w /Purchase 01/18/2011 $111.30
Service or Feeder
Occupancy Grp: 1 ea 12% State Surcharge - 01/18/2011 $77.82
Electrical
Total $726.28
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 O • - '52 001 - 0090. You • ay ob • - - • , • p - rules or •' ect questions to OUNC by calling 503.232.1987 •r 1.800.332.23
Issued By: _ % .�. _ =�� Permittee Signature: i V ar ' i :.'
�� 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 ApplicatiR iECE ` °rD FOR OFFICE USE ONLY
C T 2 2010 Received / 2 /
City Of Tigard /O ( / p k, A,
ET. 13125 SW Hall Blvd., Tigard, OR 972 3 Plan Review / f ^ / �� 2 �
Phone: 503.639.4171 Fax: 503.59 Date/By: /� / i / (' G/ V Other Permit: e( v . /
T I GARD Inspection Line: 503.639.4175 C O TIGAIiD Date Ready /By: // r r
Permit No.: Qv CIXJ
Juris: El See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified /Method: 14 6l, o e 1 '��7 Supplemental Information
/ —lr7
y r o .... �.:.. YPE'OhriVe K r i s 4 - 1 e+ , "
❑ New construction ® Addition /alteration /replacement Please check all that a.. y (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
1 1 ' �s 11CO sOR1 I �O TS'141 , O s' k:
. exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
°` less to Eround, 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
- , - 36Emergency system. larger separately derived system.
iT i CAT '
_ w. ,i o f JO E I „ DLO F i, 5 M1 Addition of new motor load of ❑ "A”, "E", "1-2", "1-3",
I- 10OHP or more. occupancy.
Job no.: Job site address: w imp Sel Y uoie ?kW), ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: —T—Ii �d D 2 9 7223 0 Health-care facilities. 0 Supply voltage for more than
L ❑ Hazardous locations 600 volts nominal
Suite /bldg. /apt. no.: Project name: Herne De # '7 aDL ID Service or feeder 600 amps or more
I t F01$
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total I s
New residential single- or multi - family dwelling unit.
Se /UV /. a 'L-DA1� 2014 C2J til 1 Teri -mate- 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
%. s 3 ✓ (with above sq. ft.
�1 � �tS�ip1 , o�� IOW diesel e eri woR> / ;� ( q )
ESCRIP ION O
. ,; {7 " „ „ �: �.,, , ' Limited energy, multi - family
/Ce e � Go 'emL (41\e'" residential (w ft 75.00 G 2
Services or feeders ith above install atio
n, alteration, and /or rel
� N al new /GO e diesel see > c 1 200 amps or less (� 100.70 2
° � v ®.PROPERr OWNER )kR . 11, ( +gi q TENT . , ilpi 201 amps to 400 amps e 133.56 2
401 amps to 600 amps 200.34 2
Name:
jr__ H>arnv� 601 amps to 1,000 amps 301.04 2
Address: Zeiss Lies Frew - Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: AtI31,,ta- 3331 relocation
Phone: (170) q 33 _ 8'2 t I Fax: ( ) 200 amps or less 59.36 54, 3(, 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 1 68.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
above service or feeder fee,
"'-1 ' _. APPLIGANT� lgj }`CON]: 3r PERSON 7.42 11 .
p� r // ... �.,,,.. „, each branch circuit I S 111.30 2
3
Business name: L g . gh3e rs Elu l e, l C.o L S !ne • B. Fee for branch circuits without
J q service or feeder fee, first 56.18 2
Contact name: Dvu,it! CAJI Gr branch circuit
Each add'I branch circuit 7.42 2
Address:15b(s {N. vhisperae j �/in l 4 -. #130 Miscellaneous (service or feeder not included)
Y Each manufactured or modular
City /State /ZIP: 'Phoen ix, A Z g5i08S dwelling, service and/or feeder 67.84 2
Phone: (( Sit, . 73 10 Fax :: ( )
Reconnect only 67.84 2
I ' Pump or irrigation circle 67.84 2
E Du G
d Q lri(�erfdetrsz C.oni Sign or outline lighting 67.84 l9' 2
:tl Wj . C,ONT�RACTOR i
,
: .. .:- f ,. ' ..v, <.,, <�., „, �,,., „� <.. , , �t i -<: ,, .,„ ,, :�` Signal circuit(s) or limited- energy [' OO
Business name: Lin Iz - poyelrs EleG�r al C_D I r.ael—,rs /ne_. panel,alteranon,orextension. Paget 7J 2
/� L e Each additional inspection over allowable in any of the above
Address: 2050 A4,j,";," 1 Dr. Ste . 2 .60 Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: A lph i -elf 9 £ A 3oet,
Investigation plant 1 min) 66.25/ hr
� Industrial plant (I hr m in) 78.18/ hr
Phone: (7 7 7 7/„ . .. 3 ti I Fax: ($(A,) 2,p� gi,J(o Inspections for which no fee is 90.00 / hr
11$03S
specifically listed (% hr min)
CCB Lic.: � 4 Elec trical Lic.: 7�717G Suprv. Lic / ells ., f , y ELE PERMIT : „
/R « / �� / ) tI N / //3 2
Subtotal: 3 ,
Suprv. Electrician signaturere, , requi �/ '' t��� Plan review (25% of permit fee): � D
Print name: �ZN-1 M • P�e 1 l Date: 10_ i 4 _ to State surcharge (12% of permit fee):
TOTAL PERMIT FEE:
Authorized signature: • This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complet .
Number o inspections allowed per permit. ^72 .
1: \ Building \Permits \ELC- PermitApp.doc 07/01/10 440- 4615T(11/05 /COM/WEB / �(Y (
Electrical Permit Application - City of Tigard
- Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESTDENfiIAI:SMM,.O N Y '" lrka
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 „1�®RIs®I�ILY: ''
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
❑ Data Telecommunication Installation
•
❑ Fire Alarm Installation
•
❑ HVAC
❑ Instrumentation
•
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling /�
�✓ Other TephCG C.YNI'9CM� ie�er - Apr • Please- Ste_ L eitachei 3C�t. •Fibe-
J �J r” 1)."- 1 n ni,�70N •
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1: \Building\Permits\ELC- PermitApp.doc 07/01/10