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Permit y CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2012 -00021 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/17/2012 Parcel: 2S113AB00800 Jurisdiction: Tigard Site address: 16125 SW 72ND AVE Project: St. Jude Medical Center Subdivision: COUNCIL VIEW ACRES (LOTS 21 -44) Lot: 30 Project Description: Electrical for TI. Contractor: IES COMMERCIAL INC Owner: DUNCAN, JOHN ARTHUR & JANICE LEE 16135 SW 74TH AVE 9929 NW UPTON CT TIGARD, OR 97224 PORTLAND, OR 97229 PHONE: 503 - 648 -1900 PHONE: FAX: 503 -670 -9572 FEES Quantity Description Date Amount 1 ea Limited Energy 01/17/2012 $75.00 Specifics: 4 crt Branch Circuits wo /Purchase 01/17/2012 $78.44 Service or Feeder Type of Use: COM 1 ea 12% State Surcharge - 01/17/2012 $18.41 Class of Work: ALT Electrical Type of Const: Occupancy Grp: Total $171.85 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 • the • es o •irect questions to OUNC by calling 503.232.1987 or 1.800 332.2344. 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. 01/13/2012 13:52 5036709572 IES COMMERCIAL INC PAGE 01/03 Metrical Permit Application FOR OIL V ICE USE ONLY City SW 1 of Tigard Roceivea ! es slag Pe rmit No.: i� .125 1311 T31vd,, Tigard, dR 7 . 1 ` D R ca =L `e :� 1.3 �- , ��• 1 1 I• inn :Review Pitons: 503.7.18,2439 FaX 56 ?5 99L 960' 3 rt Date/IS ; Other _ �� •r t C; A 1 R l3 Inspection g d -or. av 5 Date Rana /lay 0 • Interact: www,tf ar C, t $e P ent 2 for ,P ; O N o ifrccumethod: mental t ur.; �,. ,.. -r ("'. 5npplc nformntEOn Line: 503 639.4 , ,. ,,D /r 12 New construction . Addit 'ion /alterafitf 1)f cement Please Check a l that apply (submit i acts or plane w /items ellceked below): ❑ Demolition ❑ Other: 6tS\ 0 Service or feeder 400 amps or more 0 BntklfnR over throe stories. G il" I` PG" UIi1' iO�i (. „...,,� ..:. :... . where current OMnrinnsnnd � available C Lt CII ,.; . "r; r. : , :.. ' 1 . ., .,., .. CTTO ; . , oxteeds10,000amps01150voltsor ❑Floating - . boatyards. .;. :.., ,.. � : ) RIJ 1� ..., � ; :: i _. buildings. �.! 1- and 2 - family dwelling loss to ground, or exceeds 14,000 ID Commercial -uso agricultural i�Commcrcial /industrial ❑ Accessory building amps for all other installations. buildings. 1:3 Multi••faniily 0 Master builder ❑ Other: 0 Fire pnm1. uI ,.�, S,, ;o :rr . : p em. larger gepR • �.,,•„•:,,.,.. ;,., ..; ,;..,......,..,, Installation o: or y dli:rS�T>;!'- INFt71tMA r • 1VI] r, Emerc system' derived system, � � � � ' ' ' ❑Add of new motor Iond of © "A", "F.", 1.2”, �� _ Job no.: Job site address: a>t%Ji 5 L ; , - 7. f v � O lOOHP or mere, occupancy, + �T Six or more residential units. ❑ Recreational vehicle parks, City /State/ZIP: 4 ir. e_ 9 7P-0-9 D.T-Tenith -ears facilities. I] Suppl voltage for more Ili to ❑ Tiazmdous locations. 600 volts nominal. Stiite/bldg. /apt. no,: Project name: i svc . ,t-ct, A d r- m , 0 Service or {seder 600 amps or more. Cross street/directions -� , :' :..; • • „ . > . ii : ;p: ��"" <; cet/directions to job site: � uvJ 4—v - F FT>C.: IeKh(],�) .',!