Permit CITY OF TIGARD ELECTRICAL PERMIT
II I a , COMMUNITY DEVELOPMENT Permit #: ELC2009 -00410
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08112/2009
Parcel: 2S102AB04300
Jurisdiction: Tigard
Site address: 12400 SW MAIN ST
Subdivision: Lot: 0
Project: Sunshine Gallery
Project Description: (10) branch circuits for TI.
Owner: FEES
TIGARD MAIN ST COMMERCIAL PROPER Quantity Description Date Amount
12488 SW AUTUMNVIEW ST 10 crt Branch Circuits 08/12/2009 $106.70
TIGARD, OR 97224 wo /Purchase Service or
PHONE: Feeder
• 1 ea 12% State Surcharge - 08/12/2009 $12.80
Electrical
Contractor:
OCHSNER ELECTRIC INC
8724 SE YAMHILL ST
PORTLAND, OR 97216
PHONE: 503 - 254 -0015
FAX: 503- 254 -8126
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $119.50
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 - • •a = . ith approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspe• • - • for more the 180
days. A NTION: Orego law - quires you to follow the rules adopted by the Oregon Utility Notifica'= Center. Those rules - - -. =t forth in OAR
952 -00 0010 through OAR 95 •-• 11-010#. ou may obtain a copy of the rules or direct questions to OUNC by calling 5 • •.6699 : 40.332.23.4.
Issu % Permittee Signature: . I.
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' I" Date:
41101111— •
al
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 ske until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
Electrical Permit Application I R ()Hi( 1: i.51.: 0 \ 1 . 1
City of Tigard Received 1 09 A i PermitNo.: ■ — z /a
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Raw ,!
• Other Permit: ap4�l— /`>!
Phone: 503.639.4171 Fax: 503.598.1960 Date/13 .
r 1 t_ is D Inspection Line: 503.639.4175 Date Ready/By: kris": El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: or lee- Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction rAddition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEG RY 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 Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E", `• 1 -2", "1 -3 ",
--� 100HP or more. occupancy.
Job no.: Job site address:
r?.!4 0 0 5 w M yet ►J 5 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: - t;, /¢C 6 Z_ • ❑ Healthcare facilities. ❑ Supply voltage for more than
❑ Haasrdous locations. 600 volts nominal.
Suite/bldgiapt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
75.00 2
4°• 14 7 & M(b f tA kNan .*- (0 t. C residential (with above sq. ft.)
i Services or feeders installation, alteration, and/or relocation
Q,(0 04 L ** - L0 V., _ 200 amps or less 80.30 2
❑ PROPERTY OWNER 1 ❑ TENANT 201 amps to 400 turps 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/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 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
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT 1 ❑ 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, I 46.85 �L ,8'j 2
first branch circuit
Address: Each add'I branch circuit q 6.65 57,F 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: ' `? l�eX �l (� e, i Q° 0 , energy panel, alteration, or
Address: 3' 1 Z J E. y�,,t -, 1, \ 3 4 extension. Describe: Page 2 2
City/ State/ZIP: vvvv o f -- --4-1 c,..,k( ,. c) 72...) (o Each additional inspection over allowable in any of the above
I �, a 'ZC Per inspection 62.50
Phone: �603 2.54 . 0 ® /5 Fax: Investigation per hour (I to min) 62.50
CCB L' .: 88 62, Z Electri —%. Suprv. Lic.: 2...&620,-.$ Industrial plant per hour 73.75
rlrfo -11 I l `I ra / r ELECTRICAL PERMIT FEES
S prv. (ectrician signature, required: D Subtotal: D , O
Print name s hs st3 -� Date: ' Z Z 00 di, P lan review (25% of permit fee):
t State surcharge (12% of permit fee): Z ,w
Authorized signature: TOTAL PERMIT FEE: , q r 60
Print name: This permit application expires if a permit is not obtained within 180
Date: _ L . - - -- - - -- - - -- -•-