Permit CITY OF TIGARD ELECTRICAL PERMIT
I
a COMMUNITY DEVELOPMENT Permit #: ELC2012 -00202
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/06/2012
Parcel: 2S101AC01900
Jurisdiction: Tigard
Site address: 12615 SW 72ND AVE
Project: Lowe's Subdivision: BEVELAND NO.2 Lot: 18 -19, P
Project Description: (10) branch circuits for electrical end cap remodel.
Contractor: BERGELECTRIC CORP Owner: WASHINGTON COUNTY SCHOOL
13650 NE WHITAKER WAY DISTRICT NO. 23
PORTLAND, OR 97230 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 503 - 255 -1818 PHONE:
FAX: 503 - 255 -1919
FEES
Quantity Description Date Amount
10 crt Branch Circuits wo /Purchase 04/06/2012 $122.96
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/06/2012 $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 Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through 0 95 - -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: Permittee Signature: QA/ /9-,,z../69
?2i' v
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 Ina 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 ApplicatiOr. . z' I/ FOR OFFICE USE ONLY ■
I ' i � Received
City of Tigard DateB : -7 / Permit No.: 64410 a 00(902
'a 13125 SW Hall Blvd., Tigard, OR 9722A PR 0 2012 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 Date/B . Other Permit:
T I G A RD Inspection Line: 503.639.4175 ;q ou' P , 1- • '. v Date Ready/By: Juris: 65 See Page 2 for
Internet: www.tigard- or.gov e . u, . r Notified/Method: Supplemental Information
'v i lf`� r -, `:
'` .... ... ; ... TYPE • OI T' WOR1�t'. o "
.. g :; t i;' -` , ? ; - .. x.� ' , . ' ..P - REVIEW _ , - ,. -
❑ New cons ® Addition/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.
El Demolition El Other:
where the available fault current ❑ Marinas and boatyards.
: ., excee 10,000 amps at 150 volts or Floating buildings.
CA OF .CONSTRUCITON.. .. _ P ❑ B 8
"' " ' 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
larger separately derived system.
. • • : :; jOB': SITE INFORMATION- AND L0CATI015 " ni'. - Addition of new motor load of ❑ "A ", 'E", "L2", "I -3
Job no.:13 5 5 0.11 Job site address: 12 615 SW 72nd Ave I00HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 9722 3 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Lowe s of Tigard ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: Description ' .= FEE :'SCHEDULE :
I Qty. I Fee. 1 Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.:
Limited energy, residential 75.00 2
(with above sq. ft.)
Limited energy, multi- family 75.00 2
End-cap electrical remodel residential(with above-sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
:IN PROPERTY. OWNER :..'. - : Q• TENANT ' - j ;;,' : .. ; : 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:Lowe I s Company, Inc
601 amps to 1,000 amps 301.04 2
Address: 1000 Lowe ' s Blvd Over 1,000 amps or volts 552.26 2
City / State/ZIP: Moore svi I le , NC 2 8117 Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( 7 0 4) 758.1000 Fax: (3 3 6) 6 5 8 .4 7 6 6 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
above service or feeder fee,
_ '' - [ 'App
PPLANT ,.. li :CONTACT :PERSON ': 3 7.42 2
° each branch circuit
Business name: Bergelectric Corp B. Fee for branch circuits without
service or feeder fee, first I 56.18.1 b 2
Contact name: Paul Moss branch circuit
Each add'I branch circuit 9 7.42 (Ol n . 1 2
Address: 13650 NE Whitaker Way Miscellaneous (service or feeder not included)
City/State/ZIP: Portland Oregon 97230 Each manufactured or modular 6784 2 '
dwelling, service and/or feeder
Phone: (503) 255 - 1818 Fax: : (503) 255 - 1919 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: @bergelectric.com Sign or outline lighting 67.84 2
. ' . ... CONTRACTOR' "' . .. _ . 1 ` - '"` Signal circuit(s) or limited- energy
Business name: Bergelectric Corp panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 13650 NE Whitaker Way Additional inspection (1 hr min) 66.25/ hr
City/ State/ZIP: Portland Oregon 97230 Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 255 - 1818 Fax: (503) 255 - 1919 Inspections for which no fee is 90.00 / hr
specifically listed ('/, hr min) _
CCB Lic.: 110521 Electrical Lic.: 37 -6820 Suprv, Lic.: 5485S .ELECTRICAL PERMIT FEES- _:;
ta(
Suprv. Electrician signature, required: /i // Mme\
4.— Plan review (25% of perm S ubto it fee ) : 1'L C10
Print name: Ken Fill s �— Date: 4 / 3 / 12 State surcharge (12% of permit fee): 1' — 10
-
a,_ l TOTAL PERMIT FEE: 3� Z
A
Authorized signature: -�
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Heather Weidman Date: 4/3/12 • Number of inspections allowed per permit.
1:\ Building \Permits PermitApp.doc 07/01/10 440-4615T(11/05/COM/WEB