Permit ,, CITY OF TIGARD
ELECTRICAL PERMIT
'' ;` COMM DEVELOPMENT Per mit #: ELC2011 -00404
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/20/2011
Parcel: 2S 110AA00600
Jurisdiction: Tigard
Site address: 10650 SW MCDONALD ST
Project: 7- Eleven Subdivision: Lot:
Project Description: (2) branch circuits for lighting retrofit.
Contractor: BERGELECTRIC CORP Owner: TEXLAND PROPERTIES CORP
13650 NE WHITAKER WAY TAX DEPT #16394
PORTLAND, OR 97230 PO BOX 711
DALLAS, TX 75221
PHONE: 503 - 255 -1818 PHONE:
FAX: 503 - 255 -1919
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 07/20/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/20/2011 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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. ATTENTIO : r n,, law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0010 rough OAR 95 : -Or .'9. You may obtain a copy of the rules or direct questions to OUNC by callin. 5r -. 987 or 1.800.33 .2344.
Issued By. y
O e Permittee Signature. ) ' /C=a"'/ -R _J
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' , , / 6,--A---- 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.
07/19/2011 12:10 FAX 5032559932 PDX.PURCHASING Il 002/003
p �o :
Electrical Permit Application p , �� � , 1 ?1: t,r► •► 1.51•: ONLY
City of Tigard Received 7 Ia /f�/ ma
1,,,
Permit No.: Aw—
• I3125 SW Hall Blvd., Tigard, OR 97223 JUL 1 9 2 011 Dazh✓B : plan Rev1Cw
m ' ` Phone: 503,718,2439 Fax; 503,598,1960 fasts /13 , Other parmh:
TIGAItf.)
Inspection Line 503.639.4175 C OF TiGA D Da l °Ready /BY: ,un� ICI See Pale 2 for
I nternet: www.tigard- or,gov Notified/Method; supplem°nralInformation
o`- -- –�r -•r• -. • I A _ r1Q 1 +rail _t,_– _ —_ —
- - : `' : >` � ru:� ::r -, r.Z : r-�c ^.mc■a � _�.r.,r -,� ;.,.: .:�. -r:.:
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:..,..._..,•_,:� ::...........:.,..::q •,,,., ., :fn`. '� 1 ?'
�_... — h... -- – �, .11_. , � a .,,re. , . , '! : 6Nt� ;I: (t is t_,�s
„ .�__._�� _ _ .. _ r _J �'` '� �'!Y�i:�..aM,.�e: � ,.�4�c�::•:asv;:'il:..��¢•'�
❑ New COnStruction P i Addition /alteration /replacement plooro chock all that apply (eubmhl.ats of plane willow checked below):
0 -� ❑Service or feeder 400 amps or more ❑ Building over three stories.
; Dolition ( em � ID Other: _ where the nv°iloblo thult eummt El Maim and bo°lyard■,
,wljP«ilii �:,rz''' ;;:7::L r:', i °'iT ' (�J S'!a5:�~ .i2i. irlruA, exceeds 10.000 amps of 150 volts or ❑ g di
;�.;, � - .,• _,: ;.,. - � �J � ° Floating buildings,
n
' .- less to ground. Or exceeds 14.000 ❑ Commerciol.uge agricultural
❑ 1 - and 2- family dwelling KCommercial /industrial ❑ Accessory building amps 1brall otherinahalladona- buildings.
❑ Multi- family ❑ Master builder ❑ Other. ❑ Firc pump. ❑ Installation of 75 KVA or
- . r^I=�r tla)r. � T _ •a - I , ❑ Emergency system, loser to I mrawl derived ■ of
Y , It',y ,l�l2 ` l' , •,r ! •y : . ._ l ie .), , _ II 1 s ) 7 17r1( uIr .1:,. \r'14..i ,(:.!� -T : :-• 4,,I411 i4a r iIii tip, QAddition of new motor load of ❑ ° , °E y � n,
Job no,: 15105 2 Job site address: 31, � � � I00HP a mom. occupancy.
+1� [+1�� "�'�� 0`. ❑ six or more residential un(ts, ❑Roareallonal vehicle parks,
(Cry /State/Z)P: S. • .a C. ❑ Health -care facilities, ❑ Supply voltage for more than
❑ Hazardous loom iona, 600 oohs nominal,
•
Suite /bldg, /apt, no.: Project name; — 7 . 0 ve ` r ❑ Service or feeder 600 amps or more.
