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Permit
I I t-• • q CITY OF TIGARD ELECTRICAL PERMIT N COMMUNITY DEVELOPMENT Permit #: ELC2009 -00193 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/04/2009 Parcel: 2S 102 DA00401 Jurisdiction: Tigard Site address: 13125 SW HALL BLVD PERMITS Subdivision: Lot: 0 Project: Permit Center Project Description: Alter (1) existing branch circuit to put lights on separate switch. Owner: FEES TIGARD, CITY OF Quantity Description Date Amount 13125 SW HALL BLVD TIGARD, OR 97223 1 crt Branch Circuits 05/04/2009 $46.85 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 05/04/2009 $5.62 Contractor: Electrical OREGON ELECTRIC CONSTRUCTION INC 1010 SE 11TH AVE PORTLAND, OR 97124 PHONE: 503 - 234 -9900 FAX: 503 - 535 -2763 Type of Use: COM 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 throug OAR 552- 001 -0100. You ay obt in a copy of the rules or direct questions to OUNC by calling 5 3.246.6699 or 1 800.332.23344. Issued By 1 QIJ\ Permittee Signature: ' pA,k e\d/( 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'N 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. APR-29-09 10:20 FROM-OREGON ELECTRIC -MAIN 5032349900 T -598 P•001 /002 F -143 Electrical Per mit A Iication RECEIVED FOR OFFICE. G51 ONLY, . Received • , Permit No, • l �`A , 0013 City of Tigard Datere , t . r III 'I 13125 SW Hall Blvd -, Tigard, OR 97223 q p R 2 9 200 9 Plan Review 1 m Other Permit Phone: 503,639.4171 Fax: 503.598.1960 I}ae�B - Date Rea Inspection Line: 503.639.4175 dy/f3y. El See Pace 2 for 7' 1 G A RD Internet www,tigard- or.gov CITY OF TIGARD Notifed/MCLhod 1 C Supplemental leformatlon DING DIVISION..• — • pI, tEV� .. .... Please check all that apply (submit 2 sets of plans wlitems checked below): D Ncw construction ® Addition /alteralion/teplacement ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault turrent ❑ Marinas and boatyards. CATEGORY OF CbNSTRIJCTION. ! exceeds 10,000 amps at 150 volts or 12 Floating buildings. less to ground or exceeds 14,000 ❑ Commercial -use agricultural 0 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for an other instnllatioos. buildings. . ❑ Multi- family ❑ Master builder ❑ Other: El Firc pip. (] Installation of 75 KVA or ❑ Emergency system. larger separately derived system. • • JOB SITE' INFOIRMATION AND LOCATION • El of new motor load of 0 "A". - E" "1-2", "1.3 ". _ 10011P or more. occupancy. Job no -: 80016-110 I Job site address: 13125 SW HALL 0 Six or more residential units. El Recreational vehicle pals. ❑ Health care facilities. ❑ Supply voltage fbr more than City/State/ZIP: TIGARD OR ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: PERMIT CENTER ❑ Service or feeder 600 amps or more. 1 E SCHEDUI E Cfoss street/directions to job site: - nderipoon - - i U4' I Fee. 1 Tora' 1 • New residential single- or mold- family dwelling unit. • Includes attached garage. _ Subdivision: Lot no.; 1,000 sq. n. or less 145.15 4 Ea.. add'l 500 sq- ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential • DESCRIPTION OF WORK 75.00 2 (w ith above sq. ft,) Limited energy, multi - family 75.00 2 PUT TWO EXISTING LIGHTS ON SEPARATE SWITCH residential (with above 50. ft,) -- Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 • 0 IPROPP,RTY OWNER . - - I . • .0 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 I_ 454.65 2 City /State/ZIP: Temporary services or feeders installation, alteration. and/o _ __ 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 unps 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. Fee for branch circuits with • © APPLICANT • 0 CONTACT PERSON . above service or feeder fee, 6,65 2 each branch circuit Business name: B, Fcc for branch circuits Contact name: without service or feeder fcc, 1 46.85 46,55 2 first b ranch circuit Address: Each add'l branch circuit 6.65 2 - . Miscellaneous (service or feeder not Included) City/State/ZIP: Each manufactured or modular 90.90 2 dwelling, service and/or feeder 1 Phone: ( ) I Fax: : ( ) Reconnect only _ 66.85 2 E-mail: Pump or irrigation circle 53,40 2 • • CONTRACTOR . . .i Sign or outline lighting 53.40 2 Signal panel, circuit(s) or limited - Business name: OREGON ELECTRIC GROUP energy p alteration, or Address: 1010 SW 1TFI AVE extension Describe: Paget 2 City /State/ZIP: PORTLAND OR 97214 Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: (503) 234 -9900 l Fax: (503) 535 - 2763 Investigation per hour (1 hrmin) 62.50 CCB Lie.: 203 Electrical Lie.; 26 - 95C Suprv. Lie.: 45495 Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature req �^_ . -\1 Subtotal: 46,85 - Print name: RICHARD MCELLIOTT Date: 4-29-09 Plan review (25% of permit fee): State surcharge (12% of permit fce): 5.62 Authorized signature: TOTAL PERMIT FEE: 52.47 Print name: RICHARD MCELLIOTT Date: 4 -2909 This permit application expires if a permit is not obtained within 180 days aftcrit has been accepted as complete- " • Number of inspections allowed per permit :1 9undarawermirl ■Ei_e.I'cnnitApp.doc 0523 05 440- t615TO t,05 /COM/WM APR -29 -09 10:20 FROM- OREGON ELECTRIC -MAIN 5032349900 T -598 P.002/002 F -143 City of Tigard Building vision = • 13125 SW Hail Blvd, Di Tigard, OR 97223 Phone: 503.639.4171 Fax: 503398.1960 Inspection Line: 503.639.4175 TI G A R D Internet: arww.tigard- or.gov PAYMENT AUTHORIZATION FORM Permit No. (if available): Job Site Address: 13125 SW HALL BLVD Project Name: CITY OF TIGARD Credit Card Information; n VISA n MasterCard Discover (credit Curd Account Numte") Expiration Date: Cardholder Name (on card): Contact Phone No.: Address for this card is: Zip code for this card is: Electrical Trust Account Information: For electrical permit applications only. Trust Account (CCB) No.: 203 — T Contractor Business Name: Or - ;.n Electric Grou• Contact Phone No.: 505- 535 -2660 I hereby give the City of Tigard permission to pay for the above referenced permit with the credit card or electrical trus d „. • t number provided above. / rr Authorized Signature: Name Printed: RICH LADD Date: 4-29-09 Please fax this completed and signed form to 503.598,1960. This form will be destroyed after your payment has been processed. I;\ Building\ Forms \Pa } mentAuthocizadon.doc 10/31/07