Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00177
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/06/2011
Parcel: 1S136CA01600
Jurisdiction: Tigard
Site address: 11655 SW PACIFIC HWY
Project: Raz Transportation Subdivision: Lot: 0
Project Description: (1) branch circuit.
Contractor: LA LONDE ELECTRIC LLC Owner: RAZ TRANSPORTATION
PO BOX 2220 11655 SW PACIFIC HWY
ESTACADA, OR 97023 TIGARD, OR 97223
PHONE: 503 - 969 -8491 PHONE: 503-684-3322
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 04/06/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/06/2011 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 rule adopted by—the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OA' • 52- 001 -0090. Yo •• • - •• • • of the rue t que-tions to OUNC by calling 503.232.1987 or 1.800.332.2344.
f / �
Issued By: s0 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.
04/05/2011 07:26 5036308513 ESTACADA SCH DIST PAGE 01/01
.E.J.rcuricat .rermit A Iication
FOR OhFiC iC Ii•SE ON'l,1'
City of Tigard Received
13125 SW Hall Blvd., Tigard, OR 972x23 Date/I3 ; Permit No,;
al' )'hone; 503,639.4171 Plan Review
Pax: 503,598.1960
Date/Hy: Oncer.Perntic
9,4175
Date Ready/ET
I if.; n it p
FM inspection Line; 503,63
Internet; www.tig 03,63,gov Ready/ET Notified/Method S e ge 2 far t 9appleme t
. TYPE OF WOC
Ncw eon structjon Add ition lteration /re iacemcnt pLAr! R VI pla
Demolition tI�--t p Please check all that apply (submit $ seC9 ofphha w /items c hecked below):
r� Other: ❑Service or feeder 400 amps Or more ❑ Building over three stories.
CATEGORY OF CONSTRUCTION — .. where the available fault current ❑ Marinas and hoatyards,
El I -and 2, _ exceeds to,0oo amp at ISO volts or ❑ Floating buildings.
familydwciling mercial /Industrial — amps gr alloth rins 0
Accessory building El Colnmereial -ose agricultural
� Multi - fatally [] Master builder } -- t amps for all other installations, buildings, 0 Other: ❑ Firepomp,
JOB Si __ INFORMATION —� ID Installation of 75 KVA or
AND LOCATION ❑ E mergency system, larger separately derived c
Job n0.:
l OnHP ❑ Addition anew motor load of yam
Job site address: _ or more. A» nc
�`� occupanc
City /State/ZIP: 116 Ss ❑ 3ix or mom residential units, ❑ Recreational vehicle parka,
G i i C � f CI licalth -care facilities, ID Supply voltage for more than
Suite/bldg./apt. n0,: 0 Hazardous locations. 600 volts nominal -
Project name: , z r _ ❑ Service or feeder 600 amps or more.
—
Cross street/directions to job site: fi - • PEE JCETFDU
treacti. a
New residential single- or multi -far dwelling nit �.t
Subdivision: ^ � IncIudcs attached garage.
_ Lot no.: .1,000 sq. ft. or less
Tax tnap /parcel no.: �� lase. add'l 500 sq. ft portion 4 "
�~ Limited energy, residential 33.40 I
� DESCRIP OF 'WORK •
with above s . R. 75.00 MN 2
- idltr5, � P 1►� Limited energy, multi - f amil y
residen with ab ove . , ft. 75,00 2
Services or feeders installation, alteration, and /or relocation
a' P1OPE$TX OWNER. TENAN 200 amps or lees 80.30 2
Name: h. T _ _�� 201 amps to 400 amps . 106.85 2
• _ Wit _, 401 amps to 600 amps 1
Address: _ - 601 amps to 1,000 amps 240.60 2 IM 2
Over 1,000 amp or volts
454 NM 2
Temporary services or feeders Installation, alteration, sad/or
Phone: ( ) - relocation
Fax: ( ) 200. 201 Owner installation: tarps or less 66,85 1
intended for sale, lea rent, orle being
ording to ORS 447, 10030 2
449, 670, and 701 not 401
Owner signature: amps to 599 amps 133,75 2
Date:
------ Branch cirraita - new alteradon, or extension, per anel
API )(CANT A. Fee for branch circu with -
0 CONTACT PERSON above service or feeder fee,
Business name: �O,'.1 • r� — cacti branch circuit 6.65 2
Contact name: G B. Pee for branch circuits
w 4 Z , 1).4. without service or feeder fee,
Address. _ f rscbranch circuit • �'s( I • 2
Each add'! branch circuit 6.65 !
Cj1y /State/ZiP; �� s _Miscellaneous (service or feeder not Include) ?
Phone: ( ) _ Hach manufactured or modular
Pax: : ( ) dwelling service and/or feeder _ 90 2
E-mail: Reconnect only 66.85 2
CONTRACTOR 53. Pump or irrigation circle 53,40
Sign or outline lighting 2
2
Business Warne:
"' i ��r YR i Signal circuit(s) or limited..
Address: enemy panel, alteration, or
• 2 .40 extension. Describe: Page 2 2
City/State /ZIP: ,57-, a CO. 1 -207- 3
Each additional Inspection over allowable in any of the above
Phone:) g _ t�4'a7 1 Fax: ( ) A Per inspection _ 62.50 -`
)4 . Investigation per hour (1 hr min) 62.50
CCB Lie.; i -7 T 4, 1 Electrical Lie.: 7 C. Suprv_ Lie.: 'earn "x industrial plant per hour 7175
Suprv. Electri :(t, are, r aired: • ELECTRICAL PE , •
eQ X Na- ',,' PERMIT. FEW
Su btotal: < <�`
Print name: �•�^ -
! ,i ce c , o t,,t,tr Date: -'► _ Plan revie per mit fee): -
� State surchargefflarapermit fee): ,
Authorized signature: - {�� -
�' •i TOTAL PERMIT FEE; /� 41 L
Print name: S h ,•..e__ LAI Date; ' - "'3 ( - Thb permit application expires If: permit is not obtainedwith no
days after it bar been accepted .a complete,
I kaundlntt\Perm itnIPL,GPennit 0512Y06 ' Number of inspections allowed per permit.
.14n I 5T(11/0 s/COM/WEB