Permit d , t CITY OF TIGARD ELECTRICAL PERMIT
I COMMUNITY DEVELOPMENT Permit #: ELC2011 -00677
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/01/2011
Parcel: 2S102CB03200
Jurisdiction: Tigard
Site address: 9975 SW FREWING ST 220
Project: Spec Space Subdivision: FREWING'S ORCHARD TRACTS Lot: 21
Project Description: TI
Contractor: SAFE ELECTRIC INC Owner: BY PICOCO
PO BOX 1677 MASSIH LLC
GRESHAM, OR 97030 4343 VON KARMAN AVE 3RD FL
NEWPORT BEACH, CA 92660
PHONE: 503 - 998 -8832 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 12/01/2011 $100.70
Specifics: amps or less
10 crt Branch Circuits w /Purchase 12/01/2011 $74.20
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 12/01/2011 $20.99
Electrical
Type of Const:
Occupancy Grp:
Total $195.89
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 C pt_ . Those rules are set forth in OAR
952- 001 -0010 through 0A' • 2- 001 -0090. You ma obtain a • • • .: - - •r direct questions to OUNC by calling 503.2521987 or ;00.332.23, .4.
Issued B — " ��� Permittee Signature: _ `'
OPP tr 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 ApplicatiorRECEIVED FOR OFFICE USE ONLY
111 City of Tigard N V 0 0 Date/B ii h /r A�� Permit No.: i t ,, i i — i 77
v 13125 SW Hall Blvd., Tigard,OR 9 7223 Plan Review
0 Phone: 503.718.2439 Fax: 503.598. l Date/By: Other Permit:
RY OF TIGARD
Inspection Line: 503.639.4175 Date Ready/By: luris' ® See Page 2 for
T1 G A R D
Internet: www.tigard-or.gov BUILDING DIVISION Notifie ' Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ 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.
CATEGORY OF 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 V Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ 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 ", "l -2 ", "l -3 ",
Job no.: Job site address: 9,15 5 4 FREw IN°, S S S or more occupancy.
❑
0 Six or or more residential units. Recreational vehicle parks.
City/State /ZIP: - 7 - 14.4e D ®x 47a2. 3 ❑ Health-care facilities. ❑ Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: 2 2-C') Project name: '' VA JX sh l.. ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 11 MI . Ff £ w I / i `4 S T Description 1 Qty. I Fee. I Total I
1 ' v New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION 'OF WORK (with above sq. ft.) 75.00 2
IN t o / tl , t p f� L / A Limited energy, multi - family 75 00 2
STALL PI Q I' EL - I t I WI i 1 v C A NS - E C PT'I £.4L s - residential (with above sq. ft.)
anj t� try ` 5 // s1J Nl Services or feeders installation, alteration, and /or relocation
flP_0c.00 " U0/ G yfs' 200 amps or less i 10070 ( U d Z
j "PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: Pi UZ ypgetivo I1G1/V\ 601 amps to 1,000 amps 301.04 2
Address: 8 E I C c 7 D ST Over 1,000 amps or volts 552.26 2
L O � r W` Temporary services or feeders installation, alteration, and /or
City /State /ZIP: 0 G . d Q relocation
Phone: (503 ) 704 42 40 Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation 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
f above service or feeder fee,
APPLICANT ❑ CONTACT PERSON / Q 7.42 71 2
each branch circuit I r
Business name: B. Fee for branch circuits without
MAC 4 4 k / � . BOV% I service or feeder fee, first
5618 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Ci /State /ZIP: Each manufactured or modular 67.84 2
ry dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
_1 Pump or irrigation circle 67.84 2
E - mail:; f; C �ppeie., pl aLA I . [. 0 Sign or outline lighting 67.84 2
CONT Signal circuit(s) or limited- energy
Business name: S -- /DI � C i 2 / C_ I r C panel, alteration, or extension. Page 2 2
J Each additional inspection over allowable in any of the above
Address: P. CJ, /3 J N / G Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: c/(, S 4 04, 9-:?--4) 30 i Industrial plant (1 hr min) 78.18/ hr
Phone: (6 998' - 0 Z Fax: ( ) Inspections for which no fee is 90.00/ hr
/, specifically listed (%I hr min)
CCB Lie.: ( Electrical Lie.: 2
C -5 /� Suprv. Lie.: 43 �+S ELECTRICAL PERMIT FEES
- 7�/ � Subtotal: G! 4 (6
Suprv. Electrician siK attire required: 4�2 ^c°'� _ I O )' I I3 I
Plan review (25% of permit fee):
Print name: ) /l frl y /3 0 T i f 4- - Date: 1 I -- 3 v . if State surcharge (12% of permit fee): ,
TOTAL PERMIT FEE: 4 Authorized signature: v This permit application expires if a permit is not ob ed within 180
�}—� Date: .f days after it has been accepted as complete.
Print name:
/ ( 'r� �1.• /3 117 J / 4- _, I' — � r * Number of inspections allowed per permit.
1 \Building \Permits \ELC- PermitApp.doc 07/01/10 440- 4615T(I1/05 /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*
❑ 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
❑ . Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1 \ Building \Permits\ELC- PermitApp.doc 07/01/10