Permit ri CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00097
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/17/2011
Parcel: 2S 110AA00700
Jurisdiction: Tigard
Site address: 14030 SW PACIFIC HWY
Project: TIGARD 76 Subdivision: Lot: 0
Project Description: Disconnect to propane pump.
Contractor: E C COMPANY Owner: KHAN OIL LLC
PO BOX 10286 2919 BEACON HILL DR
PORTLAND, OR 97296 WEST LINN, OR 97068
PHONE: 503 - 224 -3511 PHONE:
FAX: 503 - 295 -3012
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 02/17/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/17/2011 $6.74
Type of Use: COM Electrical
Class of Work: ALT 1 ea Plan Review Electricial 02/17/2011 $14.05
Type of Const:
Occupancy Grp:
Total $76.97
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 952- 001 -0090. You may obtain a c o s or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B . !/0; <�c''
y: Permittee Signature:
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.
Feb. 15. 2011 11:21AM No. 8860 P. 1/5
Electrical Permit Application .f.- role ')I I'I( I. I �h: ("1.1
City of Tigard ' Received:
III
r 13125 SW Hall Blvd., Tigard, OIft�97223' , II '' " ri% \ PIso.Review Pemr No. Z���/ C Ow
_ Phone: 5 Fax: 503.548060 l v p 111 %1 `j4ti Other Permit: I C : \ R D Inspection Line: 503,639,4175 `,.lv Ready/By. ht's: 0 See Page 2 for
Internet: www.tigard-or.gov � � ( 4v \ �)� \NonBedMethod: l ill Supplemental Information
\ - .1 \7 '
TYPE OF WORIf A1, •., � PLAN REVIEW . . .
•
❑ New construction E Addition / alteration /repin tent Please check all that apply (submit 2 sets of plans w /items checked telow):
�Vv" ❑ Service or feeder 400 amps or more ❑ Building ova throe stories.
:I Demolition [3 Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or ❑ Floating buildings.
lass to ground, or exceeds 14,000 [ ] Commercial-use agricultural
❑ 1- and 2- family dwelling ® Commercial/industrial 0 Accessory building amps tdr all other installations, buildings.
❑ Multifamily ❑ Master builder i_.I Other: ❑ Fite pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived system.
. - ❑ Addition of new motor load of ❑ "A ", `E", "1 -2 ", 1-3 ",
Jobno.:7110 -09 Job site address: 14030 SW Pacific Hwy So moue ectrp�y.
❑ Six or mgors raeiderttial units. ❑ Recreational vehicle parts.
Ciry/ Tigard OR 97224 ❑ Health-care hcilities. 0 Supply voltage for more than
- ® Hazardous locations. 600 volts nominal.
Suite/bldg./ apt. no.: Project name: Arne r i ga s - C i rc 1 e K 1:1Service or feeder 600 amps or more.
FEE SCHEDULE.'
Cross street/directions to job site: umenoOOn I oh. I Fee. ] Toms - - 'f-
Now residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.:
1,000 sq. ft. or less 168.54 _ 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sQ. ft.) 75.00 2
Limited energy, multi - family 75.00 2
Install disconnect to propane pump residential (with above Sq. ft,)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
® PROPERTY OWNER L 0 TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 snips 200,34 2
Name: .
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 Snips 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 z
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 imps to 599 amps 168.54 2
_ Branch circuits- new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
Kt APPLICANT I ❑CONTACT PERSON above service or feeder fee. 7.42 2
each branch circuit
Business name: BC Comp any B. Fee fbr branch circuits without
service or feeder fee, first 1 56.18 56 . 18 2
Contact name: Kathy Kelley branch circuit
Each add'I branch circuit 7.42 2
Address; Pp Box 10286 Misceilaneons (service or feeder not Included) - _ '
City/State/ZIP: Each manufhctured or modular 67.84 2 :
Portland, OR 97296 dwell n% service and/orfeeder
Phone: ( 5 0 3) 224-3511 Fax; : (503) 295-3012 Reconnect 67.84 2
-- Pump or irrigation circle 67.84 2
E -mail: kathyk @e - c - co , Com Sign or outline lighting 67.84 2
•
CONTRACTOR Signal circuit(s) or limited- energy -
Business )tame: EC Company panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in an,of the above
Address: PO Box 10286 Additional inspection (1 hr min) 66.25/ hr
P ortland, O R 97296 investigation (I hr min) 66 ...
City /State/ZIP: Industrial plant (1 hr min) 78.18/ hr .
Phone: (5 03) 224 Fax: (503) 295-3012 Inspections for which no fee is
r d ('h br ruin) 90.00/ br
CCB Lie.: 49737 [ Eleetri le.: ` spccificall� list
6 5 C .5 FEES Suprv. Lie.: 03Y $ ELECTRICAL PERMIT
f Subtotal; _ 56 ,18
Suprv, Electrician signature, required: Plan review (25% of permit fee): , %,- \ ,
Print name: Ron Coffman Date: 2/15/2011 State surcharge (12% of permit fee): (Q .'
Authorized si ~ TOTAL PERMIT FEE: l.9 `
r _ This permit application expires if a permit is not obtained within 180
Print name: Andrea Stinger Date: 2 5/2011 days after It hero been accepted as complete. •
• Number of inspections allowed per permit.
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CITY OF TIGARD
Approved [% ]
Conditionally Approved [ ]
See Letter to: Follow [ ]
Attached [ ] CLASS 1 DIV 1 GROUP 0
Permit Number: ELL30 • DO091 WIRING METHOD
Address: 14 O 30 5 vJ PA c4 - L A YJ y
By: & L■ Date: V 17 • U EMERGENCY STOP
MAINTAINED MUSHROOM PROPANE
120V HEAD SWITCH PUMP
2OA CKT
Fri RUN
SWITCH
7 SEAL —OFF �1
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$ I 1
co — SEAL —OFF
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OFFICE COPY
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CIRCLE K STORE + GAS STATION TIGARD
---_- €C AMERIGAS PROPANE DISPENSING TANK ELECTRICAL
14030 SW PACIFIC HIGHWAY
2121 NW THURMAN ST
` TIGARD OR 97224
±' PORTLAND OR 97210 SHEET NO.
503 224 -3511
OREGON ELECTRICAL SUPERVISOR DATE: 14 FEg11 XS�G ER:
�— RONALD COFFMAN JOBg ESK-1
711002 -09 SCALE: —
a, LICENSEE' 2345S nEscRiPnoN: ELECTRICAL LAYOUT AND ONE —LINE