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Permit CITY OF TIGARD ELECTRICAL PERMIT It.: COMMUNITY DEVELOPME Permit #: ELC2009-00214 Date Issued: 05/12/2009 T IGARD 13125 SW Hat Blvd., Tigard OR 97223 503.639.4171 Parcel: 25102DA00401 Jurisdiction: Tigard Site address: 13125 SW HALL_BLVD_CITY HALL Subdivision: Lot: 0 Project: City Hall Courts Project Description: Install /alter (2) circuits.5 /20/09 ADDED (3) circuits. Owner: FEES TIGARD, CITY OF Quantity Description Date Amount 13125 SW HALL BLVD TIGARD, OR 97223 2 crt Branch Circuits 05/12/2009 $53.50 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 05/12/2009 $6.42 Electrical Contractor: 3 crt Branch Circuits w /Purchase 05/20/2009 $19.95 OREGON ELECTRIC CONSTRUCTION INC Service or Feeder 1010 SE 11TH AVE 2 da 12% State Surcharge - 05/20/2009 $2.39 PORTLAND, OR 97124 Electrical (manual PHONE: 503 - 234 -9900 FAX: 503 - 535 -2763 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $82.26 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 952-001-01Q. 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: _. � � - � .� � , 2, • ♦ ! Permittee Signature: c401() I,l' C'ri ah 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. MAY-15-09 09:47 FROM- OREGON ELECTRIC- At H C EVE 5032349900 T -651 P001/002 F -365 Electrical Permit Application r (� l. lcl: Ii t1 0 a. . ivea City of Tigard Dare/B . ` ' r Permit No.: aft — cxsZ-14 13125 SW Hall Blvd, Tigard, OR 97223 MAY 1 5 2009 Plan Review . _ C . Phone: 503.639.4171 Fax: 503.598.1960 DatOB . Other Permit: T l GA ri U Inspection Line: 503.639.4175 CITY OF TiGARD Datc Ready/Br BM 0 Sec Pate Z for Internet www.tigard-or.gov NotiLed/Methori Supplemental Informadon DI III hr' In TYPE OF WO 1 /I Aril ery ... v Vl, PLAN..1ilEV>EW • RIC Please chock all that apply (submit 2 sets of plans w /items checked below): ❑ New Construction IZi Addition /alteration/replaccment ❑ Service or feeder 400 amps or more ❑ Building over three storirv. ❑ 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 E Commercial/industrial ❑ Accessory building amps for all other installations. buildings. © Multi- family ❑ Master builder ❑ Other: El Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND 'LOCATION ❑ n o system. larger E", "1 .27, derived system_ ['Addition of new motor load of ❑ "A ", "E ", "i •� ", °t -3 ", Job no.: 80016 -111 I Job site address: 13500 SW HALL IOOHI or more. o ceti pncy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City / State/ZIP: TIGARD OR ❑ Health -care facilities. ❑ Supply voltage for more th:m ❑ Hazardous locations. • 600 volts nominal. Suite/bldg./apt no.: 7 Project name: CITY HALL ❑ Service or feeder 600 amps or more. Cross street/dircctions to job site: Description . I Qtr. I Fee. I Total • I New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: I Lot no.: 1,000 sq. R or less 145.15 4 Tax map /parcel no.: Ea. add'! 500 sq. ft_ or portion 33.40 1 Limited energy, residential 75.00 2 • DESCRIPTION OF . WORK .. • (with above sq, R.) ADD 3 CIRCUITS TO PERMIT # ELC1009 - 00214 Limited energy, (with ab o a sq . 11 75.00 2 residential (with ab sq. 11.) Services or feeders installatlon,,alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROIP.ERT1f OWNER • . . . " "' . ❑ TENANT 201 amps to 400 amps 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/ Statc/ZIP: Temporary services or feeders installation, alteration, and/or . relocation Phone: ( ) I 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 Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A Pee for branch circuits with . 0 APPLICANT' ' : ❑ 'CONTACT PERSON . ' . . above service or feeder fee, 6.65 2 each branch circuit Business name: B. Fee for branch circuits — Contact name: without service or feeder fee fast branch circuit 46.85 2 Address: Each add', branch circuit 3 6.65 19.95 2 Miscellaneous (service or feeder not included) City /State/ZIP: Each manufactured or modular dwelling, service and/or feeder 90.90 2 - Phone: ( ) I Fax: : ( ) Reconnect only 66.85 2 E Pump or irrigation circle 53.40 2 • • CONTRACTOR. .' • ' . . Sign or outline lighting 53.40 2 Business name: OREGON ELECTRIC GROUP Signal circuit(s) or limited - energy panel, alteration, or Address: 1010 SE 11 AVE extension- Describe: Page 2 2 City /State/ZIP: PORTLAND OR 97214 Each additional inspection over allowable in any of the above Phone: (503) 234 - 9900 Fax: (503) 535 - 2763 Per inspection 62.50 Investigation per hour ( hi tam) 62.50 CCB Lic.: 203 Electrical Lic.: 26 -95C I Suprv. Lic.: 4549S , Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: 19.95 Print name: RICHARD MCELLIOTT Date: 5 15 Plan review (25% of permit tee): State surcharge (12% of permit fee): 2.39 Authorized signature: TOTAL PERMIT FEE: 22.34 Print name: RICHARE MCELLIOTT This p ermit application expires If a permit Is not obtained wi thin 180 ))ate 5-15-1)9 days after it has been accepted as complete. LlBuitdinglvennirskaLC -remtltApp,000 05/23/06 44 • Numt, erofinspectionsallowedparpermit. P - 4 0Isr (t 1/05/COnt/wES