Permit CITY OF TIGARD ELECTRICAL PERMIT
`` COMMUNITY DEVELOPMENT Permit #: ELC2009 -00215
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 639.4171 Date Issued: 05/13/2009
Parcel: 25101 BB01400
Jurisdiction: TIGARD •
Site address: 12_1.5.0= SW- GARDEN_P_L,-BLDG #3,
Subdivision: PARK 217 Lot: 0
Project: Harris Workstations
Project Description: Add and alter (12) circuits
Owner: FEES
WALTON CWOR PARK BC 8 LLC Quantity Description Date Amount
BY TTA/EPROPERTYTAX DEPT 325, PO BOX 12 crt Branch Circuits 05/13/2009 $120 00
4900 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 05/13/2009 $14.40
Contractor: Electrical
RELIANT ELECTRIC LLC
20200 SE OLDENBURG LN
SANDY, OR 97055
PHONE. 503 - 860 -4240
FAX: 503 - 668 -4190
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $134.40
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will
be done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the
180 days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952- 001 -0010 thro.. h 0 • R 952 - 001 -0100 You may obtain a copy of the rules or direct questions to OUNC by calling 503 246 6699 or 1 800 332 2344
Issued By: ♦ 1 _ti _ .S! A • .. 91_1 Permittee Signature: • / r4! I .
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
MAY., -11 -2009 12 :02P FROM: RELIANT ELECTRIC 5036684190 TO: 5035981960 P.1
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Electrical Permit Appl1C$ti, 1 ' . , i t)i2 t),,i It I t,'I ti, hyl ", ,ga m.1 ",
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71 City of Tigard N AY 112009 Dat ed . - I 1 � [�1.�.'�L
s ° 13125 SW Hall Blvd., Tigard, OR 972 Plan Review
• . Inspection Line: 503.639.417503.59 I9If0 CAF TIGARD Date Ready/By: Other Permit
Si Page 2 for
r i: a � � Internet: www.tigard- or.gov 1 Notified/Method: Supplemental information
BUILDING DIVISION T" C�,
TYPE OF WORK l PLAN REVIEW
❑ New construction IN Addition/alteration /replacement Please chock all that apply (submit 2 sets of plans wlitems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
173 Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATS ORY OF CONSTRUCTION exceeds 10,000 amps at LSO volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling Cotnmercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi-family 0 Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB ❑ Addition system. larger E", "1 "1 system.
OB SITE INFORMATION AND LOCATION
place / / /��j ❑ Additiaa of mans motor load of ❑ "A", "E ". "1 -2" "l -3"
Q 1212 3 !Z1����t� � ( Kl_C 1 ixor o more. ue�cy
Job n0.: Job site address: ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: J / p / / r� � � q -� L Z 3 ❑ Heelih -care facilities. ❑ Supply voltage for more than
f� ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Part' - 1 S 1,001' e-S�d- - ❑ Service or feeder 600 amps or more.
job site: Description FEE Cross street/directions to SCHEDULE
J ptlan I Q4:7 pee. I Total I ,
New residential single- or multi - family dwelling unit.
Includes attached garage, _ _
Subdivision: Lot no.: 1,o00 sq. tL 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 2
DESCRIYPION OF WORK (with above sq. ft.) ,
�� Limited energy, multi family 75.00 2
� I r� � _ n �- r Services or feeders installation.,alteration, and/or relocation
IF A 1 — r t added * ctt-1-0.ci Cpl rau �s 200 amps or leas 80.30 2
II PROPERTY OWNER ❑ TENANT ' 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 mmnpe 240.60 2
Address: Over 1,000 amps or volts I 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 amp 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 t to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, p r panel
Owner signature: Date: A. Fee for branch circuits with
0 PLICANT I [� CONTACT PERSON above service or feeder fee, 6.65 2
r N each branch circuit
Business name: [ ( ajt 1 t.€ . 11 C i L B. Fee for branch circuits
Contact name. , without service or feeder fee, 46 85 � p J j� 2
first branch circuit ,
Address: Q 2-0 p 5G C/ 1d. e n. CJ wr �_a Each add'► branch circuit 6.65 ? 3,1e', 2
Sa ll , 4 t1 "7 5 xtens Miscellaneous manufactured or modular
Phone: (510a s 1 !/(C/ -lam' 6113 dwelling, service and/or feeder
3 { — Fax:: ) " Reconnect only 66.85 2
E - mail: g.e l j eL -(-S .yi 0D1, _)M Pump or irrigation circle 53.40 2
CWITRACTOR \S Sign or outline lighting 53.40 2
Business name:
�eti� f Z�1 �] Signal circuit(s) or limited -
1 energy panel, alteration, or
Address: extension. Describe: Page 2 2
City /State/ZIP: 12-a/rite 0,,� �� _ Each additional Inspection over allowable in any of the above
t��`` Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lie.: ` ( if Electrical Lie,: 050 Suprv. Lic.: 514-1 S Industrial plant per hour 73.75
• ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: /2 Subtotal; j ]..e:), 0 v
Print name :K04 / 1 -TJ ' l L r--- ` '1 Date: 5-�1 t D3 c Plan review (25% of permit fee): ,�t ..
' (V (� /� /� I State surcharge (12% of permit fee): III-, 4
Authorized signature: �' 10 r 1 1le_A- r �, �f ha 41/A TOTAL PERMIT FEE: . 1 3 4 ;
i
Print name: r y - ' ` [" D ate : J �) This permit application expires If a penult is not obtained within 150
O 5 2 a 5 — / r " days after it has been accepted as complete.
e Number of inspections allowed per permit.
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