}-; J. ..! •. . .: „ ' t! �. � Tn t n l !' /C �✓ New residential single- or multi - family dwelling unit. { Fr._ teC6-1 -T /t om 4 -7- 4 P includes attached garage. SUbdivisi 1: I Lot no.: 1.000 sq, ft, or less ____W 1 68,54 4 Tax map /parcel no.: Ea. addrl 500 sq, R. or portion 33.92 I , ,,..; Limited energy, residential 0 `nt s c to (� r WO lil ( ,; 7S 00 2 . . T with lbovc sq. .) ��1 t . " Limited cncrgy, mul family !: 7 �- /' -- 41. a.21.4.-1 " — rhe - 0 —S"u,a ✓�ca./C.-S residential (with above sq. ft,) 75.00 2 - - -- Services or feeders installation and /or relocation "' e_ Cap I-4, .. b 200 amps or less 100,70 2 r EROP.tii1'V.i 1.V.Rili , i *.TENA'..T....... .. : ". :i � ` � . , 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 2 City /State /7TP: Temporary services or feeders instnilntion, alteration, and/m4 relocation Phone: ( ) 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, peLpanel Owner signature: Date: , A. Pee for branch circuits with I ':Ar 'LIcAN I' ......... ,: .., 0'T'lPiRSON 742 2 above service o r feeder fee, each branch circuit Business name; B. Pee for branch circuits without service or feeder fcc, first / 56.18 ,cG 7 Contact name: branch circuit Each add'l branch. circuit ._ 7.42 i A,1 2 Address: • M iscellaneous ( service o f eeder not included) City /StatCJTIP: Each manufactured or modular dwelling, service and /or feeder 67.84 2 • Phone: ( ) F ax; : ( ) Reconnect only 67.84 2 Pump or irrigation circle p g 67.84 2 E S i g n or outline lighting 67,84 2 , Co , - �_ � alteration l orc cnsian, jj Pagc2 1 � • Business name: „ r te 2 Each additional inspection over allowable in any of the above Address: /4- t..5 g r.o. ,e/ 771— U Additional inspection (I hr min) 66.25/ hr City /State /7...iP: 0 investigation (1 hr min) 66,25/ hr 4 , ne d Industrial plant (1 hr min) 78.18 / hr Pho ( 3) ,.4i p-,/ 9 P Fax (.” _3) 4 i , " Inspections for which no fcc is specifically listed ( hr min) 90.00 / hr CCI3 Ti „e.: / g - Electrical Lic. C lt4I > ,5 ? Suprv, Ti c.. I' r;t; I.': . . r;�xil��n.�' r�rin�tT. . Suprv. Electrician signature, required: Subtotal: /1, i 4,14 Plan review (2S% o f permit fee): Print name � r,✓ Date: / - -w•�fi_ State surcharge (12%of /' p4 � FNl ; I Authorized signature: • TOTAT :PT.TtMIT' '��� . ' This permit appticntinn expires it a permit is not obtninett within ISO Print name: Date: days after it hap been accepted at complete. ” Number of inspections allowed per permit, t: uiuilding\Pcrmlt4Pr,r;- normitApp.dot 07 /011ie 440 40157 {1110 /COM/WEA 01/13/2012 13:52 5036709572 IES COMMERCIAL INC PAGE 02/03 • Electrical Permit Application - City of Tigard Page 2 - Supplemental Information • LIMITED ENERGY PERMIT FEES: Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* n Burglar Alarm ,❑ Garage Door Opener* ❑ H eating, Ventilation and Air Conditioning System* ❑ V acuum Systems* ❑ Other: T_mr S..O1iLX Fee for each commercial $75.00 system (SEE OAR 918 - 349 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls Li Clock Systems Data Telecommunication Installation ❑ Eire Alarm Installation HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling n Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1:1 Qu11AIng lrrrmifA \1:LC•PcrmItApp,4oc 07/01/10