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Permit CITY OF TIGARD ELECTRICAL PERMIT Per � . COMMUNITY DEVELOPMENT Permit #: ELC2012 -00184 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/30/2012 Parcel: 2S 114AA00100 Jurisdiction: Tigard Site address: 8680 SW DURHAM RD Project: Tigard Swim Center Subdivision: 1993 -078 PARTITION PLAT Lot: 2 Project Description: Sign lighting. Contractor: K & K SIGNS & LIFTS Owner: TIGARD - TUALATIN SCHOOL DISTRICT PO BOX 327 6960 SW SANDBURG ST DAYTON, OR 97114 TIGARD, OR 97223 PHONE: 503 - 864 -4933 PHONE: FAX: 503 - 864 -4934 FEES Quantity Description Date Amount 2 ea Sign or Outline Lighting 03/30/2012 $135.68 Specifics: 1 ea 12% State Surcharge - 03/30/2012 $16.28 Electrical Type of Use: COM Class of Work: ALT Type of Const: • Occupancy Grp: Total $151.96 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 • -'01 -0090. You may obtain a copy of th ct questions to OUNC by calling 50 32.1987 or 00.3 344. Issued By: _ _.— Permittee Signature: 11111W – 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 503.539.4175 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 �o 1:014 oFFICF. usl: oNi Ci}� of Tigard e� Received Permit No.: `.7 g Date/B : / _ i , ° 1 3125 SW Hall Blvd., Tigard \ . �� Plan Review : C Phone: 503.718.2439 Fax: .1 % Date/By: Other Permit: TI li D Inspection Line: 503.639.4175 M�� g ARQ Date Ready/By: Juris: Si See Page 2 for GA Internet: www.tigard- or.gov ��..`` ^ G'. \C? Notified/Method: Supplemental Information TYPE OF �1(O` ��G�\� `, PLAN REVIEW ❑ New construction ddition/altt Please check all that apply (submit a 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. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ l- and 2- family dwelling ommercial/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 ", "I -3 ", Job no.: Job site address: / ! 7 C --S" I OOHP or more. occupancy. L9 j J " Q(.,c.\ ❑ Six or more residential units. 0 Recreational vehicle parks. City/State/ZIP: S (a OZ Q' ❑ Health -care facilities. ❑ Supply voltage for more than OZ ) 'CFI 4- _ 0 Hazardous locations. 600 volts nominal. Suite/bldg./apt. no.: Project name: l 0q,ry� l r �� r ❑ Service or feeder 600 amps or more. •mi FEE SCHEDULE Cross street/directions to job site: x o 7( - -k- -77i yQs-.e.. Description I Qty. I Fee. I Total I • New residential single- or multi- family dwelling unit. k c 3 vS •\--.. j e," p1. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1 Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi-family Sr 0/U /J °� rvW residential (with above sq. ft.) 75.00 2 J " J J . _ Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER ❑ TENANT 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/ZIP: Temporary services or feeders installation, alteration, and/or ty 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 ex tension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: \\ rr B. Fee for branch circuits without d. ►J lD S �lJS 1 l�� service or feeder fee, first 56.18 2 Contact name: branch circuit rt� \ JJ Each add'I branch circuit 7.42 I 2 Address: L77, .4t...-- c ` e .tv..\ Miscellaneous (service or feeder not included) Each manufactured or modular 67.84 2 City/State /ZIP`� . \ ©� t l, ` dwelling, service and/or feeder `` ,, \ Fax: : Q /� Reconnect only 67.84 2 Phone: (�G ���'��' (� V v 1/49 .,(..E_ Pump or irrigation circle 67.84 2 E - mail: 4C.Qi �.o.6 C CAS eQ.0 C 5 \ J Sign or outline lighting � �o� 67.84 �� 2 CONTRACTOR Signal circuit(s) or limited- energy Business name: c S(` 'ts a rr ''__ � n , panel, alteration, or extension. Page 2 2 r^e ;GOO" Each additional inspection over allowable in any of the abov Address: Additional inspection (I hr min) 66.25/ hr Investigation (1 hr min) 66.25/ hr City/State /ZIP: Industrial plant (1 hr min) 78.18 / hr Phone: ( ) Fax: ( ) Inspections for which no fee is specifically liste (% hr min) 90.00 / hr CCB Lic.: 9z 5 - Electrical Lic CL.S k O Suprv. Lic.: J 2t - ELECTRICAL PERMIT FEES Suprv. Electrici si nature, required A y , � + lbl '� Subtotal: 67e fee) L ! Plan review (25% of permit fee): Print name:�� ;..t -4 i c V ` Date: _3 _ Z_ State surcharge (12% of permit fee): ��Ot Authorized signature: \ ` ` TOTAL PERMIT FEE: / 4(e This permit application expires if a permit is not obta ed within 180 Print name: Date: days after it has been accepted as complete. N um b er of inspections allowed per permit. I:\Building\Pe mits\ELC- PermitApp.doc 07/01/10 4404615T(I1/05 /COM/WEB ' Electrical Permit Application - City of Tigard Page 2 - Supplemental Information . LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all 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: • r COMMERCIAL WORK ONLY: 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 El Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation El Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical • • El Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other • Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1: \ Building \Permits\ELC- PermitApp.doc 07/01/10 '