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Permit pr n +c) Q. scRfu a_dctut&L to of CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2009 -00255 T I G AR O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/02/2009 Parcel: 1S135DD05102 Jurisdiction: Tigard Site address: 11993 SW PACIFIC HWY Subdivision: Lot: 0 Project: 1st Choice Project Description: (10) branch circuits.6 /15/09 ADDED 200 amp panel, changed branch circuits to (9). • Owner: FEES GLADSTONE, HELENE D FAMILY TRUST Quantity Description Date Amount BY JEFF PAINE, 9155 SW 69TH AVE TIGARD, OR 97223 10 crt Branch Circuits 06/02/2009 $106.70 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 06/02/2009 $12.80 Electrical Contractor: 33 da Investigation Fee (Equals 06/15/2009 $33.45 E R ELECTRIC INC Permit Fee) PO BOX 912 1 ea Investigation 12% 06/15/2009 $4.01 CANBY, OR 97013 Surcharge PHONE: 503-760-2095 1 hr Hourly Electrical Rate 06/15/2009 $62.50 FAX: 503-266-1464 1 ea Hourly Electrical 12% 06/15/2009 $7.50 Surcharge Type of Use: COM Class of Work: ALT Type of Const: • Occupancy Grp: Total $226.96 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 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: Permittee Signature: —•— CV, z 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 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. p r1•riktd �or * 2 oo Q..m n € . CITY OF TIGARD I b ref ridn - ELECTRICAL PERMIT I II l: COMMUNITY DEVELOPMENT Permit #: ELC2009 -00255 T j G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/02/2009 Parcel: 1 S135DD05102 Jurisdiction: Tigard Site address: 11989 SW PACIFI Subdivision: Lot: 0 Project: 1st Choice Project Description: (10) branch circuits.6 /15/09 ADDED 200 amp panel, changed branch circuits to (9). Owner: FEES GLADSTONE, HELENE D FAMILY TRUST Quantity Description Date Amount . BY JEFF PAINE, 9155 SW 69TH AVE TIGARD, OR 97223 10 crt Branch Circuits 06/02/2009 $106.70 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 06/02/2009 $12.80 Electrical Contractor: 33 da Investigation Fee (Equals 06/15/2009 $33.45 E R ELECTRIC INC Permit Fee) PO BOX 912 1 ea Investigation 12% 06/15/2009 $4.01 CANBY, OR 97013 Surcharge PHONE: 503 - 760 -2095 FAX: 503 - 266 -1464 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $156.96 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 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. C �1 • Issued By: - ILQ /tJ Permittee Signature: C tc nax p • OWNER INSTALLATION ONLY r 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 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. • r CITY OF TIGARD ELECTRICAL PERMIT NI o. - . COMMUNITY DEVELOPMENT Permit #: ELC2009 -00255 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/02/2009 Parcel: 1S135DD05102 Jurisdiction: Tigard Site address: 11989 SW PACIFIC HWY Subdivision: Lot: 0 • Project: 1st Choice Project Description: (10) branch circuits. Owner: FEES GLADSTONE, HELENE D FAMILY TRUST Quantity Description Date Amount BYJEFF PAINE, 9155 SW 69TH AVE TIGARD, OR 97223 10 crt Branch Circuits 06/02/2009 $106.70 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 06/02/2009 $12.80 . Electrical Contractor: E R ELECTRIC INC PO BOX 912 • CANBY, OR 97013 PHONE: 503 - 760 -2095 FAX: 503- 266 -1464 • Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: • Total $119.50 Required Items and Reports (Conditions) ' • This permit i . 'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done ' accordance wit' - •prove• = - ns. 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 la • --quire • • to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 01 -0010 through OAR 952 -01 $100. Yo obtain a copy of the rules or direct questions to OUNC by calie x37246.6699 or 1.800.332.23 . Is ued By: L���LI _ Permittee Signatu• -4 /"� I j 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 �i SIGNATURE OF SUPR. ELEC' j - % i Qr /W tT Date: � ©Q- LICENSE NO. 57 A S s • 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. 06/01/2009 10:03 877 - 222 -2857 ANDREW A WATKINS PAGE 03/04 Electrical Permit A nplicati EcovE I O R O F I (:1: u s 1.. U• I.1' Received P ermitNo.: c g• a City of Tigard i �� "�� 1N„..