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Permit 1s� CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2009 -00322 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/29/2009 T1Gi4R V Parcel: 2S102DB00100 Jurisdiction: Tigard Site address: 8840 SW BURNHAM ST Subdivision: Lot: 0 . Project: Verizon Project Description: Add 3 branch circuits for expansion battery room Owner: FEES VERIZON NORTHWEST INC Quantity Description Date Amount PO BOX 152206 IRVING, TX 75015 3 crt Branch Circuits 06/29/2009 $60.15 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 06/29/2009 $7.22 Electrical Contractor: E C COMPANY PO BOX 10286 PORTLAND, OR 97296 PHONE: 503- 224 -3511 FAX: 503 - 295 -3012 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $67.37 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 •5 iii 0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503 246.6699 or 1.800.332.2344. Issued By: A • 0 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. 25/2009 1 0: 30 .5032205346 PAGE 01/02 Electrical Permit Application CE 1.01( (0. i' 1( V I. . i (I N. I, 5 . City of Tigard JUN 2 5 2009 �a�e a �S Petxnit NQ.: G- L G 77 13125 SW Nall Blvd., Tigard, OR 97223 P Fcvicw Q�Y Phone; 503.639.4171 Fa x: 503.598.19 1 `ITY OF TIGARD Da/aBy: Other Permit: . 1r, A r, n Inspection Line: 503.639.4175 *t natc Rcady/0y: r° y r ® See Page - for Internet: www.tigard or.gov B DIVISIO {V Notified /Method: I Supplemental Information TYPE OF WORK FLAN REVIEW Q New construction C2fAddition/alteratiolt/t eplacement Please check all that apply (submit a wets of plans w /items checked below): ❑ Service or feeder 400 amps or more 0 Building over three stories. 0 Demolition ❑ Other: 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 fit' © 1- and 2- family dwelling Commercial/industrial ❑ Accessory building amps for an other installations. buildings. ❑ Multi•falitily ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE F'WORMATION AND LOCATION ['Emergency system. 'A" E". scparatcly " d1: -2 yr Jul 111. (] Addition of new motor load of © , "A" "E ". "l •2, " "1-3", Job site addres i,J 100111' or more. occupancy. Job no.: /71,L,:?../y1- _get y ,Sle1 f V lnix i /v t . ❑ Six or more residential units. ❑ Recreational vehicle parks. ZIP: ❑ Health - care facilities. ❑ Supply voltage for snore than City/State/ZIP: - t e/ ! r(� /I. o i l� , - - -- . El Hazardous lnoations, 600 volts nominal. Suite/bldg. /apt. no.: Project name: 'I i ff riV 4,2._ � ❑ Service or feeder 600 amps or more. _ — J FEE SCHEDULE Cross street/directions to job site: Description -" I Qfi ,l__,_F�__1, Taw _ - New residential single- or multi - family dwelling unit Includes attached ;arage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 - -- ga. add'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential —_ —____ DESCRIPTION OF WORK (with above sq. ft.) _____ 7500 __ 2 at Limited energy, multi - fancily 75.00 2 a ■. yR, re.. .. 1 ' 12 � � , residential (with stove sq. 8.) Services or feeders inatailatian, slteradon, and/or relocatio 200 amps or less 8_0.30 2 ' PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 _w_,..,,_i `. 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: ( ) Fax: ( ) 200 atnps 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 Branch circuits new, alteration, or extension, per panel Owner signature: Date: _ A. Fee for branch circuits with s" APPLICANT r ❑ CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: L"' (" CP /r ya ill B. Fee for branch circuits `� I / Q, l 'without service or feeder fee, 46.85 (�� 2 Contact name: name: f � lL sr- (1 ail J:c ,J. first branch circuit Address: /� Each add'! branch circuit 07 6.65 6,A-2 2 iir AO i . I le - Miscellaneous (service or feeder not included) City/State/ZIP: p yl..{-ia0 tie— gl2a4k Each manufactured or modular 90 -90 2 ��� . , `' Y dwelling, service and/or feeder Phone: r i Fax: : ) Reconnect only 66.85 2 E -mail: .. .,,0„ 0 . ; — • V P ump or irrigation circle 53.40 2 - CONTRACTOR Sint or outline lighting 53.40 2 — J "' Signal circuit(s) or limited - Business name: / i ,/ _ energy panel, alteration, or Address: / extension. Describe: Page 2 2 City/State /ZIP: �l. howl / 4f Each additional Inspection over allowable in any of the above Per inspection _ _ 62.50 Phone: ( Ii ) — / � �^ _ Fax: .56 } 1 ?Z' Investigation per hour (1 he mia) M , 62.50 CCI3 Lie.: ; % S r i Electrical Lie.: r, r 5 Suprv. Lie.: Industrial plant per hour __ _ 73.75 ELECTRICAL PERMIT FEES . Suprv, Electrician signatu -, ) /i i g� �O - Subtotal; , j mtrne: J Y Date: Plan review (25% of permit fee): �T -r Yl�, ^ � State surcharge (12% of pemrit fee): Authorized si ature: : -' f TOTA1, P) It1vfIT FE E r This permit apptiration expires if a permit is not obtained within 180 Print name: e 7. �4.,(..rr f r t -,r0) 3 �W„ Date: � tj - 0 J days after it has been accepted us complet �4� • Number of inspections allowed per permit. 1:\Buil ding \P¢rtnit3\ELC- PeratitApp,doc 05/23/06 440-4612T(11/05/COM WEO