Permit CITY OF TIGARD ELECTRICAL PERMIT
.14 ° PERMIT #: ELC2008 - 00687
COMMUNITY DEVELOPMENT DATE ISSUED: 12/30/2008
r - IGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102AB -03900
SITE ADDRESS: 12370 SW MAIN ST ZONING: CBD
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: TIGARDVILLE STATION
Project Description: Remodel.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNALJPANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 4 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
NICOLAS CAPISTRANO TEAM ELECTRIC CO
12370 SW MAIN ST 9400 SE CLACKAMAS RD
TIGARD, OR 97223 CLACKAMAS, OR 97015
Phone: Contact #: PRI 503 - 557 - 7180
FAX 503 - 557 -8201
FEES
Description Date Amount Reg #: ELE 3 -225C
[ELPRMT] ELC Permit 12/30/2001 $73.45 LIC 173043
[TAX] 12% State 12/30/2001 • $8.81 SUP 4416S
Total $82.26 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center.
Those rules ar set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503.246.66 9 or 1.8 .33 .
Issued By: Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property 1 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.
I 1,2-29 -08 :11:08 :Team Electric :503.557.'8201 # 2/ 2
D � 1
Electrical Permit Applica o Fclu clrrlc 1. I tiF: cl.l
F, City of Tigard ���� 9 Received ti • 13125 SW H Bl Tigard, OR 97223 fi �7 2003
Pl Re Re
A2 og A(/ Permit Na: g�C/�� & - Q0687
= Phone: 503.639.4171 Fax: 503.59. C T (,eRC� Date/By: / Other Permit
T l C; n R D Inspection Line: 503.639.4175 CITY OF IIGA " Date Ready/By: • Juris: ® See Page 2 for
Internet: www.tigard- or.gov BUILOIt °l, mils* Notified/Method: - ,( Supplemental Information
• TYPE OF WORK PLAN REVIEW.
❑ New construction I terat acement Addition/alion/repl Please check all that apply (submit sets of plans w/items checked below):
❑ Servile or feeder 400 amps or more ❑ Building ova three stories.
❑ Demolition
❑ Other, where the available fault cement ❑ Marinas and boatyards.
CATEGORY 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 L Commercial/ industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other. ❑ Fire pump. ❑ Installation of 75 KVA or
JOB ❑ Emergency ddi i of new system. larger "E", "1- "1 system.
OB SITE INFORMATION AND LOCATION
❑ Addition of new motor load of ❑ "A ", "E', "1 -2 ", "1 -3 ",
Job no.: 3048 I Job site address: 12 3 7 0 SW MAIN STREET . S tea occupancy.
❑ Six ix or or more ore residential units. ❑ Recreational vehicle parks.
City/ State/ZIP: T I GARD , OR 97223 ❑ Health - care facilities. ❑ Supply voltage for more than
. ❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: Tigardville Station - ❑Servicc orfeeder600
FEE SCHEDULE
Cross street/directions to job site: Dncripttun 1 Qty. 1 Fee. 1 Tow 1 •
New residential single- or multi- family dwelling unit
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Restaurant Remodel Limited energy, multi - famil 75.00 2
residential (with above sq. 0.)
'Services or feeders installation; alterati on, and/or relocation
200 amps or less 80.30 2
12 PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 '2
401 amps to 600 amps 160.60 2 _
Name: iJ , t d pr `7 CA- P � �j 601 amps to 1,000 amps 240.60 2
Address: ep(6 Li (G to 3
Over 1,000 amps or volts 454.65 2
City/State/ZIP: PrL'r o2 9 79 i Temporary services or feeders installation, alteration, and/or
relocation - -
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.3 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: Die Branch circuits — new, alteration, or extension, per panel _
A. Fee for branch circuits with
❑ APPLICANT . ' 1 ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: Team Electric B. Fee for branch circuits
Contact name: without service or feeder fee 1
46.85 2
first branch circuit 4 6 • $
Address: Each add'I branch circuit ,4 6.65 2 6 . 6 C 2
Miscellaneous (service or feeder not included)
City/ State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) I Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Team Electric Signal circuit(s) or limited-
_ energy panel, alteration, or
Address: 94 0 0 SE Clackamas Rd. extension. Describe: Page 2 2
City /State/ZIP: Clackamas, OR 97015 Each additional inspection over allowable in any of the above
Phone: (503) 557 -7180 I Fax:(503) 557 -$201 Per inspection 62.50 Investigation perhour(Ilirmin) 62.50
CC$ Lic : 173043 Electrical Lic.: 3-225C Suprv. Lic.: 416 - S Industrial plant per hour 73.75
1 `• 1 V - IO 'Z',' 1 ` b l • tO ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:�7H ) Subtotal: 73.45
z!' CI Plan review (25% of permit fee):
Print name: Michael Trusheim I at
/ State surcha rge (12% of permit fee): 8 • 8 1
:/ � Authorized signature, TOTAL PERMIT FEE: 82. 2 b
Print name: Michael Trusheim Date: 12 /29/ 0 8 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
t:■Building wermits■ELC- PrnnitApp.doc 05/23/06 440-4615Tp1ro5iCOMN EB