Permit �� CITY OF TIGARD ELECTRICAL PERMIT
'� COMMUNITY DEVELOPMENT Permit #: ELC2011 -00244
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/11/2011
Parcel: 1 S135BC00300
Jurisdiction: Tigard
Site address: 10840 SW CASCADE AVE
Project: Franz Subdivision: OAKBURG Lot: PTS 25 -.
Project Description: (2) branch circuits with low voltage for data telecommunications system.
Contractor: HUGHES ELECTRICAL CONTRACTORS INC Owner: UNITED STATES BAKERY
10490 NW JACKSON QUARRY RD PO BOX 14769
HILLSBORO, OR 97124 PORTLAND, OR 97214
PHONE: 503 - 647 -2221 PHONE:
FAX: 503 - 647 -7754
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 05/11/2011 $63.60
Specifics: Service or Feeder
1 ea Signal circuit or Limited 05/11/2011 $75.00
Type of Use: COM Energy Panel
Class of Work: ALT 1 ea 12% State Surcharge - 05/11/2011 $16.63
Electrical
Type of Const:
Occupancy Grp:
Total $155.23
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 OA: •52- 001 -0090. Yo ..ay.obtain- or • • - - ions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: i _L.d / i Permittee Signature: K %'�2 �y
drallk
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.
From: 05/10/2011 14:23 #979 P.002/004
Electrical Permit Application FOR OFFICE USE ONLY
,11 - 1�� City of Tigard Received —
13125 SW Hall Blvd., Tigard, OR 97223
, Qaten3 : fl' Permit No.: IL k
Phone: 503.718,2439 Fax: 503.598.1960 � v / Plan Review
�\ 1 � O DateB : Other Permit.
T I GA R D Inspection Line: 503.639.4175 .� rt • eady/By: kris: See Page 2 for
Internet: www.tigard- or.gov v (OW ii: ethod: lir Supplemental Information
TYPE .OF WORK �ti (} D
lid
❑ New construction Addition /alteration/re e Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Other:
where the available fault current Marinas and boatyards.
t ❑ tyard .
'. ' CATEGORY :OF CONSTRUCTION : ' "' - ` " exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I - and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family 0 Master builder El Other: ❑Fire pump.
❑ Installation of75 KVA or
JOB SITE INFORMATION ,AND :LOCATION E3 Emergency system. larger separately derived system.
0 Addition of new motor load of ❑ "A ", "E "I -2 ", "1 -3 ",
Job no.: 11/1241 Job site address: 10340 SW Casarb Ave IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
Pi Jam, CR 97773 ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: F ranz ❑ Service or feeder 600 amps or more. • • Cross street/directions to job site: FEE SCHEDULE
Deuriplion I Qty. 1 Fee. 1 Total j •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no,: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq, ft. or portion 33,92 1
Limited energy, residential
' DESCRIPTION OF :WORK .. .- •'. ... (with above sq. ft.) 75.00 2
Limited energy, multi - family
75.00 2
] - J - 11 ptl-1� art rnlrrai 1 feut- (' h ie'EEO residential (with above sq. R.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER . ' ' f _ , • • ❑ 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 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 t 2
Branch circuits - new, alteration, or ex tension, per panel
Owner signature: Date: A. Fee for branch circuits with
.
'❑ APPLICANT " : ' CONTACT `PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: H11G1'IPS F.lar1 (1-711- B. Fee for branch circuits without
service or feeder fee, first
Contact name: 1STi� , branch circuit 1 56.18 56.18 2
Each add'l branch circuit
Address: 1 art TV Tariccrri Q>a-ry Miscellaneous (service or feeder n included) 7.42 2
City /State /ZIP: Each manufactured or modular 67.84 2
al. ter dwelling, service and/or feeder
Phone: ( 503) 647.2221 Fax :: ( 503) 647.7754 Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
. B1vTRACT'OR .'.' .: 67 84 2
Sign or outline lighting
Signal circuit(s) or limited-energy
Business name: E1 17W1 panel, alteration, or extension. 1 Page 2 7c (� 2
Each additional inspection over allowable in any of the above
Address:
104% IV Jaciscrn OArrY Fri _ Additional inspection (1 hr min) 66.25/ hr
City!$tate /ZIP: Investigation (1 hr min) 66.25/ hr
Hi 11 �"r 01_ 97174 Industrial plant (I hr min) 78.18/ hr
Phone: ( 503) 647.2221 Fax: ( 503 ) 647.7754 Inspections for which no fee is
specifically listed (% hr min) 90.00 / hr
CCB Lie.: , •: 1 Electrical Lie.: . uprv. Lic.: 1` ', • ' r :; ELECTRICAL PERMIT .FEES .
Suprv. Electrician signature, required: 7 Subtotal:
.138 6
Plan review (25% of permit fee):
Print name: David Tracy 010 11 State surcharge (l2% of permit fee): 1 6 6
Authorized signature: TOTAL PERMIT FEE: 1 95 23
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.
IA Building \ Permits 'ELC•PermitApp.doc 07/02/10 440- 46IST(l l /05 /COM/WEB
From: 05/10/2011 14:23 #979 P.003/004
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*
Burglar Alarm
, Garage Door Opener*
Heating, Ventilation and Air Conditioning System*
L Vacuum Systems*
Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
sys tem
(SEE OAR 9l8- 309 -0000)
Check Type of Work Involved:
I 1 Audio and Stereo Systems
— Boiler Controls
I Clock Systems
Data Telecommunication Installation
I Fire Alarm Installation
HVAC
n Instrumentation
El Intercom and Paging Systems
Landscape Irrigation Control*
n Medical
LJ Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
IF • er • • a t •C."•
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Huildmg\Pennits \ELC- PermitApp doc 07/01/10