Permit CITY OF TIGARD ELECTRICAL PERMIT
•_ COMMUNITY DEVELOPMENT Permit #: ELC2009 -00308
13125 SW Hall Blvd., Tigard OR 9 7223 503.639.4171 Date Issued: 06/22/2009
, • AR•• Parcel: 2S102DA00401
Jurisdiction: Tigard
Site address: 13125 SW HALL BLVD PERMITS
Subdivision: — Lot: 0
Project: Permit Center
Project Description: Install /alter (1) branch circuit to replace roof unit.
Owner: FEES
TIGARD, CITY OF Quantity Description Date Amount
13125 SW HALL BLVD
TIGARD, OR 97223 1 crt Branch Circuits 06/22/2009 $46.85
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/22/2009 $5.62
Electrical
Contractor:
GLOBAL ELECTRIC, INC.
PO BOX 162
NORTH PLAINS, OR 97133
PHONE: 503 - 647 -5650
FAX: 503 -647 -5649
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $52.47
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 952-001-0100. 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: �Q1.. lX l Permittee Signature: Stp A A CC(*idC
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.
PIL F.rom: 06/19/2009 16:27 #890 P.002/002
Electrical Permit Application FOR of rice tlsr o'i.z
City of Ti aril 8 ZOOS R eceived
•
ry'r *: `r g Dat /B : ` 4 Permit No 0 00.06 O o
111=>
13125 SW Hall Blvd., Tigard, OR 97223
) U N 1
® Plan Review
Phone: 503.639.4171 Fax. 503.598.19 Dat /B :
Inspection Line: 503,639.4175 CI Other Permit:
CITY OF TIGARD C� See Page 2 for
'f'I "(.�,\ R1�, p Date Ready /B y
Internet: www.tigard- or.gov BUILDING DIVISIO Notified'Method: Supplemental Information
L -'
TYPE .OF .'W ,
v.,,,, ;
' ` ". ,- ` • p p ' y(submit ` . _ �'.; 1.. p -:_. ;`=,:ia,•:•a;:'�'`�is)�;�;:,.• � 1 '� .;=T,,
Please check all
❑ New construction Addition /alteration /rcpiacemem ll that apply 2 sets of plans wrilcros checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
Demolition
❑ Other: where re the available fault current ❑ Marinas and boatyards.
a CATEGO Y: - exceeds 10.000 snips at 150 vol or -... .,..__, R ..OF;;C'ONSTR�LGI'ION.':�: "= volts ❑Floatin buildings.
1 - and 2 dwelling commercial /industrial ❑ Accessory , building Floating s.
6
less to ground, or exceeds 14.000 ❑ Commercial -use agricultural
❑ y y ding amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
;:, - l',..� . ' -�:: �. :; < -: - - - - - -- a larger separately derived systems.
., ,..'; JOB SIT INFORMATION ''AND`; LOCATION'. -` , ' :•
, . ' ^: . - ntergcncy syst•n
- -� - - . *. ., -- .-- ...... ,... <,..- ...,_, ....._ .�. _.,..,, �. ,,;:- ,._..�� ❑ Addition of new motor load of ❑ -A-. .. ..1 -2-. ..1 -3.,,
Job no.: Job site address: i t _3] 5 - iv ,( j, A/vJ 100HP or more. Occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZiP: % 7 m /ZZ b JZ y 7 213 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg, /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
{ ;, ; ; ;; . ":u ';, „;..: k4FEEsSCHEDULE r:” ;!,,':' ;,a h: '; :,
Cross street/directions to job site:
Description 1 Qty. 1 sec. T Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: - Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.:
Ea. add'! 500 sq. ft. or portion 33.40 1
Limited eneigy, residential
,: ,...,,. •;,;,,,,,;,,,;,,, 5.00 2
,.' .., �..;,. - DESCRIP�30N'�
_.. ,.�...., .. : ^..., ....�:.,,.- ":_..ate.. - '� :, -fS (with above NA.)
Limited energy, multi- family
75.00 2
.A#1 -ex. Ao-cf GUS residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 PRF ,' " `` " ,.:' ,,:.:•, :- ;,
or s
, .'.' a :• :.:.. O - ::,,.:.:,..;.:..,,,•,.,._„ z_,.. amps � 80.30 2
_: TENANT';;;,'::?
ERTY„ W ;N❑
Q NER °`'
- ,...,,. .,� ,,:..,, ,..;`... ....,.,,.;,`�= .:...... ... ..: 201 to 400 amps
s'' ; 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 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 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
sw
,, A _ ;,,- Fee orbranch circuit with
P ANT > ""
�=CQNT'' above service r
,.. rr PEItS:.,N ' -� feeder fee
„F �:. „..,;:; >� � ���,..-• •::•. 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 e f� �� 2
first branch circuit
Address: Each add'] branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( )
Reconnect only 66.85 2
E-mail: _ or irrigation circle 53.40 2
- -.
C O
NTRA
: C'i`UR`
.. i nor
outline l ighting ......:. ...... ,. �„ Y,. > - : ° ; : - ' ° ;.;`,- _trr.;, g ghting
Business name: 6 /.. '2 A L E' c. F 7f2 / _ i! c • Signal circuit(s) or limited -
energy panel, alteration, or
Address: R0 /30 t- /1). extension. Describe: Page 2 2
City / State/ZIP: it/G',ij'/ ?14 /n o :2 4 7711 2 Each additional inspection over allowable in any of the above
/ Per inspection 62.50
Phone: (5O ) C't' r? 7 -- 51 Fax: (5 pi ) C17- 54 c / Jr Investigation per hour (I he min) 62.50
CCB Lie.: 15 g. g Electrical Lie.: 3'1- 655c Suprv. Lie.: 5.)i 0 S Industrial plant per hour 73.75
I'MLECTRI CAL; PERIVIIVFIEES=' ` - :tit:';;;;:;;
Suprv. Electrician signature, required: pc Subtotal:
Print name: je:.Sili✓ . l .J Date: �7 V/ Plan review (25 % of permit fee):
State surcharge (12% of pennit fee): 5, C
Authorized signature: 21.1,y¢4 TOTAL PERMIT FEE: 5a. e- 17
Print name: !t i Ai / JJJ This permit application expires if a permit Is not obtained within ISO
/ E' /2 l ✓✓� Date: C / 011 days after it has been accepted as complete.
Yj • Number of inspections allowed per permit.
I: mudding ',Petmits''ELC- PermvApp.doc 05123.06 440 - 46 15T( II'OJ'C'OM /WEIt