Permit CITY OF TIGARD ELECTRICAL PERMIT
111 4
s . COMMUNITY DEVELOPMENT Permit #: ELC2011 -00107
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/23/2011
Parcel: 2S112AC01800
Jurisdiction: TIGARD
Site address: 15055 SW 72ND AVE
Project: Pacific Pride Subdivision: FANNO CREEK ACRE TRACTS Lot: 46
Project Description: Install new LED lighting for canopy.
Contractor: NORTHWEST PUMP & EQUIPMENT CO Owner: PETROCARD SYSTEMS INC
2800 SW 31ST AVE 730 CENTRAL AVENUE SOUTH
PORTLAND, OR 97210 KENT, WA 98032
PHONE: 503 - 227 -7867 PHONE:
FAX: 503 - 205 -1465
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 02/23/2011 $78 44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/23/2011 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
Required Items and Reports (Conditions)
This per . subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be • e in accordance • approved •fans. This permit will expire if work is not started within 180 days of issuance, or if • • susp- •ed for more the 180
da s. ATTENTION: Oregon -w -qui es you to follow the rules adopted by the Oregon Utility Notification Center. �--+••' r are set forth in OAR
9'r- 001 -0010 t L ough OAR 952- 9.1 -009r • may obtain a c..y of the rules or direct questions to OUNC by calling 503.232.19: • i:�. 2344.
•
Is ed By: l■_ `I L I.. .4 L/ Permittee Signature: "g fV
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 ApplicationRECEIV D FOR OFFICE I. SE ()NIA
CI of Tigard E � ! Received ��a Permit No.:
13125 SW Hall Blvd., Tigard, OR 972237r D , Plan Review
' 111 Phone: 503.718.2439 Fax: 503.598.1966 Date/B : Other Permit:
I WARD
Inspection Line: 503.639.4175 Date Ready/By: ® See Page 2 for
Internet: www.tigard- or.gov ° 1 ! z 111- .1 a Notified/Method: Supplemental Information
� i�i i J G DIVISION TYPE OF Wf3RIC JM V PLAN REVIEW
❑ New construction Addition/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 C ommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: I SO. S` SI� 7 2 Six
❑ Six or or or more. occupancy.
more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: T + r ,,,,, (fit Z n ❑ Health -care facilities. 0 Supply voltage for more than
I ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: (Project name: . , 1►-) e, b a ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I 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
Ea. add' 1 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
I
t Limited energy, multi - family 75.00 2
T(/S j a I / � n , � ' L L a r � v ( I - `aU
t , _ / residential (with above sq. ft.)
U 1 7 Vl V ( 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
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
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
fEr APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
1 B. Fee for branch circuits without
N
Business name: , 1 ,'� R (A el .( t- serv or f ee r f ee, first � 9. A J feeder
56.18 �G •!� 2
Contact name: We , branch circuit
3 I sr edder 3 7.42 2 ( � 2
Address: `� t!/1v\ Miscellaneous cellann eous ous (service or feeder not included
City /State /ZIP: PO� r"
C M r 7a Each manufactured or modular
� dwelling, service and/or feeder 67.84 2
Phone: (503 ) � 7� off Fax: : (603) a I(.I % Reconnect only 67.84 2
P 1 • c u <n1,T •e it e, /I t . (O,,� Pump or irrigation circle 67.84 2
E -mail: n
I _ Sign or outline lighting _ 67.84 2
CONTRACTOR _ Signal circuit(s) or limited - energy
Business name: Air) � �'- D� . .L A ; �� � panel, alteration, or sp tension. Page 2 2
I V ! / Each additional ins ection over allowable in an of the above
avi 1 �W --3/ 1r A - . Additional inspection (1 hr min) 66.25/ hr
/J j Investigation (1 hr min) 66.25/ hr
City /State /ZIP: a + 0 !�` O 70.10 Industrial plant (1 hr min) 78.18 / hr
Phone: (t)3) 2 z7-70 , I Fax: Q3) r t y , � Inspections for which no fee is
G specifically listed ( hr min) 90.00/ hr
CCB Lic.: Cf '7 Electrical Li G . g ! . Lic.: D g ELECTRICAL PERMIT FEES
r
%/� , / / g Subtotal: t. ? $ .
Suprv. Electrician signature, required:`' S f A ve ei , - it (25% r E - Plan review (25 /o of permit fee):
Print name: l • N _ t Date: a, 23 I( State surcharge (12% of permit fee): Q . 4 I
Authorized signatur J' TOTAL PERMIT FEE: q 1. $ s-
This permit application expires if a permit is not obtained within 180
int name: �Jl Date: / * day after it has been accepted as complete.
Pr
fi � G.� a ` 3 ( (� Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(l1 /05 /COM/WEB
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*
n Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10