Permit CITY OF TIGARD ELECTRICAL PERMIT
•` `'9 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00036
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/24/2012
Parcel: 2S 102AC00700
Jurisdiction: Tigard
Site address: 12540 SW MAIN ST 120
Project: Pacific Paint Subdivision: BURNHAM TRACT Lot: 1
Project Description: TI. Relocating power for signs and additional circuits.
Contractor: BELL MOUNTAIN ELECTRICAL TECHNOLOGIES LLC Owner: DOLAN & CO LLC
PO BOX 895 BY FLORENCE T DOLAN
BATTLE GROUND, WA 98604 4523 NE DAVIS ST
PORTLAND, OR 97213
PHONE: 360- 624 -1580 PHONE:
FAX: 360 -666 -5053
FEES
Quantity Description Date Amount
10 crt Branch Circuits wo /Purchase 01/24/2012 $122.96
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/24/2012 $14.76
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $137.72
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Uti' ion Center. Those rules are set forth in AR
952- 001 -0010 through OAR 952- 001 -0090. You may obt - - . :'rect questions to OU by callin r - 232.1987 or 1.800.332.2344.
Issued By: - - ��_ - • . • • Signature: •
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application -1 FOR OFFICE USE ONLY
City of Tigard 005 S . - ' I Received l Permit No.: t,---- c....
13125 SW Hall Blvd., Tigard
, e , , OR 23
III Lk Date/B :
Plan Review _ /AO
l I .• ' Phone: 503.718.2439 Fax: 503.598.1960 \ r., Other Permi -"-
t:
t 't 9) k V ...- Date/B :
TIGARD
Inspection Line: 503.639.4175 . ,..4C)17.0,01:" Date Ready/By' ( 0 See Page 2 for
Internet: www.tigard-or.gov elVNOV' Notified/Method I ',.-(-- ,0 Supplemental Information
4il9fj* ' '* SCie: ':',.1:1,244:4*
0 New construction El Addition/alter$} n/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 12 Building over three stories.
O Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
Ort . exceeds 10,000 amps at 150 volts or D Floating buildirigs.
- ------'''''''•""' ' • ''''''''" less to ground, or exceeds 14,000 0 Commercial-use agricultural
0 1- and 2-family dwelling Ei Commercial/industrial 0 Accessory building . amps for all other installations. buildings.
O Multi-family 0 Master builder 0 Other: 0 Fire pump. D Installation of 75 KVA or
' El Emergency system. larger separately derived system.
., . ............ -, ; „...., ':;:t ,:t . ,Ovtvirk 11 Addition of new motor load of 11"A" E "4
100HP or more occupancy. •
Job no.: Job site address: 12540 SW Main Street
0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: 97223 0 Health facilities. 0 Supply voltage for more than
ID Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: 120 Project name: Pacific Paint 0 Service or feeder 600 amps or more.
tat'i;IIi., t ; Wi:$040, iingk.A.::M
Cross street/directions to job site: SW Burnham St and SW Main, S. 1/2 block Description I Qty. I Fee. I Total I *
New residential single or multi dwelling unit.
on east side of SW Main street Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
75.00 2
graillitit*7011:1W 'kI!t':':' VV611i1C1.77 (with above sq. ft ) .
" Limited energy, multi-family
75.00 2
Power up Signs and Relocate circuits residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
• 200 amps or less 100.70 2
• ili,, 0 P.ROPEliPL:OA;aIpni: 0 TENANT::.T:',._,:w,,,,; 201 amps 10 400 amps 133.56 2
401 amps 10 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
MOViikk'1 ::::iCi above service or feeder fee,
each branch circuit 7 42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first 1
56.1 8
56.18 2
Contact name: branch circuit
Each add'I branch circuit / 7.42 29.68 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: dwelling, service and/or feeder 67 84 2
Phone: ( ) Fax: : ( )
Reconnect only . 67.84 2
Pump or irrigation circle 67.84 2
E
Sign or outline lighting 67.84 2
M0::4:' si circuit(s) or limited-energy
.
Business name: Bell Mountain Electrical Technologies LLC panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 23101 NE 246 Court PO Box 895 Additional inspection (1 hr mm) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: Battle Ground, WA 98604
Industrial plant (1 hr m) 78.18/ hr
Phone: (360) 624-1580 Fax: (360) 666 Inspections for which no fee is
90.00/ hr
specifically listed (/2 hr min)
CCB Lie.: 176481 573d/ .? Electrical Lie.: C700 , i Suprv. Lie.: 5664S t I, i 3 E::'
' ,------' 7 / 1 / 1 Y Subtotal: . 6
Suprv. Electrician signature, required: C j 4X--- Plan review (25% of permit fee):
Print name: Terry W Carlson . - Date: 1 State surcharge (12% of permit fee): .30 /1,7p
TOTAL PERMIT FEE: .. ,..96-.-1 - 41 - 3 7 7)
Authorized signature: ----- '
This permit application expires if a permit is not obtained within llin
days after it has been accepted as complete.
Print name: Terry W Carlson Date: 1-24-12 * Number of inspections allowed per permit.
I: \Building \Penults \ELC-PermdApp doe 07/01/10 440-46 I 5T(11/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RE SI °DENTI W ORK;CINLY :' _°_' >`.' ; ;, -;
Fee for Al residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
�.... ,�, ., . -._�.
SC. RRERCLAL:WORK
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation .
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
•
•
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Building \Permits\ELC - PermitApp doc 07/01/10