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Permit CITY OF TIGARD ELECTRICAL PERMIT °f.' COMMUNITY DEVELOPME Permit #: ELC2011 -00444 Date Issued: 08/04/2011 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S101 DCO3900 Jurisdiction: Tigard Site address: 7150 SW SANDBURG ST Project: Progressive Insurance Subdivision: Lot: Project Description: Electrical for TI. Contractor: REESE & SON ELECTRICAL INC Owner: PROGRESSIVE CASUALTY 16310 SE RHONE INSURANCE COMPANY PORTLAND, OR 97236 REAL ESTATE NOTIFICATIONS CLEVELAND, OH 44101 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 5 crt Branch Circuits wo /Purchase 08/04/2011 $85.86 Specifics: Service or Feeder 1 ea 12% State Surcharge - 08/04/2011 $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 accordance with approved plans. This permit will expire if work is not started within 180 days of issuancez•r if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification - ter. Those ru - a - set forth in OAR 952 - 001 -0010 throu 52- 001 -0090. You may obtain a co• of th.- • . •r direct questions to OUNC by calling 503. .1987 or 1.80 '.2'44 Issued By: �` Permittee Signature: /. / _ _ �-'t ✓o`er 41114 _ OWNER INSTALLATION ONLY The installation is being made on property 1 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 ‘) FOR OFFICE USE ONLY R eceived City of Tigard p © % Permit No.: 1 '^ 1 13125 SW Hall Blvd., Tigard, OR 97 ' r \; > � Plan Review ,.y. , , 0 Other Permit: 1 Phone: 503.639.4171 Fax: 503 / � • � �� Date /B . / /Ji o do( LI T IG A R D Inspection Line: 503.639.4175 . 0 w . Date Ready/By: IHIM El See Page 2 for Internet: www.tigard- or.gov Q O � ` N � � Notified/Method: Supplemental Information TYPE OF WORK ,(5 PLAN REVIEW ❑ New construction $'Addition/alteration/I lent Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: Q> where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling $ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "I - ", "1 -3 ", Job no.: I Job site address: (/ � Q S� i �� Ski I Six or or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City / State/ZIP: r ❑ Health -care facilities. ❑ Supply voltage for more than t / a ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: ci Project name f �, S g / > Go � Ksu ra km. ❑ Service or feeder 600 amps or more. `� FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total I • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family �J Y1 7 , � V D V(Jf,4 e u A- 1 ` 1 b r ,/� residential (with above sq. ft.) 75.00 2 ' /� Q , Services or feeders installation, alteration, and /or relocation j WI, 200 amps or less I I 80.30 I 12 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City /State/ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 , Owner signature: Date: Branch circuits — new, alteration, or extension, per panel A. Fee for branch circuits with ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: B. Fee for branch circuits • Contact name: without service or feeder fee, / 46.85 � j 2 first branch circuit ttvv t Address: Each add'I branch circuit 6.65 2 Miscellaneous (service or feeder n t included) City /State/ZIP: Each manufactured or modular dwelling, service and/or feeder 90.90 2 Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 " CONTRACTOR Sign or outline lighting 53.40 2 Signal circuit(s) or limited - Business name: Pse 72-5 J� j f, , ryi( o energy panel, alteration, or Address: // 3/ 5, C k ge — extension. Describe: Page 2 2 City/State/ZIP: 0 (fi . Q q 7 , 2 3 Each additional inspection over allowable in any of the above J q Per inspection 62.50 Phone: ( ibq- 2 I Fax: ( f � Investigation per hour (1 hr min) 62.50 CCB Lie.: �qg,6 3 L / Electrical Lie Z5a� � Su rv. Lic -:/6R� J Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: % � 1 // Subtotal: I o� . Plan review (25% of pe fee): :, ,, Print name S / Date: �✓ r �tpf State surcharge (8% of permit fee): W. 3't Authorized signature: TOTAL PERMIT FEE: 7f . Print name: Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. • Number of inspections allowed per permit. 1:\ Building\Permits\ELC- PennitApp.doc 05/23/06 440 4615T(I I /05 /COM/WEB 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: E l Audio and Stereo Systems* ❑ Burglar Alarm El Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* El Vacuum Systems* El Other COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 260 -260) Check Type of Work Involved: E l Audio and Stereo Systems E l Boiler Controls El Clock Systems ❑ Data Telecommunication Installation E l Fire Alarm Installation • El HVAC ❑ Instrumentation El Intercom and Paging Systems ❑ Landscape Irrigation Control* El Medical El Nurse Calls ❑ Outdoor Landscape T.ighting* El Protective Signaling El Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations L\ Building \Peamits\ELC- PennitApp.doc 0323/06