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Permit
,! CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2011 -00330 TI ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/16/2011 c Parcel: 1 S 134 DB02000 Jurisdiction: Tigard Site address: 11492 SW 115TH AVE Project: Bank Of New York Subdivision: WINTERS ADDITION Lot: 6 Project Description: (1) branch circuit for pump. Contractor: ALL AMERICAN ELECTRICAL CONTRACTORS Owner: BANK OF NEW YORK MELLON, THE TR PO BOX 1426 400 NATIONAL WAY SV -73 GRESHAM, OR 97030 SIMI VALLEY, CA 93065 PHONE: 503 - 657 -4351 PHONE: FAX: 503 - 496 -3995 FEES Quantity Description Date Amount 1 crt Branch Circuits wo /Purchase 06/16/2011 $56.18 Specifics: Service or Feeder 1 ea 12% State Surcharge - 06/16/2011 $6.74 Type of Use: SF 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 rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy oft rect questions to OUNC by calling 503.232.1987 or 1.800.332.23 Issued By: for-. f.i / � � Permittee Signature: �P �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' 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 Application 1 OR 01+ 1 ( I : l ' 14l\ City of Tigard i Rece II r- 13125 ved Ihtmtit No,; t'' Blvd., Tigard, OR 972 PC D : r as ri - 0133 t) 1.25 SW Hall Plan Review Phone: 503.718.2439 Fax: 503,598.1960 fate/fl: Other Permit: T I :. 1: 1 r Inspection Lino: 503 - 639.4175 N 1 5 201i Date Ready /By; lulls' jp pa 2 for interne: www.tigard-or.gpv Notifled /Method: � ' An Suoolcmentel Information _ TYPE OF WOR 1TY ® � v RD PLAN REVIEW ❑ New construction Add'►tion /alterat � r�iV Please check all drat apply (submit 2 sets of plans :v/items checked below): 11 Demolition Other: 0 Service or feeder 400 amps or more in Building over three stories. - em Demolition where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings, 1 - and 2-family dwelling less to Wound, or exceeds 14,000 ❑ Commercial -use agricultural y g C] Commcrcial/industrial D Accessory b uilding amps Ibr all other installations. buildings, ❑ Multi - family ❑ Master builder 0 Other: ❑ Fire pump. ❑ Installation of 75 KVA Or JOB SITE INFORMATION AND T.00A'C10N © Emergency system. larger separately derived system. ❑ Addition of new motor load of 0 "A ", `'L•' ", "1 -2 ", "1 -3 ", Job no.: J Job site address: 11412._ 1 IOOHPormore. Occupuuuy. . _ El Six or more rasideulitsi nits. El Recreational vehicle parks. City/State/ZIP: ❑ Health - care facilities. Supply voltage �' � a y � (/� ❑ Su 1 volt for more Bran 13 Hazardous locations. 600 volts nominal. Suite/bldg./apt. no.: Project name: �^ ❑Service or feeder OD amps or copra, l� �� •�' _ FEE SCHEDULE Cross street/directions to job site: Docrladen I Qtr. 1 Fes 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 - Tax map/parcel no.: — . Ea. add'1500 sq. ft. or portion 33.92 1 Limited energy, residential DESCRIPTION OF WORK (with above srgit) 75.00 2 - • • Limited energy, multi- fbmity )444101,11 t - ...1v- t��„ ip u N�4 residential (with above sq_ ft.) 75.00 2 Services or feeders installation a iteration and/or relocation _ 200 amps or less _ 100.70 2 to ' ROPERTY OWNER _ 0 TENA 201 amps to 400 sups 133.56 2 Name: / A �P�, 401 amps to 600 amps _ 200.34 2 "� /l / � ✓Ll 601 amps to 1,000 amps 301,04 2 Address: Over 1,000 amps or volts , 2 City /State/ZIP: Temporary services or feders Installation, alteration, and /or relocation Phone: ( ) I max: ( ) 200 amps or less 59,36 - 1 Owner installation: This installation is being made ade on property that I own which is not 201 amps to a0(1 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 2 J Branch circuits — newalteration, or extension, per nand Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, each branch circuit 7.42 2 Business name: B. Fee for branch circuits wltFrrut 1 service or feeder fee, first Contact name: branch circuit I 56.18 5'64 2 T ' - "° Each add'I branch circuit [ 7.42 2 Address: Miscellaneous (service or feeder not Included) City/State/ZIP: mstiuibctured or modu 67.84 2 dwelling, service and/or feeder _ Phone: ( ) Fax: : ( ) Reconnect only 67,x4 2 E -mail: Pump or irrigation circle 67.84 2 Sign or outline lighting 67.84 2 CONTRACTOR r, Signal circuit(s) or limited-energy Business name: 041,_ Rat i V„T ecec x)141, dc0 r.4 1 �ancll aitcration or e xtension Paget 2 P, Each additional Inspection over allowable in any of the abov Address: P, 0 • a )x /y2.. Additional inspection (1 hr min) I 66.25/ hr J City/State /ZIP: Y .ej' J p l y 97O30 Investigation (1 hr min) 66.25/hr r Industrial plant (1 hr min) _ 78.18/ hr Phone: (SO)) (Q S - c/-SS / Fax: ('o3) L j f(,... 99 ` Inspections for which no fee is 90.001 hr specifically listed (14 hr min) CCB Lic.: II S2_91e Electrical Lic.: j(, _ //Yyc Suprv. Lie.: t{7 31-f - ELECT.RICAL PERMIT FEES Suprv. Electrician signature, required: D, l k Su it fee) "( ,� ---- -- Plan review (25% of permit fee): Print name: D . /NA, �ilno�i�l / , Date: ( // Slate surcharge (12 %ofpormit fee): C,'7e/ Authorized signature: TOTAL PERMIT FEE: ( , 97_ 0 - , This permit application expires If a permit is not obtained within 180 Print name: V *, days aver It has been accepted as complete, j lr Ch. */ Date: 6,, e Number of inspections :mowed per permit. 1'\ auildingPennits1flLC •PenaitApp,4ec U7/0I /10 440-46151(11 /05 /COM/WCD Z00I(j 1VDI HID TIS NVD I 2IHNIV — 11V CLI717 1617 COS XV,3 LZ :2T TTOZ /ST /90