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14 CITY OF TIGARD ELECTRICAL PERMIT
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:' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00208
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/21/2011
Parcel: 2S 102AA04100
Jurisdiction: TIGARD
Site address: 12230 SW MAIN ST 120
Project: Live Laugh Love Glass Studio Subdivision: Lot: 0
Project Description: Install subpanel and (7) branch circuits. 5/19/11, reprinted permit to include (2) branch circuits.
Contractor: AFFORDABLE ELECTRIC INC Owner: 3DM HOLDINGS INC
PO BOX 1870 12230 SW MAIN ST STE C
FAIRVIEW, OR 97024 TIGARD, OR 97223
PHONE: 503 - 351 -1078 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 04/21/2011 $100.70
Specifics: amps or less
7 crt Branch Circuits w /Purchase 04/21/2011 $51.94
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 04/21/2011 $18.32
Electrical
Type of Const: 2 crt Branch Circuits w /Purchase 05/19/2011 $14 84
Occupancy Grp: Service or Feeder
2 12% State Surcharge - 05/19/2011 $1.78
Electrical
Total $187.58
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 is -nce, or if work i suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility N. atio Center. Tho rules are set forth in OAR
952- 001 -0010 through OA' • 2- 001 -0090. You may obtain a co. of the rules �t questions to OUNC by , . ling 503 : -.198 or .800 3 32 7 2344.
Issued By�� ` %��- _ _ -i 'b Signatur• • '�< t"
A
•WNER INSTALLATION ON
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.
CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00208
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/21/2011
Parcel: 2S102AA04100
Jurisdiction: TIGARD
Site address: 12230 SW MAIN ST 120
Project: Live Laugh Love Glass Studio Subdivision: Lot: 0
Project Description: Install subpanel and (7) branch circuits.
Contractor: AFFORDABLE ELECTRIC INC Owner: 3DM HOLDINGS INC
PO BOX 1870 12230 SW MAIN ST STE C
FAIRVIEW, OR 97024 TIGARD, OR 97223
PHONE: 503 - 351 -1078 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 04/21/2011 $100.70
Specifics: amps or less
7 crt Branch Circuits w /Purchase 04/21/2011 $51.94
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 04/21/2011 $18.32
Electrical
Type of Const:
Occupancy Grp:
Total $170.96
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 appli .- •le law. All work will
be done in = • • - • e with app • • - • plans. This permit will expire if work is not started within 180 days of issuance, or if work is - pen • ed for more the 180
days. • ENTION: Oreg• • . requi you to follow the rules adopted by the Oregon Utility Notification Center. Those rules - e set forth in OAR
952-'11-0010 t• ugh OAR 9: r01 -0�: . Yo may obtain a cop of the rules or direct questions to OUNC by calling 503 987 or 1.800.'
Iss• - By: § :2.23•
/ r'
� Y Permittee Signature: 1 �.. — _ 4 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:
C• •R INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' f i INFO L / Date:
LICENSE NO.
Call 5' .639.4175 by 7:00 a.m. for the nex avail. e inspection date.
This permit card shall be kept in a conspicuous place on t • b site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigar Date /B Received � � Permit No.: . /` !/
.1 ° 131 25 SW Hall Blvd., Tigard, t97223, Cc
, x rs Plan Review
Q ' • Other Permit:
Phone: 503.718.2439 Fax: 503.5 81960 Date /By:
Ins ection Line: 503.639.417 '1 ` Q� 201 Date Ready /By: Juris. ® See Page 2 for
T I G A R D p Notified/Method: Supplemental Information
Internet: www.tigard- or.gov 0 pP
*gel
TYPE OF WORK s n . \� �c dt1A PLAN REVIEW
t ' t r ,.
v:.•
q +• . Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition 0 Other: '\\''' ❑ New construction ❑ Addition /alteraticiri eplacement
\lam`" ❑ Service or feeder 400 amps or more ❑ Building over three stories.
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 ❑ Commercial /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 - ", "I - ",
Job no.: Job site address: /h2 /y� I OOHP or more. occupancy.