Cross sttcct/directions to job sift: � b " i •''�� I r e ' : /' I
Dwariailon 1 Qw. j Rea _ Tai l •
New residential single- or multi - family dwelling unit.
Includes attached garNRe.
Subdivision: Lot no.; 1.000 sq. ft. or less 168.54 4
Ea, add'I 500 sq, R or portion 3 1
Tax map /parcel no.: ,
Limited energy, residential
. ;: ,.,.., �•- :. 75,00 2
t
; :I :,r.', l d °� lf,U.,•.. . „ N.' iwith °h.q.
Limited energy, multi.(Amlly
� a t f residential (with above sq. R) 75.00 2
Services or feeders Installation. alteration, and /or relocation
200 amps or less 100.70 2
le)6,g 3.K 1J1� � I•.111Ji u`id,: 201 am to 400 am 2
a t:" • i :.r.. a �� ;: " .:,:: �. .... 1 1!� J:— - Pa A s 133.J6
401 amps to 600 amps 20034 2
Name: _ eV , • 601 amps to 1,000 amps • 301,04 2
Address: -
-b Ai Over 1,000 amps or volts I 552.26 2
- Temporary services or ftcdcrs installation, alteration, and /or
Ciry/State/ZIP: Ili S, a It. relocation
Phone: ( ) Fax; ( ) 200 amps or lose 59,36 I
201 amps to 400 amps 1 25.08 2
Owner installation: This installation is being made on property that I own which is not
401 amps to 599 amps 169,54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration. or extension, r panel
Owner signature: Date: A. Foe for branch circuits with
:,,' i , '`"t'�i•:3a a� ' ' �'� 'I'r• I h" ; 11 -" , ,.r 1 .' above service orfooderfee,
1 7_ 1 :'ii ? Tai ul �4 , %t each branch circuit
_ t' 4 :.�;' �.� LL..Ft I S . W � � l ' l r i !. � 7,42 2
Business name; Borgoloctric Corp 13, Feb for branch circuits wlrfa it
service or feeder tee, first 56 I B 1g
, 2
Contactnamc: r �, !r. ' ��� branch circuit p •
L Each add'I branch circuit ! 7,42 '•j,0 - 2
Address: 13650 NE Whitaker Way Miscellaneous (service or feeder not Included)
Each alarm thawed or modular
City/State/ZIP: Portland Oregon 97230
dwelling, service and/or feeder 67,94 2
Phone: (503) 255 - 1818 Fax: : (503) 255 - 1919 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: 11
Sign or outline lighting 67.84 2
_
per, I .,,
�' ^.�S r a F�, i:.. ' 1-- I . , : . ,• :. q
1 = :ari�:. , l'�i::.�u� �tl Signal circuits) or limited-energy
Business name: Bergeluctric Corp panel, alteration, or cotton/don. Page 2 2
Each additional inspection over allowable in any of the above
Address: 13650 NE Whitaker Way Additional inspection (1 hr min) 66,25/ hr
City /State/ZIP: Portland Oregon 97230 - Invesligollo (1 fu min
66.25/ hr
Industrial plant (1 hr min) 78.1 hr
Phone: (503) 255 - 1818 Fax: (503) 255 - 1919 Inapeeton{ far which no fee is 90,00/ hr
R � - �` specifically listed ('/a hr min)
CCB Lic.: 110521 , Elcctricul Lic. 3 7 - 682C ‘ K 1®1 r
Suprv. Electrician signature, required: ,
` 1 I 'MINIM Subtotal: D3.l00
Plan review (25% ofpermit fee):
: ` Date: `7 - State surcharge (12% of permit fee): , L
Authorized signature: TO'T'AL PERMIT FEE; ` - • - 2
,/, This permit application expires Ira permit is net obtained within 1 50 omitted ute
Print name: �� DatC: • day■ attar It has been omitted as comp.
- 0 /, I • , A Ail M Number of inspections allowed per permit.
I: U, uildinoN■tma11ELC•PermliApp,dou 07/01/10 aa0.44I5T(IIID!/COMLW05