Permit CITY OF TIGARD ELECTRICAL PERMIT
1111 a COMMUNITY DEVELOPMENT Permit #: ELC2009 -00157
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/09/2009
TIGARD 9 Parcel: 1S136DB02601
Jurisdiction: Tigard
Site address: 11606 SW PACIFIC HWY 250
Subdivision: Lot: 0
Project: Living Art Tattoo
Project Description: (5) branch circuits.
Owner: FEES
HWY 99 LLC Quantity Description Date Amount
2655 MARYLHURST DR
WEST LINN, OR 97068 5 crt Branch Circuits 04 /09/2009 $73.45
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 04/09/2009 $8.81
Contractor: Electrical
LOVETT EXCAVATING INC.
PO BOX 86280
PORTLAND„ OR 97286
PHONE: 503 - 504 -2847
FAX: 503- 288 -1630
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $82.26
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 do in accordance w • 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 •ays. ATTENTION: Orego . .w r.. s you to follow the rules adopted by the Ore.• •' ion enter. Those rules are set forth in OAR
95 . -001- 0010th gh OAR 9 -00 -01 Y 'u may obtain a py of the rules or direct questi• to OUNC b R r-. • 6.6699 or 1.800.332.
I sued By: / � Pem?ittse 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'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.
2 3/2006 15:39 FAX 503788233 .1 CE1 V EDTT EXCAVATING a 003
- Electrical Permit Application 1.1)1( (,I: I, icy 1 ;t: can I .,
City of Tigard APR ' 7 2009 Receiv
`J g [htloi 7 49 4 y Permit No.: 1.ccloo 2.49/57
• 13125 SW NaI1 Blvd., Tigard, OR 9 � OFTIGAItD Plan Review
_ Phone: 503.639.4171 Fax: 503.5' : r p Other Permit:
I I t , n I{ I , Inspection Linc: 503.639.4175 Btu 1 D ING DIVISIO Dale Re rime:
® See Page 2 for
Internet: www,tigard- or,gov Notilied/Method: f Supplemental Information
TYPE OF WORK
•
•
❑ New construction Et Addition /alteration/replacement - Please check all that apply (submit 2 sets of plans whims checked below):
❑ Service or feeder 400 amps or more LI Building over T sdtnie�s.
❑ Demolition ❑Other:
where the available fault current ❑ Marinas and boatyards.
• CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 110 volts or ❑ Floating buildings.
les, to ground, or exceeds 14,000 ❑ Commercial -use agricultural
„en- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings,
❑ Multi - family 0 Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA ur
JOB SPPE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1.3 ",
Job no.: Job site address: i 1(p o(p g 'P f, > t 1OOHP or more. occupancy.
1 ❑ S ix or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: 7
I c -,.Z z ❑ Health care t i lies. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 5r) I Project name: ❑ Service or feeder 600 amps or more,
FEE SCHEDULE ...
Cross street/directions to job site:
Description I (Ilr. I Fee I Toml I
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 se. ft, or less 145.15 4 -
• Ea, add'I 500 sq. II. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75,00 2
Limited energy, multi - family
75.00 2
►Acre C.1rkC +a Ne t..l F,gCd1pmer1f residential (wail atxtve ,q,IL)
(� Services or feeders Installation, alteration, and /or relocation
200 amps or less 80.30 2
0 PROPERTY OWNER I . TENANT 201 amps to 400 amps 106.85 2
Name: L_..I v ; ( --k - -- 401 amps to 600 amps 160.60 2
601 amps to 1.000 amps 240.60 2
Address: , I .0
r ling --a A F.' 2 over 1,000 amps or volts 454.65 ' 2
City /State/ZIP: -n,-- am d7 (1 .2� � Temporary services or feeders installation, alteration, and/or
4 t relocation
Phone: ( ) I 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 O1(S 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
CANT I ... ACONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: + - a nee ii l . ee .VI. 1 B. Fee for brunch circuits
Contact name: 2 Q without service or feeder fee, ( .85 ILI - 2 • ` ( �i V u ( 5 first branch circuit 46
Address: J` . 0 . t ox, St Q c1 D Each WWI branch circuit - 4 6.65 I�( 44 2
11 '' Miscellaneous (service or feeder not included)
City/State/ZIP: 3 r 4 t (oe.. ° .v Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: ( 00 2) 2.-el (p - 00 to U Fax: : 603 28 & - 1 (I, 3 0 Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business { �,1 / Signal circuits) or limited -
usiness name:
LD�(P ��t r 1 � - I l I a energy panel, alteration, or
Address: 17. n , (7.- !11
` 21.0720 extension. Describe: Page 2 2
City/State /ZIP: c 2 1} 1 _ Each additional inspection over allowable in any of the above
� Per inspection 62.50
Phone: r5Q3) zc'I tv +04C,o Fax: (03) , [ t ~ '1"� dot] Investigation per hour (I he min) 62.50
CCB Lic.: z.Gp Electrical Lie.: C '- Suprv. Lic.1 2 1 C Industrial plant per hour 73.75
Suprv. Electrician signature, required: 7 / � /1 /cs r ip ELECTRICAL PERM]IT..FEES. ' ..:...:........
• 1 - Subtotal: - is _ 4g
Print name: 1:),„ E � Date:4 _.& � Pl review ( 12% o f permit fee): -
State surcharge (12% of permit fee): - $ . 1
Authorized signature: L�� TOTAL PERMIT FEE:Z -(�
r Thi permit apptieation expires if o permit is not obtained within ISO
Print name: V ut. A C Date: [� -(p - ,l) - days after It has hem accepted ns complete
• Number of inspections allowed per permit.
t: lauildingwermitxUU .C- Permitnreene M/23 a4 -773 440.4615T(II/051C0WWEa