Permit ''' CITY OF TIGARD ELECTRICAL PERMIT
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°• s ,, COMMUNITY DEVELOPMENT Permit #: ELC2009-00390
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/04/2009
Parcel: 2S 102AD03000
Jurisdiction: Tigard
Site address: 12800 SW ASH AVE
Subdivision: BURNHAM TRACTS Lot: 0
Project: City of Tigard
Project Description: Add (2) branch circuits.
Owner: FEES
TIGARD, CITY OF Quantity Description Date Amount
13125 SW HALL BLVD
TIGARD, OR 97223 2 crt Branch Circuits 07/31/2009 $53.50
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 07/31/2009 $6.42
Electrical
Contractor:
OREGON ELECTRIC CONSTRUCTION INC
1010 SE 11TH AVE
PORTLAND, OR 97124
PHONE: 503 - 234 -9900
FAX: 503 - 535 -2763
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.92
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 -00,1 -0100 You m obtain a copy of the rules or direct questions to OUNC by calling 503.246 6699 or 1 800.332.2344.
r 1 (l I Issued By: J l )( 1 I h 1 Permittee Signature: .
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 an inspection that business day.
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.
iL
JUL -28 -09 08:42 FROM- OREGON E T INN 5032349900 T -001 P.003 /006 F -496
1- C- A
Electrical Permit Applicati 1612 0 i∎ r1 C 1. USE O N I.1 . .
City of Tigard Received -- '^ r
13125 SW Hall Blvd, Tigiud, OR 97223 U L 2 8 2009 Plan Review
il Phone: 503.639-417I Fax: 503398.1960 Daze/B . Other Peanut:
Inspection Line: 503.639.4175 CITY OF TIGARD Dab: Ready/By. as See Page 2 for
T I G n K!5 Supplemental Information
Internet: www,tigard -or. gov Rt t)t nlp�r DIVISION NodSed/Melhod;
TYPE OF • WORK . . PLAN REVIEW
El New construction El Addition /altetation/teplacement Please chock all that apply (submit 2 sets of plans w/itcnts checked below);
❑ Service or feeder 400 amps or mom El Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
' CATEGORY OF CONSTRUCTION . . exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
Iess to ground, or exceeds 14400 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. building.
❑ Multi- family ❑ Master builder ❑ Other. ❑ Fire pump. ❑ Installation of 75 KVA or
0 Emergency system. larger separately derived system.
)OS SITE INFORMATION AND LOCATION O Addition of new motor loud of ❑ "A ", "E "r -2`, " -3 ",
10011 or morn. occupancy.
Job no-: 80016 -119 Job site address: 12800 SW ASH 0 Six or more residential units, G Recreational vehicle parks.
City / State/ZIP; TIGARD OR CI
Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg, /apt. no.: l Project name: CITY OF TIGARD) El Service or feeder 600 amps or more. • FEE SCHEDULE _
Cross strcet/directions to job site: , Ue i pLea I atv. I Fee. 1 Teat 1 •
New residential single- or multi- family dwelling unit_
Includes attached garages
Subdivision: Lot no.: 1,000 sq. ft or less III 145.15 4
Ea_ add'1500 s., R or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF .WORK (with above a�. ft.) 75.00 2
Limited
ADD TWO NEW CIRCUITS resident a ( th abo q. sq. ft.) 75.00 2
Services or feeders Installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER - . ❑ 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 ;imps or volts 454.65 2
City /State/ZIP: Temporary serviccS Or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1 1
Owner installation: This installation is being made on property that I own which is not 201 reps 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
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: 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, I 46 85 46.85 2
first branch circuit
Address: Each add'1 branch circuit 1 6.65 6,65 2
Miscellaneous (service or feeder not 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
GROUT' Signal p t(s) or tio, limited-
Business name: OREGON ELECTRIC GROU energy panel, alteration, or
Address: 1010 SE 11 AVE extension Describe: Paget 2
City / State/ZIP; PORTLAND OR 97214 Each additional inspection over allowubic in any of the above
-- Per inspection 62.50
Phone: (503) 234 -9900 Fax: (503) 535-2763 .
Investigation per hour (1 hr min) 62.50
CC13 Lie.: 203 Electrical Lie.: 26 -95C Suprv. Lie.: 4S49S Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, requi d .r F'-c3 � Subtotal: 53.50
Print name: RICHARD MCELLIOTT Date: 7- 28-09 Plan review (25% of permit fee):
State surcharge (12% of permit fee): 6.42
Authorized signature: * T.
TOTAL PERMIT FEE: 59.92
This permit application expires If a permit Li not obtained within I80
Print name: RICHARD MCELLIOTT Date: 7 -28-09 days after It has been accopted ns complete_
• Number of inspection- allowed per permit
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