Permit CITY OF TIGARD ELECTRICAL PERMIT
• • COMMUNITY DEVELOPMENT Permit#: ELC2012 -00376
T t G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/19/2012
Parcel: 2S102AB02300
Jurisdiction: Tigard
Site address: 12519 SW MAIN ST
Project: Tigard Cleaners Subdivision:ELECTRIC ADDITION TO TIGARDVILLE Lot: 15
Project Description: (1) branch circuit - new sign circuit
Contractor: RELIANT ELECTRIC OF OREGON LLC Owner: HANSON, DONALD E TRUST
20200 SE OLDENBURG LN PO BOX 12
SANDY, OR 97055 WELCHES, OR 97067
PHONE: 503 - 701 -4562 PHONE:
FAX: 503 - 668 -4190
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 06/19/2012 $56.18
Specifics:. Service or Feeder
1 ea 12% State Surcharge - 06/19/2012 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 OA 952- 001 -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: A PYu C4-T / 0
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.
Jun.19.2012 03:35 PM Reliant Electric of Orego 5036684190 PAGE. 2/ 2
Electrical Permit AnoLiR ! 1) t it 1H 11, t t I ( l
2 O Received P amir N u.: E
City of Tigard 9 t>r: & �C 9 (L y LGo� -n! a-- p937(e
13125 SW Hal Blvd., Tigard, O 3 Men Review Other Permit:
Phone: 503.7182139 Fa.v� Date/By: + p
i . Inspection Line: 503.639.4I i lr.'titlli N m otrbeJIM . 11 ( e et se e r g al t rormafloo
Internet: www.tigard-or !LD1NG D1 \ / 1S1oN
TYPE OF WORK _k PLAN REVIEW
Ram c h ee k all lint apply (submit a sets of plans WIitems chocked below):
❑ New construction /ddition/allteradnn/teplaeCn nl
I:I Service or feeder 400 amps or more D Building over three Stumm.
❑ Demolition ❑ Other: where the available fault =rent ❑ Marina and boatyards.
CATEGORY OF CONSTRUCTION �_ exceeds 10,000 amps at 150 volts or D Floating buildings.
Ws to ground. to exceeds 14,000 D Commercial -use agricultural
❑ 1- and 2- family dwelling RCommercial/industrial ❑ Accessory building Emma for all other innalle>ioes. buildings.
❑ Multi- family ❑ Master builder 0 Other. D Fire pump. ❑ Installation of 75 KVA ur
q a Emergency system. larger separately derived system,
JOE STIR INFORMATION AND LOCATION (� r D Addition of new motor load of ❑ "A ", - C ", "1.2 ", „ 1.3°
10011P or more. occupa •.
Job no.: r2......24 Job site address: 2-1 55 S YYlabi 1 , ❑ Six or more residential units. ❑ Recreational vehiclo parts.
City/State/ZIP: -[ ! , A (_ 01-12.2- D facilities, 0 Supply vmha"°I Hart than
[]` liar81da11e locations.
Suite/bldg./apt. no.: Project name: , / IL ' j J ' D Service or tinder 600 amps or more.
• FEE SCHEDULE
Cross street/directions to job site: . Desn1 vim'
New residential single- or multi- Pamlly dwelling unit.
Includes attached mirage.
Subdivision: jLot no.: I ,000 sq. ft. of less
' 13683. 54 4
Ea. add'I 500 sq. tt. or portion 92 1
Tax map/parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. R) ,
�- -- Limited energy, multi-Brady 75.00 2
new Q t n CA-Kau-4- residentialiwith above sq. ft.)
�7 ``!/� Se rvices or feeders installation, alteration, and/or relocation
200 amps or lass 100.10 2
❑ PROPERTY OWNER — 1 ❑ 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
' Temporary services or feeders installation, alteration, end/nr
City /State/ZIP: relocation _.
Phone: ( ) { Fax: ( ) 200 amps or Ion 5936 1
Owner installation: This installation is being made on property that l own which is not 2 amps to 400 amps _.. 168.54 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
❑ APPLICAN'T 1 ❑ CONTACT PERSON above service or feeder fee, 7,42 2
� ,Al�( � _ n `/P each branch circuit
Business name: /% lr � ( [ of � B. Foe for branch circuits without it _ Jl Fcc
service lbe
or feeder 18e, first
Contact name:B (I - yt�../t 1 -_ m brunch circuit 56.18 51 leg 2
Each edd'I branch circuit 742 � 2
Address: 7-0 20C' 5 6 t7 I�M. )l Miscc leneoos (service or feeder Dot included)
v ^ 1 , 5
Each ing service or modular 67.84 2
City/ State /"LIP: ‘, 4 11 . 11 . 41_,A 1 U f� dwelling, , navieic s et+d/or feeder
Phone: 1,40p. ¢/ ,, r A 4 fQ Fax: : ) ' 4 (01 U Reconnect only 67.84 2
171 L.I Pump or irrigation circle 67.84 2
E -mail: V /. .. ,!%l. . t t a) L I W \ Sign or outline lighting 67.84 2
• r r • CTOR Signal circuit(s) or limited-energy N
Business name: panel, alteration, or extension. . Page 2 r 2
Each additional inspection over allowable in any of the above
Address: , Additional inspection (1 hr min) 66_25/ hr
Investigation (I hr min) 66.25/ hr
City /Statc/ZIP: A ' J. / / ) I ha _ Industrial plum (1 hr min) 78,18/ hr
Phone; ( ) a ) I
� / ra b ' w" Inspections for which no lbe is
listed 'A hr min) 90.00 / hr
CCB Lie.: \ : 1 � � r - : EL ECI'RICAL PERMIT FEES
�// j Subtotal: IA g Suprv. Electrician signature, required: �� �/ Plan review (25%ofpermit fee):
Print name: f r "5 1 / I a ; c: 1 , 2_ . State suraarge (12% of permit fee): r 1
� J � l 3
TOTAL PERMIT PEE: i 2, `
Authorized signature: , ` ��1 This permit a pplication caplets If a permit Is Dot obtained within 180
days after it has been accepted as complete yT
Print name: g Se ( , 1 i y/' "t(,j, . , Date: l0 r ()_. r Number of inspections allowed per permit. l(r
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