Permit CITY OF TIGARD ELECTRICAL PERMIT
' '- COMMUNITY DEVELOPMENT Permit #: ELC2011 -00309
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/08/2011
Parcel: 2S114AA00200
Jurisdiction: Tigard
Site address: 16285 SW 85TH AVE 103
Project: Happy Camper Subdivision: DURHAM HALL BUSINESS PARK Lot:
Project Description: (5) branch circuits for kitchen.
Contractor: CROWN VOLTAGE Owner: WH SHIPMAN LIMITED
609 SW EATON BLVD BY NORRIS & STEVENS INC
BATTLE GROUND, WA 98604 621 SW MORRISON STE 800
PORTLAND, OR 97205
PHONE: 360- 666 -0995 PHONE:
FAX: 360- 666 -4673
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo /Purchase 06/08/2011 $85.86
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/08/2011 $10.30
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $96.16
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 - • •ance 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. AT NTION: Oregon - -quires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 9' '001 I You may obtain a copy of the rules or direct questions to OUNC by callin• : • . 32.1987 or 1.800.3 2.2344
Issue• By: 0 ' Permittee Signatu ' . �1� /��ri♦/ 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:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' • •02 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 A R EUC q r Fog Oi 1(c1 II"I: ONLY
City of Ti and Received
N... a7 Permit No,; /
•
13125 SW Hall Blvd , Ti d, OR 97223
JUN a 20 �� Date/3 : d; - �f �y_
g Plan nevrevu
e I . : Phone: 543.718,2439 Fax; 503,598,1960 ,. D:tto /e ether Permit:
I c.A Inspection Line' 503.639.4175 CITY OF TIIf` t,"lARD Date Itoany /Ily, FIRM ® Sae Page 2 for
Internet: www.tigard - nr.gov BUILDING DIVISIONNnti6ad)Mathnd' Supplemental Information • - �I'',' $ ,. OF WO!S': • A � 'W } . , 1�,
. .... :-j��a'r4 :,i.,, ,,, , ;, .,: `,,l `?�1Y:P .. _ .. r„+. :�� !� �'.
'y.
❑ New construction ® Addition /alteration /replacement . Plensechock all,hat apply (submit '/sets or plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ nuilding over three thrice.
❑ Demolition ❑ Other whore the available Fault oi.trrelt ❑ Marinas and boatyards,
ri,y` '•- e..: '' it ':i "^ °' 11 i�i'r11fF,kr V '•tl2' •'or.IOh1, ' .. 0,0,d. 10,000 amps ma 150 volts or 0 Floating buildings,
MA 6141114'tin' :CU l0 ground. �r eKe Ced6 14,f00 0 Commcrelal•ose agricultural
g Commercial /industrial Q Accessory bulldiltg nines for all otl7e1 installations. buildintta.
❑ Multi - family ❑ Master builder ❑ Other: U Piro pump, 0 Installation 01'75 KVA or
:`'.:; , a 'r+ ` r;e;:.'.fi >!;rt Q ' )i
rmmgcuc eya�om larger separately derived system,
:lt4oRMAtION AND LOCA
� ❑AddilionoCnecr ❑ "A" "E" "I -2" "1 - ?"
Job no.; lob site address: 16285 SW 85TH AVE 1001.6' nr mare. occupency,
Q Six or aura residential units. ❑ Recreational vehicle parka.
City /State /ZIP: TIGARD OR 97224 O:- Icelth -oaro Militias, ['Supply voltage for flora than
❑ Hazardous locations, 600 volts nominal.
- / Hite /bldg. /apt, no,; 103 Project name. f LA -PP ,,° Pf ❑ Service or feeder 600 amps or MOM
D ` , ' o ' "
Cross street /directions to job site:
Dgscriptlon r Qty, ) Poo. I Total
New residential single- or multi - family dwelling unit.
includes attached garage.
Subdivision: trot no.; 1,000 sq. R or less — 168.54 4
- Ea. 0(.1'1 500 a9 ft or portion 33.92
Tax map /parcel no.;
Limited energy, residential
:', ,: is; 1 r, ,i' :;aDEI�if i+IPT(OI4 ,O1�';.WORK .' (with above sq, rt.) 75.00 — 2
1 °1nited energy. nultmlndy
75.00 2
MOD CIRCUITS
FOR KITCHEN residential (with above a9. ft.)
Services or feeders Installation, alteration, and /or relocation
200 amps or less 100.70 2
. 4Q:' P, `r,4 )•QWYV', ; n r- Xi TEN . T 2(11 amps to 400 amps 133,56 2
Name: LACEY GILLHAM 401 amps to 600 amps 200.34 2
601 amps in 1,000 amps 301,04 2
Address: Over 1,000 amps or volts 552.26 2
City /State/ZIP; 'Temporary 0rvieea or feeders installation, alteration, and /or
relocation _
Phone: ( ) Fax; ( ) 7 amps or loss 39.36 l
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 59 amps 169,54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 7(11.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Foe for branch circuits whir
2 :: ,; ' b ove service or feeder fee .
;i 'j i ,:' r'(ij l T;' . I' 0 <,CU1TACT 1'iJRSON a 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder I'ce, first I
36.18 56,18 2
Contact name: branch clrcult
-- 1_ach add'I branch circuit 4 '7.42 29.68 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67,84 2
dwelling, service and /or tbeder
Phone: ( ) Fax:: ( ) Keconneet only 67.84 2
E-mail: Pump Or irrigation circle 67,84 2
Sign nr outline lighting 67.04 2
a , . :'!"ONR
.` a ' ' ? ",' TACTOR Signal eimuit(a) or limited-energy
Business name; Crown Voltage, Inc.
panel, alteration, ur extension. Fags 2 2
Each additional inspection over allowable in any of the abov
Address; 609 SW EATON BLVD Addilional inspection (I hr min) 6625/ hr
City/State/ZIP: BATTLE GROUND WA 98604 Investigation Cl hr min) 66.25/ hr
Ind .tatrial plant (1 hr min) 78.1 8/ hr
Phone: (360) 6660995 I'ax; (360) 6664673 Invpcctinns for which no I'co is 9110(1) itr
spaui;icnlly listed (%, hr min)
CCi� I,ic.: 153934 f t Electrical l,ic.: 37 9840 Suprv, Liu.: 4I 161s ELECTAICAI;'P RMIT 6R�9 . il,:,
Sum. Electrician sig aturc, required: —7 / //t LCt 1 _- Subtotal: 85.86
Plan review (25% of permit fee):
Print name: MARGARET HOWES Date: 6/7/I 1 State surcharge (12% of permit fee); 10.30
f • """" TOTAL PERMIT PEE; 96.16
Authorized signature; ` �/� _ ` Thft permit ApplielltiOn et iree 1(0 permit la not ohtulnud wIthia 180
Print name: 0 Date: days after It hiss been accepted as complete.
' Number of inapocticna allowed per per mit.
1: 11lwld ,ng1Permd,uaLC PermMpp.doe 07/01/10 . 446- •.e1 fi11 III05'C'Oti/WF.H
2 'd CL9I'- 999 -09C 014I 39d110A Nl02I3 WdSZtII 0002 2n171 SI