Permit CITY OF TIGARD ELECTRICAL PERMIT
1111 2 C OMMUNITY DEVELOPMENT P ermit #: ELC2011 -00137
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/15/2011
Parcel: 1 S136CD01001
Jurisdiction: Tigard
Site address: 11747 SW PACIFIC HWY
Project: Chevron Subdivision: Lot: 0
Project Description: Replace panel with like kind.
Contractor: NORTHWEST PUMP & EQUIPMENT CO Owner: CAIN PETROLEUM INC
2800 SW 31ST AVE 4512 SW KELLY AVE
PORTLAND, OR 97210 PORTLAND, OR 97239
PHONE: 503 - 227 -7867 PHONE: 503 - 546 -3535
FAX: 503 - 205 -1465
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 03/15/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 03/15/2011 $12.08
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
Required Items and Reports (Conditions)
This per ' is issued s.:' -ct to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be do = in accordance with - pprov - • plans. This permit will expire if work is not started within 180 days of issuance, or if wor ' uspended for more the 180
days. ATTENTION: Oregon : . req e you to follow the rules adopted by the Oregon Utility Notification enter Thos -. a set forth in OAR
952- thr ugh OAR 95 11 1 -0• 'r. Y.0 may obtain a co • of the rules or direct questions to OUNC by calling • .2 : 987 , r 1.800 �� -
� /' c. ��
Iss , -d By: t � 0 / / Permittee Signature: /� _I offi., �
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:
L y y�,, • R INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' - - ,%17: 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 Applicatin * CEjVED FOR OFFICE USE ONLY
City of Tigard Date/B e �
13125 SW Hall Blvd., Tigard, OR 972238 1 5 2011 Plan Review 6�� _ Permit No.:cfGCa (10/57
' . Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit:
I I t . . A 1: I Inspection Line: 503.639.4175 � - r ' OF TIGARD Date Ready/By: Juris: VI See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
F1 ,DING DIVISION
TYPE ORK PLAN REVIEW
❑ New construction p 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 p
❑ 1- and 2- family dwelling p Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or "F)
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. t
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "l -3 ", ,....
Job no.: Job site address: 17 'i'1 61 1-1-11 9 el Six or or more. occupancy.
❑
J ❑Six or more residential units. Recreational vehicle parks. t
City/State /ZIP: na (( O� El Haz Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
/ FEE SCHEDULE
Cross street/directions to job site: C�/t hr0 � 6 , / _ 4 , 5 r 4 0 t 1 Description 1 Qty. Fee. I Total I *
\\\/// fGi v\/ 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'l 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.)
tPc..9 P ' ` 4- ` 1 i 1 (w ktr w Limited energy, multi-family
iq. 75.00 2
,� arv>✓ w t 1 l l I residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less I 100.70 )c0.7 2
❑ PROPERTY OWNER I ❑ 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
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
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 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:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
N al-1 v � n panel, alteration, or extension. Page 2 2
Business name:
?)IAA.. c>te it Each additional inspection over allowable in any of the above
Address: c4 O �? �' S . 1 Additional inspection (1 hr min) 66.25/ hr
Ci /State /ZIP: ( q ` 1(� Investigation (1 hr min) 66.25/ hr
ty (� `Q 00 + 0,p ( / ` ` ' Industrial plant (1 hr min) 78.18/ hr
Phone: 6(3 5 118 Fax: ( S ( >3 Do 61 Li (4 Inspections for which no fee is 90.00/ hr
specifically listed (%2 hr min)
CCB Lie.:( Electrical Lic.. Suprv. Lie.: Lic.: ELECTRICAL PERMIT FEES
r Subtotal: 16(') .. lJ
Suprv. Electrician signature, required: , _ ../, . .
° 7
1 L Plan review (25 /o of permit fee):
Print name: } , 1 ' 0_,,, tJ 0 ( Date: State surcharge (12% of permit fee): 9 } { ( TOTAL PERMIT FEE:
Authorized signature:
This permit application expires if a permit is not obtained within 1 0
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit.
I:Building\Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(11/05 /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:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
❑ 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
n Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I PermitApp.doc 07/01/10