- 4 13125 SW Hall Blvd., Tigard, OR 972231 l i i A 1 2009 Plan Review Other Permit Phone: 503.639.4171 Fax: 503.598 -1969 Date/B Date Ready/ay, El See Page 2 for TIGARD Inspection Line: 503.639.4175 Internet: www.tigatd- or.gov CITY OF TIGARD Notified/method; Supplemental Information TYPE OF a" ■ il9 I. 1 1 t PLAN REVIEW + Addition /alteration/replacenaent Please check all that apply (submit 3 acts of plans whteme checked below): ❑ New construction Q Service or lbeder 400 amps or more 0 Building over three stories. El Del310116011 ❑ "her: where the available Ault current ❑ Marinas and boatyard& exceeds 10,000 amps at 150 volts or ❑ Floating buildings. CATEGORY OF CONSTRUCTION l ess to ground, or exceeds 14,000 ❑ commercial-use agricultural ❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building amps for all other installations. buildings. Cl Fire pump, 9 Installation of 75 KVA A or ❑ Multi -family aster builder ❑Other ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ ' A " " JOB •SITE INFORMATION AND LOCATION );', "1 -2" "1 -3 ", / 4 / Six or or mom occupancy, Job no.: Job site address: ❑ Six or more residential units. Q Recreational vehicle parks- • ❑ Health-care facilities- ❑ Supply voltage for more than City/State/ZIP: J l �'t. f it FMIIIIIIIIIRIIIIMIIIIII ❑ Hazardous locations. 600 volts nominal. � 1 Cl service or f> star 600 snaps or mote. Suite/bldg./apt. no.: Project name: ) • FEE •SCHEDu LE . Cross street/directions to job U0,.._ I Qh 1 F 1 't otal I * New residential single - or milli- family dwelling unit. Includes attached garage._ 1,000 sq. ft. or less 145.15 4 Subdivision: Ea add'1500 q, i3- or poltiots 33.40 1 Tax map/parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF s with a bove so • R) Limited energy, multi - family 75.00 2 1 // 14 0 i residential (with above so. it) , • r Services or feeders installation, alteration, and/or relocation t i R - / 200 amps or less 80.30 - 2 • ❑ PROPERTY OWNER • 0 TENANT . 201 amps to 400 amps 106.85 2 _ 401 = • to 600 amps 160.60 2 Name: _ 601 a,..s to 1,000 amps 240.60 2 Address: Over 1,000 - or volts 454.65 2 Temporary services or feeders installation, alteration, and/or City/State/ZIP: — education Fax: ( ) 200 amps or less 66.85 1 Phone: ( ) 201 amps to 400 amps 100.30 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 4 00 amps 100.3 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with AJPPLICANT . . . ...p CONTACT PERSON • ., above service or feeder fee, 6.65 2 - each blanch circuit Business name: B. Fee for branch circuits without service or feeder fee, / 46.85 411 2 i t i 11 first branch circuit Ea add'l branch circuit 1� ` 6.65 , S _ J 2 Addt ass: Miscellaneous (service or feeder not included) City /State/ZIP: ' NarfREfg Each manufactured or modular 90.90 2 L • dwLna service and/or fee der Phone: 61)5) L7 ' Q9.( Fax: : (SIP ) - r Reconnect only _ _ 66.85 2 E -mail: Pump or irrigation circle _ 53.40 2 . CO NTRACTOR . . . Sign or outline lighting M 53,40 2 Signal circuit(s) or limited- Business name: . I C / a energy panel, alteration, or extension. Describe: Page 2 2 l Address: N t r above Each additional inspection over allowable In any of the ab �� ... _ Pax inspection 62 Phone: (56 )2 (A) . g Cl1 Investigation per hour (1 In min) 62.50 CCB Lic.: /5;7 7(., Electrical Lic.: 35 /- Industrial plant hou 73.75 ELECTRICAL. PERMIT •FEES Suprv. Electrician signature, required: i . c /- Subtotal: ) 4', 'f() C 7, Plan review (25% of peroait fee): Print name: Ce7 0 c�iru Date: —/' C State surcharge (12% of permit fee): 12, gQ Authorized signature: TOTAL PERMIT FEE: f / c:4 ... , This permit application expires If a permit Is not obtained within 180 Print name: _Le le _, J — ) e 1 � Date. .. -6) days after it has been accepted as complete. 1 * Number of inspections allowed per permit. 1: tBuidiog\romits\ELC-Paxoiwpp.coc 05/23/06 440-4615T(1l/05/COM /WEB X 06/01/,2009 10:03 877 - 222 -2857 ANDREW A WATKINS PAGE 04/04 , • Electrical Permit Application - City of Tigard ❑ Protective Signaling Page 2 - Supplemental Information ❑ Other LIMITED ENERGY PERMIT FEES: Total number of commercial systems: *No licenses are required. Licenses are require RESIDENTIAL WORK .ONL:Y: for all other installations Fee for all residential systems combined.....-. $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm a Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: 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 ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical Q Nurse Calls ❑ Outdoor Landscape Lighting* I:\Buildfniamnib c.maytApp.doc 0323106