Permit F
� CITY OF TIGARD ELECTRICAL PERMIT
: - , ; COMMUNITY DEVELOPMENT Permit #: ELC2009 -00391
.TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639,4171 Date Issued: 08/04/2009
Parcel: 2S102AD03450
Jurisdiction: Tigard
Site address: 8777 SW BURNHAM ST
Subdivision: Lot: 0
Project: City of Tigard
Project Description: Add (2) branch circuits.
Owner: FEES
TIGARD, CITY OF & Quantity Description Date Amount
TIGARD WATER DISTRICT ET AL, 13125 SW.
HALL BLVD 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 $59.92
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 --
0 -- `
0. You may obtain y copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 0.71 1. I l 2 " X11 �U Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
k 1 .
l JUL- 2&-09. , t$:42 FROM- OREGON ELF, 1� 5032349900
t T - 001 P.005/006 F -496
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Electrical Permit Applicatio r t t. FoR (�i� ( USE ONLY
City of Tigard
JUL 2 8 2009 Datc . �j Permit No.: 'C3 ('
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
- �' l�l l T OF 1
.' ' Iiii
DateB . Other permit _
T
�� � rFY Sec PnQe 2 for
i',`G r1 (Z:D Inspection Line: 503.639.4175
Dare ied /Meth Supplemental page 2 Information
Internet: www,tigrd- or_gov BUILDING DIVISION Notified/Method;
. TYPE OF WORK ' PLAN REVIEW ,
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ® Addition/alteration/replacement
El Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑ Other where the available fault current O Marinas and boatyards.
CATEGOiRY OF CONSTRIICTION exceeds 10.000 amps at 150 volts or ❑ Flaming buildings,
less to ground, or exceeds 14,000 ❑ Commercial -use a
❑ 1- and 2-family dwelling ® Commercial /industrial ❑ Accessory building amps Ibr all other installations, buildin..
❑ Multi - family ❑ Master builder El Other ❑ Fire pump. El Installation of 75 KVA or
_ - ❑ Emergency system_ larger s eparately derived sycrent.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "£ ". "1 -2 ", "1 -3 ",
100HP or mote. occupancy.
Job no.: 80016`120 Job site address: 8777 SW BURNHA.M ❑ Six or mom residential units, ❑ Recreational vehicle parlux-
0 Healthcare facilities. 0 Supply voltage for more than
❑ Hazardous locations,
City/State/ZIP: TIGARD OR 600 volts nominal.
Suite/bldg. /apt. no.: Project name: CITY OF TIGARD ❑ Service or feeder 600 amps or more.
FEE. SCHEDULE.
Cross street/directions to job site: nmeri,don I . Fee_ Total
---
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R or less 145.15 I 4
- Ea_ add'1500 s9 or portion ^ 33,40 1
Tax map/pareei no_: Limited energy, residential
75.00 2
DESCRIPTION OP. WORK (with above sq. ft.) _
Limited energy, multi - family 75.00 2
ADD TWO NEW CIRCUITS residential (with above sq. it)
Services or feeders installation, alterati and/or relocation _
200 amps or less 80.3 2
L PROPERTY OWNER 1 ❑ 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 z
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
ty relocation
Phone: ( ) I 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 amps to 400 amps 100.30 i 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 - now, alteration, or extension, per panel
Owner signature: _ ) }etc: A. Fee for branch circuits with
D. 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, 1 46.85 46.85 2
_ first branch circuit —
Address: Each add'l branch circuit I 6.65 6.65 2
- Miscellaneous (service or feeder not included) -
City/Statc/ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only - 66.85 2
E- mail: pump or irrigation circle 53,40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: OREGON ELECTRIC GROUP
- Signal circuit(s) or limited-
energy panel, alteration, or
Address: 1010 SE 11 AVE extension. Describe: j Page 2 2
City /State/ZIP: PORTLAND OR 97214 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 234-9900 Fax: (503) 535 -2763 investigation per hour (1 hr thin) 62.50_
CCB Lic.: 203 Electrical Lie.: 26 -95C Suprv. Lic.: 4549S industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, req N - c. _ Subtotal: 53.50
Print name: RICHARD MCELLIOTT Date: 7 -28-09 Plan review (25% of permic fee):
State surcharge (12% of permit fee): 6.42
Authorized signature: C- TOTAL PERMIT FEE: 59.92
Print name: RICHARD MCELLIOTT Date: 7 -28-09 nix 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: 113ui1ding \Pcnnit3NELC- PCmlitApp,464 0501/06 410-4615TOI /05 /COM/WEB