Permit t CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00632
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/08/2011
Parcel: 2S114AA00200
Jurisdiction: Tigard
Site address: 16285 SW 85TH AVE 101
Project: Bridgetown Bakery Subdivision: 1993 -078 PARTITION PLAT Lot: 2
Project Description: (1) branch circuit for oven.
Contractor: E C COMPANY Owner: WH SHIPMAN LIMITED
PO BOX 10286 BY NORRIS & STEVENS INC
PORTLAND, OR 97296 621 SW MORRISON STE 800
PORTLAND, OR 97205
PHONE: 503 - 224 -3511 PHONE:
FAX: 503 - 295 -3012
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 11/08/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/08/2011 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 95 - 001 -0090. You may obtain a cop of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
I
Issued By: _ _f r i_�!/ Permittee Signature:
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.
Nov. 8. 2011 8:20AM No. 0047 P. 1
Electrical Permit Application �V � 10 FOR OFFICE USE ONLY
Received
City of Tigard �� r0 nate/B : I Permit r ./ i I Co
4 13125 SW Hall Blvd,. Tigard, OR 97223 ,,, O Plan Review
li k
i Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
GPR� l y baIeJBY:
!'1CiA1t U InSpCCtiOn Line: 503.639.4175 �``. `cl0 Date Ready/ y: rune: la SeePage2 for
Internet; www.tigard- or.gov '0 0 Notified/Method: 771PC, Supplemental Information
• • Please check all that apply (submit 2 sets of plans wfiems checked below):
❑ New construction 1 Addition/alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards,
--------- -L .k:.. }.. ce- .. F.il � tl ram _
- ' 11 11 '. • 0 �.. Cf0 e 0 T .. °,z - exceeds 10,000 amps at 150 Yalta or ❑Floating buildings.
u - less to ground. or exceeds 14.000 ❑ Commercial - use agricultural
0 1 - and 2- family dwelling El Commercial/industrial ❑ Accessory building amps troll other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other:. ❑ Fire pump. Q Installation of 75 KVA or
,� _ >m� � .y?t '-_ ::, ( Emergency system.
larger separately derived system.
_ 0 9. uy' 0 Y11Y!A!'t�'TF' 0 S ' � : � • '"1i y [(Addition oCnew motor load of Q < `A ", "E", "1 -2 ", "1 -3 ",
Job no.: 711011 - 07 Job site address: 16285 SW 85 Ave 10o11Por occupancy.
❑ Six Or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 97224 ❑ Health - care facilities. ❑ Supply voltage for more than
°Hazardous locations. 600 volts nominal.
Suitt/bldg./apt. no.: 101 Project name: Bridge Town Bakery ❑Service or feeder 600 amps or more.
Cross street/directions to ob site: -
J peacrtp uon Qrq. Nee 'rorat •
New residential single- or multi•famlly dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. It or less 168.54 4
Ea, add'I 500 sq. It. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
= . > - _x - - -zME a!' or 0 �4Y0 w - - ' ?r''sr - -- _ (with above sq. R,)
Limited energy, multi - family 75.00 2
Hook up 50A ckt for oven residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less I 100,70 L
s " _ n ' i` — — 201 amps to 400 amps 133,56 2
-
401 amps tO 600 amps 200,34 2
Name: 601 amps to 1,000 amps _ 301,0 2
Address: Over 1,000 amps or volts $52,26 2
Temporary services or feeders installation, alters lion, and /or
City /State/ZIP: relocation
Phone: ( ) Pax: ( ) 200 amps or less 59,36 1
Owner Installation; This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 -
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, er panel
Owner signature: Date: A. Pee for branch circuits with
; =- ___ _ - - --
above service or feeder foe,
- - " - -- ® =�_ , each branch circuit 7.42 2
Business name: EC Company B. Fee for branch circuits without
service or feeder fee, first 1 56.18 56,18 2
Contact name: Kathy Kelley branch circuit _
Each add'; branch circuit 7.42 2
Address: 2121 NW Thurman St Miscellaneous (service or feeder not included) _
Each manufactured or mular
City /State /ZIP: Portland Or 97210 dwelling. service and/or feeder 67.84 2
Phone: (503) 224 -3511 I Fax: : (503) 295 -3012 Reconnect only 67,84 2
- Pump or irrigation circle 67.94 2
E -mail: katItyk@e e - c - co.com Signor outline lighting 67.94 2
- .d4. - mow _ : : ;, O 4l Q ± — a w ,.r - e. Signal CinC 10) or limited- energy
Business name: EC Company panel, al teration, arextens Page 2 2
Each additional Inspection over allowable in any of the above
Address: PO Box 10286 Additional inspection (1 lirmin) 66.251W
City /State /ZIP: Portland Or 97296 Investigation (1 hr min) 66_25/ hr
- Industrial plant (I hr min) 78.18/ hr
Phone: (503) 224.3511 Fax: (503) 295 - 3012 Inspections for which no fcc is 90.00 / hr
s ecificall listed 'h hr min
CCB Lic.: • 49737 Electrica ' ' 26• A Suprv, Lie.: e 7_ (, f ��C F
J C Tfll i —
!-`
Suprv. Electrician signature, required: o Subtotal: 56.18
C Plan review (25 /o of permit fee):
Print name: Ron Coffin Date: 11/8/2011 State surcharge (12 %ofpermit fee): 6.74
TOTAL PERMIT FEE: 62.92
Authorized signature: G j }/ T his permit application expires if a permit Is not obtained within 180
� `� days after it has been accepted an complete.
Print name: Anna Hell Date: 11/8/2011 i Number of inspections allowed per permit.
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