Permit CITY OF TIGARD ELECTRICAL PERMIT
:> COMMUNITY DEVELOPMENT Permit #: ELC2009 -00136
Date Issued: 03/24/2009
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.639.4171 Parcel: 2S1016601400
Jurisdiction: TIGARD
Site address: 12156 SW GARDEN PL, BLDG# 3
Subdivision: PARK 217 Lot: 0
Project: Chermay International
Project Description: Install (2) branch circuits
Owner: FEES
WALTON CWOR PARK BC 8 LLC Quantity Description Date Amount
BY TTA /EPROPERTYTAX DEPT 325, PO BOX 2 crt Branch Circuit's 03/24/2009 $53 50
4900 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 03/24/2009 $6 42
Contractor: Electrical
PORTLAND ELECTRIC CONTRACTORS LLC
P O. BOX 1422
SANDY, OR 97055
PHONE: 503 -501 -9064
FAX: 503 - 668 -1999
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59 92
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: � C� A Q. < D A,U Permittee Signature err
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:
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.
)f �sn RECLINED
Electf*al Permit Application ' ° FOR OFFICE; USE ''
City of Tigard R L 4 Received Permit No r� ,� (� ��
- `J MAR . t Date /By aii, C3 g K C O a
II
° 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
Phone 503 639 4171 Fax 503 598 1961 �.I �+�r OF TIGARD Date/By Other Permit
TIGARD inspection Line 503 639 4175 Da te Ready /By n ® See Page 2 for
Internet www.tigard -or gov BUI DIVISI Notified Met \ CA. Supplemental Information
' TYPE OF WORK '' ,, -:,` • PLAN REVIEW , ' •' ", '; "
['New construction A Addition /aheration /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 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 ❑ Commercial /industrial ❑ Accessory building snips foi all other installations buildings
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
.4 ' 'JOB', SITE, SITE INFORMATION AND; LOCATION • •-e'''�- - ❑ Emergency system larger separately derived system
-
_ ., ° , El A Addition of of new motor load of ❑ "A', "E ", "1 - ". "1 - ",
Job site address �J / l 1001 -IP or more occupancy
Job no.:
��r/ �� y 5�����G - ❑ Six or more residential units ❑ Recreational vehicle parks
.�f� �ie'dl ❑ Health -care facilities ❑ Supply voltage for more than
(X \ City /State /ZIP: 7 - A ei�j � �� 97 -' ❑ Hazardous locations 600 volts nominal
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more
', t , '' , s FEE ;, -_
Cross street /directions to job site: Description I Qty. 1 Fee. 1 Total I *
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'I 500 sq ft or portion 33 40 1
Tax map /parcel no.: Limited energy, residential 75 00 2
DESCRH'TION OF WORK , (with above sq ft )
Limited energy, multi - family 75 00 2
� G•, residential (with above sq ft )
Services or feeders installation, alteration, and/or relocation
200 amps or less 80 30 2
•- • ❑ " PROPERTY OWNER' : =v ' „' , ❑ - 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
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 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
• ' ❑",APPLI -„ , , ` -. '.'D CONTACT PERSON, - above service or feeder fee, 6 65 2
each branch circuit
Business name: B Fee for branch circuits
without service or feeder fee, Z 46 85 2
Contact name: first branch circuit
Address: Each add'I branch circuit 6 65 2
Miscellaneous (service or feeder not included)
City /State /Z1P: 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
Business name. Signal circurt(s) or limited-
‘,,,,.. / ` :/ .. e/ ee , " .. energy panel, alteration, or
N.-- extension Describe Page 2 2
Address: 1 &"/ �/ /9.2 6• 'G ,
City/State / /ZIP: �.--- Each additional inspection over allowable in any of the above
✓ mil✓ ��` Per inspection 62 50
Phone: ( ) Fax: ( )
Invesnganon per hour (1 hr mm) 62 50
CCB Lic.:_ Electrical Lic.: Su rv. Lic.: Industrial plant per hour 73.75
' �s�r� ���� p � "- _' .7 ; ELECTRICAL" PERMIT„ FEES E. - , , ", -
Suprv. Electrician signature, required: � Subtotal
�� - Plan review (25% of permit fee)
Print name: Date:
% d' .�`7.- ��� State surcharge (12% of permit fee)
✓ Authorized signature: TOTAL PERMIT FEE
/� This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit
1 \Building \Permits \ELC- PermitApp doc 05/23/06 440- 4615T(1 I /05 /COM/WEB
Electrical Permit Application - City of Tigard � ,
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for Al residential systems combined ... $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener* _
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
'COMMERCIAL WORK ONLY 7';
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Budding \Permits \ELC- PermuApp doc 03/23/06