Permit CITY OF TIGARD ELECTRICAL PERMIT
, ® COMMUNITY DEVELOPMENT Permit #: ELC2012 -00225
• TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/19/2012
Parcel: 2S102BD01601
Jurisdiction: Tigard
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Site address: 9855 SW WALNUT PL
Project: United Car Wash Subdivision: FREWING ORCHARD TRACTS Lot: PTS E &
Project Description: TI
Contractor: FALCON ELECTRIC Owner: DAVIDSON, WILLIAM G & DIXIE L
2375 SW CEDAR HILLS BLVD 8915 SW COMMERCIAL ST
PORTLAND, OR 97225 TIGARD, OR 97223
PHONE: 503 - 208 -4709 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 ea Services or Feeders - 200 04/19/2012 $201.40
Specifics: amps or less
20 crt Branch'Circuits w /Purchase 04 /19/2012 $148.40
Type of Use:. COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 04/19/2012 $41:98
Electrical
Type of Const:
Occupancy Grp:
Total $391.78
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Required Items and Reports (Conditions)
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This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and a ll 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 OA; • - 001 -0090. You may obtain a copy of the ru - scions to OUNC by calling 503.232.1987 or 1.801. • 32.2344.
Issued By: � �ii_ �a� Permittee 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' Date:
LICENSE NO.
Call 503.639.4175 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:
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Electrical Permit Application . OFFICE: USE ONLY G ' / _
City of Tigard ® Date/B : Received gird- i1/ Permit No :: �_ _,A' .1 - f � -
° 13125 SW Hall Blvd., Tigard,OR 97 Plan Rev `�
'� C Phone: 503.718.2439 Fax: 503.598. 1 `� M�" ' Date/By: 'Other Permii:m p — _“
f I C. n It u Inspection Line: 503.639.4175 l9 l Date Ready/By: 'kris: RI See Page 2 for
Internet: www.tigard.or.gov P R r t4 ligtifed/Method: Supplemental Information
TYPE OF WORK e ..rJ �� • ( - NW' PLAN REVIEW
ID New construction
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laA 'ddition/alteration/repr Please check all that apply (submit sets of plans w /items checked below):
❑ Demolition ❑Other: V ak@pfe it
g ��.� ['Service or feeder 400 amps or more ❑ Building over three stories .
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
El 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new. motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ";
Job no.: Job site address: / 7t�� /JI���Z Six or o a r es. occupancy.
`"" ❑ or mare residential units. ❑ Recreational vehicle parks.
City/State /ZIP: in D ❑ Health -care facilities. ❑ Supply voltage for more than
y)?-,2.73 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 - amps or more.
FEE SCHEDULE •
Cross street/directions to job site: e v I ---<C 9 tAi Description I Qtr. I Fee. I 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
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 . '1
Limited energy, residential
DESCRIPTION OF WORK : (with above sq. ft.) 75.00, ,, 2
Limited energy, multi- family 75.00 2
residential (with above sq. ft.)
- Services or feeders installation, alteration, and/or relocation
200 amps or less 0 9 100.70 Ir Gj ` 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 - amps 133.56 2
401 amps to 600 amps 200.34 . 2
Name:
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
relocation
Phone: ( • ) ' Fax: ( ) 200,amps or less 59.36 1
201 amps to400.amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
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 .
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7.42 /LIf ,v 2
each branch circuit VC.)
Business name: B. Fee for branch circuits without
' service or feeder fee, first 56. l8 2
Contact name: . branch circuit •
Each add'I branch circuit - 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or. modular- 67.84 2
n dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67:84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy .
Business name: r j ^ >�7x . I , panel, alteration, or extension. Page 2 2,
7 Each additional inspection over allowable in any of the above
Address: c2 3 �C ,J Ge _virL1.<5 ,V so Additional inspection (I hr min) ,66.25/ hr
City/State/ZIP: c c2 Investigation (1 hr min) . '• 66.25/ hr '
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j7.l -c i'l / 9 Industrial plant (1 hr min) 78:18 / hr
Phone: Fax: ( ) Inspectio for w hich no fee is
4�`�`) �7 / / /�I �U � I specifically listed (%: hr min) 90:00 / hr •
CCB Lic.: f 9 Electrical Li c.: C. 71 • . Su r rv. Lic.: 56685 ELECTRICAL PERMIT FEES
RR Subtotal: . 3 `f �(•
Suprv. Electrici ttl�e required: �,. °
i / r Plan review (25% of permit fee):
Print name: ' y Date: / /� State surcharge (12 %of permit fee): �. ? '
TOTAL PERMIT FEE: 3Q / . 77
Authorized signature: .
This perniit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
. Number of inspections allowed per permit. •
. I :\ Building \Permits\ELC- PermitApp.doc 07/01/10 - 440- 4615T(II /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL'WORKONLY:
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:.
COMMERCIAL WORK ONLY
Fee for each commercial $75.00
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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*
El Medical
❑ 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- Permiulpp.doc 07/01/10