Permit •
• CITY OF TIGARD ELECTRICAL PERMIT
n
3 ;.... COMMUNITY DEVELOPMENT Permit #: ELC2009 -00240
T1GARb 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 05/26/2009
Parcel: 2S102CB03500
Jurisdiction: Tigard
Site address: 10050_SW GARRETT -ST --
c ,
Subdivision: Lot: 0
Project: Maple Court
Project Description: Install (1) 200 amp or less sub panel and (2) branch circuits to fire pump and flow bell.
Owner: FEES
GOOD SHEPHERD LUTHERAN HOME OF T Quantity Description Date Amount
831 SW 17TH AVE 1 ea Services or Feeders - 200 05/26/2009 $80.30
PORTLAND, OR 97205 amps or less
PHONE: 2 crt Branch Circuits w /Purchase 05/26/2009 $13.30
Service or Feeder
1 ea 12% State Surcharge - 05/26/2009 $11.23
Contractor: Electrical
DYNALECTRIC
5805 SW HOOD AVE
PORTLAND, OR 97239
PHONE: 503 - 226 -6771
FAX: 503 - 226 -7818
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $104.83
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- 001 -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: lb —A it `� _ L , Permittee Signature: ' n �
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.
£- E lectrrcal Permit Application - - FOR OFFICE USE -
City Of Tigard Received Permit No.:, - s q 0
III - a 1 3125 SW Hall Blvd., Tigard, OR 97223 Plan Review '
Phone: 503.639.4171 Fax: 503.598.1960 DateB : Other Permit:
TIGARD Inspection Line: 503.639 Date Ready /By BM El See Page 2 for
Internet: vww.tigard- or. gov Notified/Method: Supplemental Information
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❑ New construction ® 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.
�% a �. -. 12 Floating buildings.
���t= ;� =;� � ° �� CATEGORY tOF 3GONSTRUGTIONp� � �, �.. exceeds 10,000 amps at 150 volts or
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
>- ;. ,> »: � i El Emergency system. larger separately derived system.
:: a . ibi SITE, INFORMATI ? AND: ' . LOGATION : T' ,.. " "s ❑
.,..5 �4,,,,, •te, , . • , .,,Y, ;;,; � ,,,. ❑ Addition of new motor load of
Job no.: 109101 -103 Job site address: 10050 Sw Garrett St 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Maple Ct 4 Plex ❑ Service or feeder 600 amps or more.
s C ' fi ,n F E'' SCHEDUL f „
Cross street/directions to job site: Description I Qty. I Fee. I Total e l '"
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential
:; „,.�' -- :��_ »K - F:��;wj: --- ; A �.:,�
R ; k DES RIPTION_Ottl)A - - *$ l (with above sq. ft.) 75.00
Limited energy, multi - family 75.00 2
Providing and installing sub circuit breaker panel to power fire pump and residential (with above sq. ft.)
s rinkler flow bell. Services or feeders installation, alteration, and /or relocation
p 200 amps or less 1 80.30 80.30 2
7 P =ROPEB< ,OWNER * >3� , `` -4 = 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
,ddress: Over 1,000 amps or volts 454.65 2
City /State /ZIP: 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
' ®'' APPL CA zc ;m ,t2 CONTACT PERSON - W above service or feeder fee, 2 6.65 13.30 2
each branch circuit
Business name: Dynalectric Co. B. Fee for branch circuits
Contact name: Dave Coffey f i r st service or feeder fee 46.85 2
first branch circuit
Address: 5805 Sw Hood Ave Each add'I branch circuit 6.65 • 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Portland, OR 97239 Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: (503) 226 -6771 Fax: : (503) 226 -7818 Reconnect only 66.85 2
E -mail: dbcoffey @dyna - oregon.com Pump or irrigation circle 53.40 2
f 'ft" . tCONTRA'GTOR a, .. '' ' = •try ' ''" ° Sign or outline lighting 53.40 2
Business name: Dynalectric Co. Signal circuit(s) or limited -
energy panel, alteration, or
Address: 5805 Sw Hood Ave extension. Describe: Page 2 2
City /State /ZIP: Portland, OR 97239 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 226 -6771 Fax: (503) 226 -7818 Investigation per hour (I hr min) 62.50
CCB Lie.: 66793 Electrical Lie.: 26 -59C Suprv. Lie.: 4653 S Industrial plant per hour 73.75
x�. ELEC�TRICi11a PERIVII'T�FEES _- ,;"V-.: -�» -` 3
Suprv. Electrician signature, required: gumi,AA Subtotal: i(, li,, (9O
r'rint name: Edward H Ryding Da e �I Q� Plan review (25% of permit fee):
' State surcharge (12% of permit fee): `T� ••-3
Authorized signature: ~ �_ i /. / L/ 1 / TOTAL PERMIT FEE: J�1 l�
5 r ~ ��11 This permit application expires if a permit is not obtain d within 130
Print name: Dave Coffey s te : 6 days after it has been accepted as complete.
r Number of inspections allowed per permit.
I:\Building\Permits\ELC- PermitApp.doc 05/23/06 • 440 -46I 5T( I I/05 /COM/WEB