/a 1 �� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ 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: Description l 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'I 500 sq. ft. or portion 33.92 I
Tax map /parcel no.:
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
- „ IA fy ( ) / rw / t residential (with above sq. ft.)
v 4 r t� by ( 1 r r 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
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 /11471( 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)
Ci /State /ZIP: Each manufactured or modular 67.84 2
h 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
Business name: C — d G 7 £ /ieCi C panel, alteration or extension. Page 2 2
/,
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed (%2 hr min) 90.00/ hr
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: Jy, /
Plan review (25% of permit fee):
Print name: ' Date: State surcharge (12% of permit fee): 1, -'l g
if TOTAL PERMIT FEE: P.W.
Authorized �(,/ /' This permit application expires if a permit is not obtained within 180
r days after it has been accepted as complete.
Print name:
l Date: S2Q /� * Number of inspections allowed per permit.
1:\ Building \ Permits \ELC- PermitApp.doc 07/01/10 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application FOR OFFICE FS ON L1
City of Tigard DateBea ,�alB Permit No.: 5/GC ,20(I 00x2
I N II • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit:
I I RI) Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK 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 ❑ Commercial /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 ", "l -2 ", "l -3 ",
Job no.: Job site address: f ZZ 3o � / I�4.) I00HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
g
City /State /ZIP: J ❑ Health -care facilities. 0 Supply voltage for more than
600 volts nominal.
f
❑H a zardous locations.
Suite/bldg. /apt. no.: i airoject name: zzie ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 6 ,,,,,, e! /G4/ Description I Qty. I Fee. I Total I "
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
.J.-1)-1,4-11 Slit /� / d Limited
residential (with a abod energy, mub e i sqq. . ft.)
75.00 2
�
L ^ Services or feeders installation, alteration, and/or relocation
C-1 2C A i 7 3 � 2 �7 � 1 6:= 'Om (..,A) t 200 amps or less / 100.70 /pd.) l 2
❑ PROPERTY OWNER I ❑ 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: ( ) I 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 0 CONTACT PERSON above service or feeder fee, f each branch circuit 7 7.42 61" 2 il
Business name: /� , „ / �,r� l/e 6/a;‘) B. Fee for branch circuits without
�c [,�+� `1 !.{ / service or feeder fee, first 56.18 2
Contact name: `, f i branch circuit
Each add'l branch circuit 7.42 2
Address: / 36 SW 014../4i Miscellaneous (service or feeder not included)
City /State /ZIP: ' B 87223 Each manufactured or modular 67.84 2
�, �i +clJ dwelling, service and/or feeder
Phone: (c4) z4. 7p/ I Fax: : ( ) Reconnect only 67.84 2
-- -7777 Pump or irrigation circle 67.84 2
E - mail: Z.it./< 1.....a. Z,p!/p 644s S 6.41 ,4-j Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name:
% A-Lly e panel, alteration, or extension. Page 2 2
c Each additional inspection over allowable in any of the above
Address: p° D l ') 0 Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: I l Investigation (1 hr min) 66.25/ hr
n� `" 1 ! Industrial plant (1 hr min) 78.18/ hr
Phone: ( r I__ I Fax: (.,/ ) /D X /' 3 Inspections for which no fee is 90.00 / hr
W !/ specifically listed (%s hr min)
CCB Lic.: e E l ectrical Lie.: trv Lic.: _ ` (0 S ELECTRICAL PERMIT FEES
Subtotal:
Suprv. Elec - / 1. &nature, required: _, �� r a
� 1V:IL , A , A/// Plan review (25% of permit fee):
Print name: J " R t , ,� � r 01 Date: ' /I I State surcharge (12% of permit fee): /� �^
' 1 TOTAL PERMIT FEE: / 70 v 96
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\ Building \Pennits\ELC- PermitApp.doc 07/01/10 440- 4615TO1/05 /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*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ 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
n Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ 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: \Building\Permits\ELC- PermitApp doc 07/01/10