Permit IN CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00489
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/31/2011
Parcel: 2S102DA00401
Jurisdiction: Tigard
Site address: 13125 SW HALL BLVD PD
Project: City of Tigard Subdivision: Lot:
Project Description: (4) circuits for Police Department.
Contractor: MR ELECTRIC OF CLARK COUNTY Owner: TIGARD, CITY OF
14300 NE 20TH AVE. D102 -313 13125 SW HALL
VANCOUVER, WA 98686 TIGARD, OR 97223
PHONE: 360- 574 -7200 PHONE:
FAX: 360 - 546 -2158
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 08/31/2011 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 08/31/2011 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 • • - 952 - 001 -0090. You may ob e rules or direct questions to OUNC by calling 503,232.1987 or 1.800.332.2344.
Issued By: 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 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.
Aug. 31. 2011 4:17AM No, 8050 P. 1/2
Electrical Permit Application FOR OFFICE IISE ONLY
City of Tigard n ociv
pia > .i �_
IN
/'� 1 3125 SW Hall Blvd., Tigard, V •. �� Plan Review
Phone: 503.718.2439 Fax: S/e :":.1960 \ Date/B Other Permit
Ti G A It n Inspection Line: 503.639.4175 cr c� Q L 1 Date Ready/13y: l'�I See Pape 2 for
Internet; vvvvtv.tigard- or.gov 16).
w d Notified/Method: Supplemcntellnformation
TYPE OP W •Beef t ; S16 PLAN (REVIEW
❑ New Construction M Addilion/a1 tei# meat
Please check all that apply (submit 2 sets of plans w /items checked below):
p�'
El Service or feeder-400 amps Or more ❑ Building over three stories-
❑ Demolition ❑ Other: 1w where Ole available fault current ❑ Marinas end boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, Or exceeds 14,000 ❑ Commmroisl - use agricultural
El 1- and 2- family dwelling gCommercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑Ftrc pump. ❑ Installation of 75 KVA or
['Emergency system. larger separably derived system.
.1011 SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A", "E ", "1 - 2 ", "1 - ",
100H1 or more. occupancy.
Job no.; t 1 ..,..9)6 Job site address: X3125 8Lo t , \ to, V•
0 Six or more residential units. El Recreational vehicle harks.
Gity /State /ZIP: "T' t� !H' a /� (� 1 `"1 /'� n i 2.2Z ❑ Health -care facilities. ❑ Supply voltage. for store than
0 Hazardous locations. 600 volts nominal.
Suite /bldg, /apt, no.: Project name; N \ . E, 5 ❑ Service or feeder 600 amps or more.
PEE SCHEDULE
Cross street /directions to job site; e p01;1 dam nruertpdon I On. I pee. 1 Taiel I •
New residential single or multi dwelling unit.
Includes attached garage.
Subdivision: Lot no,: 1.000 sq. ft. or less 168.54 4
Ea. add'l 500 sq, ft. or portion 33.92 I
Tax map /parcel no.; limited energy, residential 75_00 2
DESCRIPTION Or WORK (with above sq. ft.)
1 1 Limited energy, multi - family
L' - Ci uA -6 6 au k r residential (with above s5. ft.)
75.00 2
1 1it-A , } Services ot feeders installation, alterat and /or relocation
200 amps or less 100.70 2
a PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
ICESIMIW P 601 amps to 1,000 amps 301.04 2
il k 2 v a Over 1,000 amps or volts 552.26 2
Temporary services Or feeders installation, alteration, And /o
City /State /ZIP: 7;cord relocation
Phone: (rte )'- 1 le -tal, 0 5 Pax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according TO ORS 447. 449, 670, and 701. Branch circuits- new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
above service or feeder fee, 7.42 2
0 APPLICANT El CONTACT P each branch circuit
Business name; B. Pee for branch circuits trithottr
service Or feeder fee, first 56.18 1 2
Contact name: branch circuit
Each add'( branch circuit 7.42 A 2
Address: Mis (service or feeder not included)
Each manufactured or modular 67,84 2
CiTy/StAte/ZIP:
dwelling, service and/or feeder _
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-energy
panel, alteration, or extension. Page 2 , 2
nosiness name:. if 11 Il •A:. L! ,f. .'.�e. ' Al .. OA ! Each additional inspection over allowable hi any of the above
Address: tLA « ` !, VQr i 10 2 1-1 Additional inspection (I hr min _ 66.25/ hr
City /State /ZIP: Van coy VQ, ` � A (1 F3 / _ v ��j Investigation (I hr min) 66.25/ hr T
` I [ Industrial plant (1 hr min) 79 19/ hr
Phone: ( 1,„,o) 6-14 -I `2_00 Fax: (.2 zi 0
AM Inspections for which no fee is 90,00 / hr
specifically listed (i4 hr min)
CC13 Lie.: / CIE A) ,Lf Electrical Lie.: C ( Suprv. Lie.: 451. 3 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: .' o Subtotal: `� e ,, 4y
_ Plan review (25% of permit fee):
Mai Print name: Date; U.' x l State surcharge (12% of permit fee): Qp � 9// I
TOTAL PERMIT FEE:
Authorized Signature: 7 ' Phis permit application expires if a permit is not obtained within 180
Print name: ' M 0Q� D II days after it allowed d per accepted a9 eempleie.
t Num o f inspections allowed per permit - 1: \ Road Ineermits\ELC- PermitApp.doc 07/01/10 440- 4615T(11 /05 /COM/VL•B