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Permit
c, CITY OF TIGARD ELECTRICAL PERMIT II a COMMUNITY DEVELOPMENT Permit #: ELC2009 -00437 T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/25/2009 Parcel: 2S102CC00500 Jurisdiction: Tigard Site address: 13500 SW PACIFIC HWY 90 Subdivision: Lot: 0 Project: Island Tan Project Description: (10) branch circuits for TI. Owner: FEES 13500 PACIFIC CORP Quantity Description Date Amount BY CAPOZZOLI ADVISORY FOR, PENSIONS INC, 21500 HAGGERTY ROAD, SUITE 100 10 crt Branch Circuits 08/25/2009 $106.70 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 08/25/2009 $12.80 Electrical Contractor: TED MEEKER ELECTRIC P.O. BOX 788 NEWBURG, OR 97132 PHONE: 503 - 538 -3845 FAX: 503 - 537 -5011 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $119.50 Required Items and Reports (Conditions) This permit is • • . - • - to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done i - •rdance with a••rov- ans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended r more the 180 days. ENTION: Oregon law requires ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules a et forth in OAR 952 X01 -0010 t •ugh OAR 952 -• 41- 10 ay obtain a copy of the rules or direct questions to OUNC by calling 503.246.669 .800.332. 3 I sued By: l / iI. ! 1 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: • • ' • CTOR INSTALLATION ONLY • SIGNATURE OF SUPR. ELEC' Zi Date: L - O� 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. • Electrical Permit Application FOR OFFICE USE ONLY City of Tigard Received : Permit N, • , i 9- ovy 3 7 q I III 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 1/ . • Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit: TI G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: El See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information TYPE OF WORK • PLAN REVIEW ❑ New construction ❑ 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. ❑ 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 ❑ 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. r ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ", Job no.: Job site address: /3 ) ©, Se../ p q�' C /i"4 1 ix or more residential units. ❑Recreational vehicle parks. City/State /ZIP: ri qtl, ❑ Health facilities. ❑ Supply voltage for more than _ \ ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: 0 Project name: ' 5 Lew-D �,r, 1 ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qty. 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 145.15 4 Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 • . DESCRIPTION OF WORK (with above sq. ft.) /, , / Limited energy, multi - family 75.00 2 / da/ J I /k Q I 4v residential (with above sq. ft.) v Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 Name: ,. 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City/State /ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) 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 ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 _ 2 Owner signature: Date: Branch circuits — new, alteration, or extension, per panel g A. Fee for branch circuits with ❑ APPLICANT • ❑ CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: B. Fee for branch circuits Contact name: without service or feeder fee, I 46.85 2 first branch circuit Address: Each add'l branch circuit 9 6.65 2 Miscellaneous (service or feeder not included) . _ City/State /ZIP: Each manufactured or modular dwelling, service and /or feeder 90.90 2 Phone: ( ) Fax: : ( ) Reconnect only 66.85 _ 2 E -mail: Pump or irrigation circle 53.40 2 • CONTRACTOR - Sign or outline lighting 53.40 2 Business name: /� / �]^ Signal circuit(s) or limited - T l�tQ ��! /C L tie / energy panel, alteration, or Address: fS eo . 7 r-P extension. Describe: Page 2 2 City/State /ZIP: I ,,,,/ 0 sr...._ OM- q , /3-2—_ Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: ) 5so -0 2 gel Fax: c5 03) C 3 7._ 5 p // Investigation per hour (1 hr min) 62.50 CCB Lic.:05?,L f 2 Electrical Lic.: ,3—/44.- C .uprv. Lic.: 3797S Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: / Subtotal: // 6. ^ n 3-01 Plan review (25% of permit fee): / .6 Print name: Date: F;(' L State surcharge (12% of permit fee): /A to Authorized signature: TOTAL PERMIT FEE: / 1/ .50 This permit 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 05/23/06 440- 461ST(II /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: • 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 ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all othei installations I: \Building\Permits\ELC- PermitApp.doc 03/23/06