Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00523
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 09/22/2011
Parcel: 1S135DD03301
Jurisdiction: Tigard
Site address: 11945 SW PACIFIC HWY 209
Project: El Porvenir Subdivision: METZGER ACRE TRACTS Lot: 9
Project Description: Replacing damaged panel.
Contractor: STAR ELECTRICAL SERVICE Owner: TIGARD PLAZA LLC
PO BOX 1784 8320 NW HWY 99
BEAVERTON, OR 97075 VANCOUVER, WA 98665
PHONE 503 - 579 -9201 PHONE:
FAX 503 - 579 -4581
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 09/22/2011 $100 70
Specifics: amps or less
1 ea 12% State Surcharge - 09/22/2011 $12.08
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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. T ose rules are set forth n OAR
952- 001 -0010 through OAR 952 - 001 -0090 You may obtain . • - - - = -s •ect questions to OUNC by calling 503.232 19: or 1 :00 332 23.4/
Issued By: ��.L — .c Permittee Signature: mill/. // /LJ
Aggro ;PA
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.
Electrical Permit Application � .� �y 1/ FOR OFFICE USE ONLY
City of Tigard
Date/By
r c //' 1/ �� Permit No �) p f + cc `]
. ° 13125 SW Hall Blvd , Tigard, O' Plan R eview /��C/t do
` Phone. 503 718 2439 Fax Ak.4 960 4� �. Date /By. Other Permit
TIGARD Inspection Line 503 639 417 GP 0.) Date Ready/By luris ® See Page 2 for
Internet: www tigard -or gov <Q <c\ .\ Notified/Method i � i Supplemental Information
TYPE OF W0 ` , c4� V� PLAN REVIEW
❑ New construction Addition /alterat ereacement Please check all that apply (submit 2 sets of plans whtems checked below)
,1' ❑ Service or feeder 400 amps or more ❑ Building over three stories
El Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards
CATEGO OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
El I- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations buildings
Ej Multi - family El Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: / IOOHP or more occupancy
�! 9 �6 � st 1 p �1) r ❑ Six or more residential units ❑ Recreational vehicle parks
City/State/ZIP: / ❑ Health -care facilities ❑ Supply voltage for more than
Cit
y 77, it ❑ Hazardous locations 600 volts nominal
Suite /bldg. /apt no.: / Project name: niclrj V c. l/' for j ❑ 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.
ee, P / / Includes attached garage.
Subdi ision: Or Lot no.: 1,000 sq ft or less 168 54 4
Ea add'I 500 sq ft or portion 33 92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq ft) 75 00 2
Limited energy, multi - family 75 00 2
R n /'i e, V M e S /�f /J l f e J residential (with above sq ft )
jv / �1J ///"jt l/ �.1[ Services or feeders installation, alteration, and /or relocation
200 amps or less i 100.70 /ad, ,O 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133 56 2
► 401 amps to 600 amps 200 34 2
Name: ✓ /// �,g ,/'
v�r� / r a r °e 601 amps to 1,000 amps 301 04 2
/ `
Address: , / ,,, Over 1,000 amps or volts 552 26 2
j 4� n Temporary services or feeders installation, alteration, and /or
City/State /ZIP: �j relocation
Phone: (,%"' 7 " / 7 q _ „ .+7 7/ / Fax: ( ) 200 amps or less 59 36 1
('J �' 201 amps to 400 amps 125 08 2
Owner installation: This ins[ llation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701 401 amps to 599 amps 168 54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with
above service or feeder fee,
�[ APPLICANT I ❑ CONTACT PERSON 7 42 2
V \ 1,..- i'
AAA each branch circuit
name 014 - 1 / � A � - B Fee for branch circuits without
Lr6 C� / /7 (r Jw service or feeder fee, first 56 18 2
Contact name: / / /�/yj� branch circuit
(� J , / Each add'I branch circuit 7 42 2
Address.
(V - /h t p 11 � / )� 7 Miscellaneous (service or feeder not included)
Ci /State /ZI I (J / J Each manufactured or modular 67 84 2
V ,,v/.7 r �n/ ` '9'(9'2 � / dwelling, service and/or feeder
! Reconnect only 67 84 2
Phone: ( ) Fax : ( )
Pump or irrigation circle 67 84 2
E - mail: Signor outline lighting 67 84 2
CONTRACTOR Signal circuit(s) or limited energy
�� panel, alteration, or extension Page 2 2
Business name: OP, i r ' Each additional inspection over allowable in any of the above
Address: f a t n / / 7 zl Additional inspection (1 hr min) 66 25/ hr
City /State /ZIP: / r Investigation (1 hr min) 66 25/ hr
1 _4_ ('t t I Industrial plant (1 hr min) 78 18/ hr
Phone: G � _ �' 6p, t Jl a 0 l Fax: ( ) Inspections for which no fee is 90 00/ hr
I s iectficall listed 'A hr min)
CCB Lie.: i ' 6"e 71 Electrical Lic. /69, 6 Suprv. Lie.. //., ' ELECTRICAL PERMIT FEES
7 / . I ✓ Subtotal ) - 7 v
Suprv. Electrician signature, required:
J. -_ . / ._ i .../V Plan review (25% of permit fee). ---..
Print name: _ / / / D. / State surcharge (12% of permit fee). l
�i' ,,,/ �� II ♦ /P
TOTAL PERMIT FEE !, i a/ot '7',
Authorized signature:
This permit application expires if a permit is not o . toned within 180
Print name. Date days after it has been accepted as complete.
Number of inspections allowed per permit
1 U3udding\Permits\ELC- Perm0App doe 07/01/10 440 -46I 5T( I 1 /05 /COM /WEB
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:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
T I Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signahng
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Buddmg\Perm ts\ELC- PermrtApp doc 07/01/10