Permit „ i
` "n CITY OF TIGARD ELECTRICAL PERMIT
"S COMMUNITY DEVELOPMENT Permit #: ELC2009 -00448
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/03/2009
Parcel: 1 S135BB00500
Jurisdiction: Tigard
Site address: 10487 SW CASCADE AVE
Subdivision: Lot: 0
Project: More Furniture for Less
Project Description: (10) branch circuits and low voltage for audio /stereo wiring.
Owner: FEES
RAM /CASCADE CENTER LLC Quantity Description Date Amount
BY ELLIOTT ASSOCIATES INC, 901 NE GLISAN
ST 10 crt Branch Circuits 09/03/2009 $106.70
wo /Purchase Service or
PHONE: Feeder
1 ea Signal circuit or Limited 09/03/2009 $75.00
Energy Panel
Contractor: 1 ea 12% State Surcharge - 09/03/2009 $21.80
EA MARTIN LLC Electrical
4233 SE 182 #202
GRESHAM, OR 97030
PHONE: 503 - 310 -9745
FAX: 503 - 658 -1935
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $203.50
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 ac - • -- ce - •proved 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. AT ' TION: Oregon la r es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 •010 through OAR 952 - 0010100. Y. -y obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1 800.332.2344.
t
1
Iss ed By: 1 . Permittee Signature: 7(
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' ' '' /n/ ""! Date: 9 //d7
LICENSE NO. 53 $ cf 5
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.
Electrical Permit Application) �T FOR OFFICE USE ONLY
H � ���g �� R eceived � ,
City of Tigard DateB : D A, / Permit No.: &eke) 'ez Si
II q 13125 SW Hall Blvd., Tigard, OR 97223 r7 ,� Plan Review
.
Phone: 503.639.4171 Fax: 503.598.1960 0 3 2009 Date/B : Other Permit:
TI G A R D Inspection Line: 503.639.4175 Date Ready/13y: 0
—`•!� See Page 2 for
Internet: www.tigard- or.gov CITY
� , OFTIGARD Notified/Method: Supplemental Information
TYPE O � b NLi D/V1J1uN PLAN REVIEW
❑ New construction 4 Addition/alteration /replacement 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: 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 0 Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION
El Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: I 0 C stk., cskS 100HP or more. occupancy.
❑
❑ Six or more residential units. Recreational vehicle parks.
City/State/ZIP: (1 n f!1 O Z 9 ,D • ❑ Health -care facilities. ❑Supply voltage for more than
` •c 1. ,_ D
El Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: r 71 A r vi i i T ❑ Service or feeder 600 amps or more.
FEE , SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
. Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.:
Limited energy, residential
75.00 a 2
DESCRIPTION OF WORK • (with above sq. ft.)
-r----LA r P 11 I r 0Y-Z Y � � J Li [ essid energy, dential wi with above . ft. ) 75.00 2
!7 ,('u Lim
s . ft.)
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
401 amps to 600 amps 160.60 2,
Name:
c >r -Fu 0 1 v.G r L� 5 S
601 amps to 1,000 amps 240.60 2
Address: / LYI 8l s (J ) C ca C X Over 1,000 amps or volts 454.65 2
City/State /ZIP: T ar,1 ( 1 . g.. 9 72,R3 Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) 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
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date:
A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: • without service or.feeder fee, 46.85 .2
first branch circuit q,
Address: Each add'l branch circuit 7 6.65 +59, 8 � 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
T ,/1 014Z-tin i n L 1 C. panel, Signal circuit(s) or limited -
Business name: (� /'7 T7 l• energy panel, alteration, or 4 Address: H D,33 sc.- � a O` V 1 ` l)lt 1 fteu o D/s7 o / Page 2 2
tde
City /State /ZIP: G-Y'� S f 01� Q 7 O3� 4 \ E additional inspection over allowable in any of the above
t' q Per inspection 62.50
41. Phone: ( 3 3 I O ' 1 Fax: ( C 3) t9- ' �'I 3
Investigation per hour (1 hr min) 62.50
CCB Lic.:1 Sy 9;1 8 Electrical Lic.: C y Suprv. Lic.: 53s95 Industrial plant per hour 73.75
�0
/� ELECTRICAL PERMIT FEES !i5l
Suprv. Electrician signature, required to d I t Subtotal: / d Print name: E R 1 G 01 )4 1Z h Date: 3-- O9 Plan review (25% of permit fee):
r State surcharge (12% of permit fee): P ! go
Authorized signature: TOTAL PERMIT FEE: 9I O , 5
Print name: Date: This permit application expires if a permit is not obtained wit in 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I :\ Building \Pemuts\ELC- PennitApp.doc 05/23 /06 440 -4615T(11 /05 /COM/WEB
A ~
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:
n Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems* .
❑ Other:
COMME WORK ONLY: ,
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: I
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 03/23/06