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Permit CITY OF TIGARD ELECTRICAL PERMIT 111 COMMUNITY DEVELOPMENT Permit #: ELC2011 00673 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/01/2011 Parcel: 2S102AA04201 Jurisdiction: Tigard Site address: 8955 SW COMMERCIAL ST Project: Essential Planning Group Subdivision: TIGARD HIGHWAY TRACTS Lot: 2 Project Description: Electrical for TI. Contractor: RELIANT ELECTRIC OF OREGON LLC Owner: BUTTERFIELD, CHARLES W JR & 20200 SE OLDENBURG LN MICHELLE S SANDY, OR 97055 825 SW VIEWCREST DR DUNDEE, OR 97115 PHONE: 503 - 701 -4562 PHONE: FAX: 503 - 668 -4190 FEES Quantity Description Date Amount 10 crt Branch Circuits wo /Purchase 12/01/2011 $122.96 Specifics: Service or Feeder 1 ea 12% State Surcharge - 12/01/2011 $14.76 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $137.72 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 -0090. You may obtain a cop s or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: `���i� _�' Permittee Signature: 46 At 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. Dec.01.2011 06:52 AM Reliant Electric of Orego 5036684190 PAGE. 2/ 2 Electrical Permit Application RECEIVED („It 011 l 11. I 1 `l 1 \I City of Tigard DEC 1 2011 ' '"'::" , i „ P' mit N°-: ilF - t 1 t —CO& j II e 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Perrcit, $ • Phone: 503.718.2439 Fax; 503.598.'9 nate/B : ,•, // — . _ --� .. Inspection Line: 503,639.4175 CITY OF TIGARD : e Ready/By; 1=11 II . Page 2 for I I ii l' Internet: www.tigard BUILDING DIVISIO Naiaed/M Supplemental Information TYPE OF WORK PLAN REVIEW Please check all that apply (submit a sots of plans w /items checked below): New construction Zr. Addition/alteration/replacement ❑ Service or fscder 400 amps or more D Building over three stories. 0 Demolition ❑ Other: where the available fault cement ❑.Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at I50 volts or 0 Plotting buildings. less to ground, or exceeds 14,000 © Commercial-use agricultural [] 1- and 2 - family dwelling ,,, 'ommcreiaVindustrial 0 Accessory building amps for all other installations. buildings, 0Multi tbmily 0 Master builder C3 Other: C3 Fire pump. ❑ Installation of75KVAor ['Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION El Addition of new motor load of ❑ "A", "E" "1-2", "1.3 ", r� 'r OO M' tor occupancy, Job no.: _ a Job site address: T~( P ) ❑ s ix or more or ro residential units. ❑ Recreational vehicle parks. Q Health-cam us facilities, 0 Supply voltage for more than City /State/ZIP: ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt no.: Project name: E 1-1 0 0 (l / ❑ Service or feeder 600 amps or more, FEE SCHEDULE Cross sleet /directions to job site: u , , . a v T ,t • New residential single- or multi - family dwelling unit. Includes attached gara Subdivision: Lot no.: 1,000 sq. R or less 168.54 EMS Ea, add'I 500 sq. ft. or portion 111 33,92 .111 Tax map /parcel no.: Limited energy, residential 75.00 DE,SC' ' ON OF WORK with above, r. ft, Limited energy, multi - family 7516 =II i CT r ; r_ pc -C,1 Of 1 - . ' +f n aye) ,• 1 6 residential with above :., ft: i Services or feeders Installation alteration, and/or relocation 200 amps or less 100.70 2 El PROPERTY OWNER 0 TENANT 201 amps to 400 amps III 133.56 wiis 401 amps to 600 amps 200,34 Name: 601 amps to 1,000 amps - 301.04 Address: Over 1,000 amps or volts 1.1111FESE111111=8 Temporary services or feeders installation, alteration, and/or City /State/ZIP: relocation Phony ( ) Fax: ( ) 200 amps or less 59,36 201 amps to 400 amps 125.08 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 intended for sale, lease, rent, or exchange, according to O(tS 447, 449, 670, and 701. Ursach circuits— new, alteration extension,' r panel . Owner signature: Date: , .. A. Fee for branch circuits with APPLICANT Q CONTACT PERSON above service feeder fba, 7.42 2 each blanch circuit uit We ., L. / 6 I '� , B. Fee Poo branch cir without 56.18 .o. aerviCC or !baler fx, first Contact name: i • branch circuit Mil Ca nam F7 i L 1 � L L - 1231112111111101211t Address: 1 f [.� / `� ', ( �%' I l � / / . I n. 5 . / Miscellaneous service or feeder not included 7 _ City/State/ZIP: 5a. Each manufactured cd d/ modular .`L y)K, q - i1 ; Each service and/or r (/ (� �� 1 nl „ � 4 l _ t / Reconnect only w 67,84 Q Phone: �) « / * `�, Fax W lV o J Pump or irrigation circle Mil 67.84 U E re. I_ I i I , r ' Sign or outline lighting I 67.84 1,111 • t NTRACI'OR Signal clrcult(s) or limited- enerE/ • P: MI •.:ncl alteration or extension. Business name: Each additional ins . etion over allowable in an of the above Address: Additional inspection (I hr min) NMI 66.25/ hr EMI . 12=2:111111111 66.25/ ht IMMO City /Statc/ZIP: AI / At 1101/111M Industrial plant (1 hr min) ,� A 1� Inspections for which no the is Phone: ( rr . . � s ∎ ificall listed I.S hr min 90,06/ hr . Eimiiftirfip Electrical Lie.: MEM Sup (� r j l Subtotal: ... Suprv. Electrician s , + "' r ' r toed /���, l ` — Plan review (25% of permit fee): Print name :` l P , r Date: I ! — , lit State surcharge (12% of pennit fee): illrakto Authorized signature: r • ' I , , , , i This permit application expires It a penult Is not obtained within I : -al days after It has beet accepted as eoruplete• i . 't a Dace :) ( . Number of inspections allowed per permit. lAnui1dina\eurmite liLCN'mmaApp.dec 07(01110 440.46151(11/05/COM/W00