Permit q CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00216
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/27/2011
Parcel: 1 S136CD01001
Jurisdiction: Tigard
Site address: 11747 SW PACIFIC HWY
Project: Chevron Subdivision: CITY BIBLE CHURCH Lot:
Project Description: Sign lighting and (3) branch circuits.
Contractor: KRONSBERG ELECTRIC INC Owner: CAIN PETROLEUM INC
PO BOX 1416 BY CAIN, RON
REDMOND, OR 97756 4512 SW KELLY
PORTLAND, OR 97239
PHONE: 541 - 923 -4664 PHONE:
FAX: 541 - 504 -4644
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 04/27/2011 $71.02
Specifics: Service or Feeder
3 ea Sign or Outline Lighting 04/27/2011 $203.52
Type of Use: COM 1 ea 12% State Surcharge - 04/27/2011 $32.94
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $307.48
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 - • • - - • • of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: /�L'!i Z 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.
E D •
lectric�l Permit Application ` 1 ( ( "(mot I I ( 1, 1 S i• um
City of Tigard , (LO Permit No.: _ ` .
1111 ' R. a.} 1 " 13125 SW Han Blvd., Tigard, s ;" ,C et % QS) Plan Review Permit. _ /`•
Phone: 503.718.2439 Fax 50 . .: ' • t 0, . O " D : Other
1 I , i „ iapeetion Line: 503.639.4175 PQ eC-_' .�j Date ReadyBy: RI See Page 2 for
. Internet: www.tigard O [ Q` Notified/Method: `/ Supplemental information
2 s , , t, _ . YY.ati i0
6 , ` • PLAN REVIEW •
❑ New construction * Addition/alterationihal�ltent Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stones.
El Demolition
❑ Other: where the available fault current ❑ Marinas and boatyards.
P .. r� , , ��� , •. -. exceeds 10,000 amps at 150 volts or 0 Floating buildings.
, « � �, less to gmlmd, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multifamily ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
['Emergency system. larger separately derived system.
... ❑ Addition of new motor load of ❑ "A', "E ^, °1-2" "1 -3 ",
100HP or more. may.
Job no.: Job site address: ,/ 747 X14 .494,---/e Hag ❑ six or more ❑ Recreational vehicle parks.
City/State/M: ❑ Healthcare facilities. ❑ Supply voltage for more than
L �YJ ��� ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I r P roject name: ❑ Service or feeder 600 amps or more.
FEE SCHED
Cross street/directions to ob site: rker;Pa.a 1 Qh . I E
1 Fee I Tool i ' _
New residential single• or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
En. add'1500 sq. R or portion 33.92 1
Tax map /parcel no
_ Limited energy, residential
r " +` v n ' ,p d 'DESa1/1470N F WORIK (with above sq. ft.) 75.00 2
Limited energy, multi - family
�4 //n G 6l�iedx✓ > residential (with above sq. ft.) 7s.00 2
----
�'�" ` Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
1� ( ii) } ,, ' :. 201 amps to 400 amps 133.56 2
401 atmps to 600 amps 200.34 2
Name: V AQ.. / Q���4(fr_/ 601 amps to 1,000 amps 301.04 2
Address : i 7�/ o ,,Iiii d` , S/ )9/r Over 1,000 amps or volts 552.26 2
7 4;t i' 9 7�� Temporary services or feeders installation, alteration, and/or
Cit relocation
Phone: (23) . 2/ _nI Fax: ( ) 200 amps or less 59.36 1
Owner installation: This on is being made on property that I own which is not 4 01'amps to 400 sumps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. oi amps to s99 amps 168.54 2
Brand circuits — new, alteration, or extension, per paned
Owner signature: Date: A. Fee for branch circuits with
i
x . r t; f " w j r f? t l s, 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 .e✓! 2
Contact name: branch circuit .�
Fart add'l branch circuit . 7.42 , `, 8 1 2
Address: Miscellaneous (service or feeder not included)
City /State /ZIY: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) I Fax :: ( ) Recomiect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
;,� Sign or outline lighting 3 67.84 >j, , 2
' ✓. . . , Siglal circuits) or hmlted- energy
Business name: , panel, alteration, or extension. P: • 2 2
�''✓ °����� ! CQ' �+ l�� Each additional inspection over allowable in any of the above
Address: �,Q 4 M,1 / 4, Additional inspection (1 hr min) 66.25/ hr
M( 9� .7 Industiatpl (1 min 66.25/ hr
City /StateiZlP:
_ Industrial plant (1 1 hr mi n) 78. I8/ hr
Phone: (' 1) 923 - / 4 r Fax: (51.1 ) J 1 .,.� inspections for which no fee is 90.00/ hr
tv specifically listed (%: hr Irvin)
CCB Lic.: f ./ e7 Electrical Lic.: f75C Supry ic.: •42355 ELECTRICAL PERMIT FEES .fit
Suprv. Electrician signature, required: Plan D Subtotal: Z7•' 1
review (25 /o of perm t fee): 0
Print name: ,e ..e AO r i Date: ,[f /7 / !/ r State surcharge (12% of permit fee): Jz t
Authorized si atlirre: • / 1 �Gd TOTAL PERMIT FEE: �� , 4g
r' 'Ibis permit application expires if a permit is not obtained within 180
Pant name: 'r / Date: days after it has been accepted as complete
Ale ��+ y 9 f?�i • Number of inspections allowed per permit.
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