Permit z? ° n CITY OF TIGARD ELECTRICAL PERMIT
s COMMUNITY DEVELOPMENT Permit #: ELC2009 -00550
1'joAR 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/16/2009
�. Parcel: 2S101BCO2401
Jurisdiction: Tigard
Site address: 12650 SW HALL BLVD
Subdivision: Lot: 0
Project: Snyder Roofing
Project Description: Replace lamps and ballast in office troffer fixtures.
Owner: FEES
KING, JAMES F Quantity Description Date Amount
12650 SW HALL BOULEVARD
TIGARD, OR 97223 10 crt Branch Circuits 10/16/2009 $122.96
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/16/2009 $14.76
Electrical
Contractor:
ENERGY CONSERVATION SYSTEMS INC
2373 NW 185TH AVE #156
HILLSBORO, OR 97124
PHONE: 971 - 327 -6055
FAX: 971 - 228 -1700
Type of Use: COM
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 applica•.le law. All work will
be done in - -- with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is susp ded for more the 180
days. • ENTION: Oreg• • law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rule are set forth in OAR
95 $01 -0010 through OAR 95 :$1 -1100 ou may obtain a cop of the rules or direct questions to OUNC by calling 503.246.• -99 1.800.332.23
Issued By: % 0 ,1 L�
0 _4 I Permittee Signature: / 191r,
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 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.
Electrical Permit Application roi O ICI: USE ONLY
• Received �5
•
City of Tigard DateB : / Cp 6 Permit No.:E _-�,- i „i 550
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: . See Page 2 for
Internet: www.tigard - or.gov Notified/Method: 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 ® Commercial /industrial ❑ Accessory building amps for all other installations, buildings
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA of
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "l - ", "1 - ",
Job no.: 1222a Job site address: 12650 SW Hall Blvd. 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, Or 97223 ❑ Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Snyder Roofing ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: South on Hall form Hw99 Description j Qty. I Fee. I Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: 2s11bc02401 Ea. add'l 500 sq. ft. or portion 33.92 1
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 67.84 2
Replace lamps and ballast in Office troffer fixtures residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ® ' TENANT 201 amps to 400 amps 133.56 2
Name: Snyder Roofing 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 12650 SW Hall Over 1,000 amps or volts 552.26 2
City/State /ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (503)6205252 Fax: ( ) 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, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT ® CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: Energy Conservation Systems, Inc. B. Fee for branch circuits
Contact name: Nathan Pollard without service or feeder fee 1 56 18 56.18 2
first branch circuit
Address: 2373 NW 185 Ave #156 Each add'l branch circuit 9 7.42 66.78 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Hillsboro, OR 97124 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (971) 3276055 Fax: : (971) 2281700 Reconnect only 67.84 2
E -mail: nathanp @econservationsys.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Energy Conservation Systems, Inc Signal circuit(s) or limited -
energy panel, alteration, or
Address: 2373 NW 185th Ave #156 extension. Describe: Page 2 2
City/State /ZIP: Hillsboro, OR 97124 Each additional inspection over allowable in any of the above
Per
Phone: (971) 3276055 Fax: (971) 2281700 inspection 66.25
Invest per hour (1 hr min) 66.25
CCB Lic.: 164536 44VI Electrical Lic.: LMS42 Suprv. Lic.: QP758 Industrial plant per hour 78.18
Suprv. Electrician signature, required: 7 1 1 1 I 1 ELECTRICAL PERMIT FEES
Subtotal: 122.96
Print name: Curtis Pollard Date: 10/15/09 Plan review (25% of permit fee): -
• , r .. ii State surcharge (12% of permit fee): Z
Authorized signature: M , , TOTAL PERMIT FEE: I r
1 Date: y / This permit application expires if a permit is not obtained within 180
Print name:
� (,� ✓4,I 6 f U -(1 �/ i cc. days after it has been accepted as complete.
66 * Number of inspections allowed per permit.
I:\Building\Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11/05 /COM/WEB