Permit ' : ;, CITY OF TIGARD ELECTRICAL PERMIT
`' " - ` COMMUNITY DEVELOPMENT Permit #: ELC2012 -00014
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/12/2012
Parcel: 2S102AD03450
Jurisdiction: Tigard
Site address: 8777 SW BURNHAM ST
Project: City of Tigard Subdivision: TIGARD HIGHWAY TRACTS Lot: 18 & 20
Project Description: (1) subpanel and (2) branch circuits for Fleet Department of Public Works.
Contractor: MR ELECTRIC OF CLARK COUNTY Owner: TIGARD, CITY OF
14300 NE 20TH AVE. D102 -313 13125 SW HALL BLVD
VANCOUVER, WA 98686 TIGARD, OR 97223
PHONE: 360- 574 -7200 PHONE:
FAX: 360- 546 -2158
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 01/12/2012 $100.70
Specifics: amps or less
2 crt Branch Circuits w /Purchase 01/12/2012 $14.84
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 01/12/2012 $13.86
Electrical
Type of Const:
Occupancy Grp:
Total $129.40
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 coy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ,
'mil - 1
Issued By: - _��- _ . ; / - Permittee Signature:
// /
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.
Jan. 12. 2012 1:32AM No. 8805 P. 1
EleetrAG'cii reI-mi6 Application ROR ()mum ` ,
City of Ti and Received
l am " �`DatcB : Permit No.;
111
,.
. * 13125 SW Hall Blvd„ Tigard, OR 9722 Pl Rev -�� - �� ��
0 Phone: 503.718,2439 Fax: 503,598.1'i0` 1 ,fi 1 ; ,rj a 1 C /B : Other Permit:
T I ti A It Ct Inspection Line: 503.639.4175 Date Ready/By: BM FZI See Page 2 for
Internet: www.ligard- or.gov JAN 1 1 201Z Notified/Method: Supplemental Information
TYPE OF WORK PLAN PLAN REVIEW
rXt�il>ra a mw‘
New construction EX ddltlorl/alteratio a
i l l ; F t mo tt Please chck all that apply (submit 2 sets of pins venoms clucked below):
BRIM ISION ❑ Service or feeder 400 amps or more ❑ Building over three stories.
III Demolition El Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OP CONSTRUCTION exceeds 10.000 amps at 150 volts or El Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
0 I- and 2- family dwelling [1 c ommercial /industrial ❑ Accessory building amps for all other installations. buildings:
❑ Multi - family ❑ Master builder Q Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION
['Emergency system. larger separalely derived system,
❑ Addition erne* motor load of 0 "A", "B", "1- 2","1 -3",
Job no-!.51-1 I I - 12.4 Job site address: �1 / -7 S W 6,U[.Y- ,, s-t 100E or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parka.
City /State /ZIP: IT 0 a. . r G( U YL 11 Z<Z 3 ❑ health - care facilities, ❑ Supply voltage for more than
t ❑ Hazardous locations. 600 volts nominal.
Suite/bldg /apt. no.; Project name: e / bit 41, ^17 e , ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: cl e vv ÷p s m is 1 V c,{ neaerterion I ow. I pas. 1 Total (—'
11 ll r� New residential single- or multi- family dwelling unit.
TU s vv (3wrr- 1A -avr" St* F u,�}- ` ,(p 4 y9 - ,k) Includes attached garage.
Subdivision: l pi„bii - (A Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'1500 sq. ft. or portion 33,92 1
Limited energy, residential 75.00 2
DESCRIPTION OP WORK (with above sgjfl.)
I Limited energy, multi - family 75.00 2
Yl s +a. - A -c Z0 art. p ai v cwT t s a.'LGt residential (with above sq. R.) _
Services or feeders installation, alteration, and /or relocation
61. !t? D eg ful fu p 1 200 amps or less I 100.70 I /0d, 76 12
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps ' 133.56 2
Name:
401 amps to 600 amps 200.34 2
_ 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 t 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
rctO ca ti0 n
Phone: ( ) f ax; ( ) 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 125.00 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 txttn$iOn, per panel
Owner signature: Date: A. Pee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee 7 42 {�1 , $ 2
each branch circuit
Business name: a L y d f ' i 'r J B. s ee for or rfcc,t3 first
service or feeder fee, first
Contact name: N i c. ,1 as Nis se-r-) branch circuit 56.18 2
Each add'1 branch circuit 7.42 2
Address: I ( e r khA, ( 431 1 , ,, cf Miscellaneous (service or feeder not included) _ _ .
City/State/ZIP; Each manufactured or modular
9 Q,,-. Q,_ '' 7 2-2- 3 dwelling, servico and/or feeder 67.84 2
Phone: ( ) ' i5e _ .2 ea Os' Fax; ; ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail Sign or outline lighting 67.84 1 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: 11 A �, (( 1 L panel, alteration, or extension. Page 2 2
r "' Each additional inspection over allowable In any of the above
Address: 4 I U NE P a$s /ed . Sic /3 Additional inspection (1 hr min) 66.25/ hr
City /State /21P 6 u_(4 f -. .w A 1 p 6,6'
—
Investigation (1 hr min) 66.25/ hr
i Industrial plant (I hr min) 78.18/ hr
Phone: (3 (0 5--7 4 - 7 2-0 U Fax; (3) 5 / f - ,2 / r f Inspections for which no fee is
90,00/ hr
111 specifically listed (S5 hr min)
CCB Lie.; �� e' 3 Z Electrical Lic EL�e 9 rt? Suprv. PIS ELECTRICAL PERMIT FEES
Suprv. Electrician signaler `required: C:. 13 Subtotal: //,..c. SY
t Plan review (25% of permit fee): tir
Print name: ` '
• Wl l 1..C, 1 5-9.N. Date: 1_4, _ i x , State surcharge (12% of permit fee): /5.-1'74
• TOTAL PERMIT PEE: A,21, 10
Authorized signature: v i ..
/` This permit application expires if a permit is not obtained within 180
days after.It has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
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