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Permit CITY OF TIGARD ELECTRICAL PERMIT 11111 . r COMMUNITY DEVELOPMENT Permit #: ELC2009 -00409 T t G A RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/11/2009 Parcel: 2S102CC00500 • Jurisdiction: Tigard Site address: 13500 SW PACIFIC HWY 90 Subdivision: Lot: 0 Project: Island Tan Project Description: Install /alter 15 branch circuits, and (1) 201 -400 amp panel. • Owner: FEES 13500 PACIFIC CORP Quantity Description Date Amount BY CAPOZZOLI ADVISORY FOR, PENSIONS INC, 21500 HAGGERTY ROAD, SUITE 100 1 ea Services or Feeders - 201 to 08/11/2009 $106.85 400 amps PHONE: 15 crt Branch Circuits w /Purchase 08/11/2009 $99.75 Service or Feeder 1 ea 12% State Surcharge - 08/11/2009 $24.79 Contractor: Electrical 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 $231.39 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 :'.plicable 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 f suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Thy- rules are set forth in OAR 952- 001 -0010 through CJAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.8 , • .332.2344. ` I Issued By: `. � t ! 1 _ . 1 �. Permittee Signature: 4' 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 603.639.4175 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 REC E V City of Tigard Date/By: Permit No.: neg.? , Cat cii a 13125 SW Hall Blvd., Tigard, OR 97223 AUG 1 1 2009 D an Review � ' I , Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: T f c; A It D Inspection Line: 503.639 CITY OF TIGA Date ReadyBy: saris' la See Page 2 for Internet: www.tigard- or.gov Noti fied/Method: � C , Supplemental Information TYPE OF WORK B UII DING DIVISION 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 ❑ I- 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 ", "l -2 ", "I -3 ", Job no.: Job site address: /3 5 (gy s(. "/ c l�� , 2 IOOHPormore. occupancy. / — fl Six or more resident un ❑ Recreational vehicle parks. City/State /ZIP: 7 Ol V�- ,r'l 0 Health -care facilities. ❑ Supply voltage for more than 0 �k// / / Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: 40 Project name: S 1 , t / ( ii 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.) A J(Po SetLcP t%v Limited energy, multi - family 75.00 2 'v residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 4 106.85 2 Name: . 401 amps to 600 amps 4 160.60 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: ( ) I 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 Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT I 0 CONTACT PERSON above service or feeder fee, Is- 6.65 2 each branch circuit �J Business name: B. Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 first branch circuit Address: Each add'I branch circuit 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 A CONTRACTOR. Sign or outline lighting 53.40 2 Business name: T v/ c ' /( E(eel panel, Signal ani,arlin !' ' 4 / 1 energy p all teeratioon, or , or Address: ND /3 o ?PV extension. Describe: Page 2 2 City/State /ZIP: N rW 10 -el<5 © Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: (spa 6,38— 3 5295 � F : (503 637- 5° ` / / 10- ( t 0 Investi g ation per hour (1 hr min) 62.50 CCB Lic.:/©�Q4 Z I Electrical L 141 St prv. Lic.: 3, ,S Industrial plant per hour 73.75 p ( t ELECTRICAL PERMIT' FEES t El s required: Subtotal: Print name: f Q/,`e Date: eV ^l/ - Plan review (25% of permit fee): / State surcharge (12% of permit fee): Authorized signature: TOTAL PERMIT FEE: 6)3\.3 q l 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- 46I5T(I I /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 other installations I: \Building\Permits\ELC- PermitApp.doc 03/23/06