Permit CITY OF TIGARD ELECTRICAL PERMIT
a COMMUNITY DEVELOPMENT Permit #: ELC2012 -00393
TI G A RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/28/2012
Parcel: 25101 DCO3800
Jurisdiction: Tigard
Site address: 7180 SW SANDBURG ST 100
Project: HVAC Power Subdivision: SALEM FREEWAY SUBDIVISION Lot: 4
Project Description: (1) branch circuit with service; (1) branch circuit without for split NC system
Contractor: BRIGHTSIDE ELECTRIC & LIGHTING SERV Owner: MCCORMACK PROPERTIES LP
203B W MAIN ST 7190 SW SANDBURG ST
CARLTON, OR 97111 TIGARD, OR 97223
PHONE: 503 - 852 -7900 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits w /Purchase 06/28/2012 $7.42
Specifics: Service or Feeder
1 crt Branch Circuits wo /Purchase 06/28/2012 $56.18
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 06/28/2012 $7.63
Electrical
Type of Const:
Occupancy Grp:
Total $71.23
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 5 -001 -0 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1800.
Issued By: Permittee Signature: t» 4 .8
J " ' 1 PL. , A l boo
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.
•
From:BRIGHTSIDE ELECTRIC 5038529573 06/28/2012 08:49 #055 P.002/002
Electrical Permit Application RECEIVE :vu drr►cr:US oNl_1'_''
City of Tigard JUN 2 8 2012 ns • 1.l X61 0- — pamitNo ali4V►ar 00343
13125 SW Hall Blvd., Tigard, OR 97223 Review
Phone: 503.718.2439 Fax 503.598.196it Plan B Other Permit
T 1 ,1, u Inspection Line: 503.639.4175 l,Mt O 'MAR). Dates
Internet: www.tigard - or.gov BU:.LD /N DIVF1S1 Notified/Method: II C SS lemental Infon
•°''%Tine`s., %�°°;��. . :: ft�� gc0. :� a•..<; •r�i.. =TO: ., i.V..'@ -c*. ti ft- .1-17 .= . l , k• a L` Supplemental
A3? * , :=4,� rv-a ,.... :.' gf.- ;.:- .r,.si.~�`= PE_y- „VI�OR'I{ : r. .. -i_:, ' i d , , . : .v'"�y y.r. r r4 _"'air.,fo ltv- : n. .a. .. gP.,+e+,
' ..- ,.. ..."N: _ ...3:...,. ;. a.,•. ..,.�.. :'.,, � :i; .. C, ; r'•.'•e. �E. � Pl�A7.�r.,, ., s..3;�:1..
.. e.' : �;:s.r�as:x,.a� •_�.'r.�. >....:..: _ Y�F'. �:. .�s , �: ~ <... .lH.' £�rx .`•.a,�S t'. ti
❑ New construction [g Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked
❑Demolition ❑ Other ❑ Service or feeder 400 amps or more ❑ Building over three st
_ _ where the available fault current ❑ Marinas and boatyard:
”" 'ra Ss ,�;� ::a , : Ca T 310 ux�''�, I 'v`4r 4 `it:�-`_ exceeds 10.000 amps at
?_ sn z. ,_ . s , %:_ =`r < R?Y�'U 3001! SCIt # :.. s � , s 14 000 mg butldin ❑ Float
.. +:k'�„':f .. ::: ,...., .:..ir.~_'%..•' >.��.i ;..a::�4�3 eor. Ss•
less to ground, or exceeds 14,000 ❑ Commercial -use nazis
❑ l - and 2 family dwelling 0 Commercial/industrial ' ❑ Accessory building
❑ Multi - Entail amps for e0 other installations. buildings. ❑ Master builder ❑ Other ['Fire pump. ❑ Installation of 75 KVA
Y, m�^eF � t t� fin •� a .+ � +s� -HA yam.: •: -jolt: n� #q ❑ Emagc�ysystem larger separatelyderiw
��� a x r' �- L��<�+:;a's:aew�rW�',' � ❑ Addition of new motor load of ❑
Job no.: 0 243 7 — (/ Job site address: 7f8 D "-A, 2 vpA 5/— t001EP or more. occupancy.
❑ Sot or more residential units. ❑ Recreational vehicle pi
City/State/ZIP: ! ' / A OR ( 7 7 z 7 3 ❑ Healthcare facilities. ❑ Supply voltage for mm
r y / 7 !i ❑Hazardous locations. 600 volts nominal.
S te/bldgiapt no.: to a Project name: //vA'C Qw e2 ❑ Service or feeder 600 amps or mote.
Cross street/directions to job site: s: • C;�?•:�.'�� ,. , i esc" `. Megg
. Idon Qty. Fee. . Tata
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or lest 168.54 ' •
Ea. add') 500 sq. ft. or portion 33.92
Tax map/parcel no.: •
Lim energy, ergy, residential
•' Y ,.a- :.arm �,. `+/ y �� a rY. %;m' , e : i • (with above ag18.) 75.00
Limited energy, multi- family 75.00
��5t »a c 7 - �o-, Sp /� 7 5 residential (with above sq. R) .
Services or feeders installation, alteration, and/or relocat
?. . 200 amps or less 100.70
V.,4,',41,00. � , 7. ; ;N :; :t ;it 201 amps to 400 amps 13156
Name: 401 amps to 600 amps 200.34
Address: • 601 amps to 1,000 amps 301.04
Over 1,000 amps or volts 552.26
City/State/ZIP: Temporary services or feeders installation, alteration, am
• relocation
•
Phone: ( ) I Fax: ( ) 200 amps or less 59.36
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amp 168.54 •
Branch circuits — new, alteration, or extension, per panel
Owner signature: • Date:
ry: g , A. Fee for bran, circuits.wiJh
!s ''c, `, " "' ° ! " ` � •''� ts:;ai above service or feeder fee
�� �_.;�, -` ' � each branch circ 742
Business name: B. Fee for branch circuits without
service or feeder fee, first f 56.18 5
Contact name: branch theta
Address: Each add') branch circuit 7.42
Miscellanepua (service or feeder not included)
• City/State/ZIP: Each manutacbued or modular I 67.84
•
dwelling, seivice and/or feeder _
Phone: ( ) Fax:: ( ) • Reconnect only 67.84
E - mail: • Pump or irrigation circle 67.84
lA tr'2;iti • "�°' 4y x -�> Sign outline lighting 67.84
Signal cirwil(s) or limited-energy
Business name: n/� � 49E ,�/ / U ation or extension. Page 2
�+�/ v, C panel alter Each additional inspection over allowable In any of the abo
Address: P 9 V - - Additional inspection (I hr min) 66.25/ hr
City/State/ZIP: �^�� Investigatiag' (1 hr min) 66.25/ hr
7pGT� f Q a2 7,// Industrial plant (1 hr min) 78.18/ hr
Phone: (5o�) B-iZ- 7 O- F ax: 3 go -2- 75 -7 B �� ) f Z Inspections for which no fee is
90.00/ hr
S listed ii br min
I l � �B Lic.: /5 n el I E c.: OL Suprv. Lic_ : ',zee S = � '• '.'., 5,t�: " 'v .. _ S
Suprv. Electrician signature, required: �._ Subtotal: (� . 6 p
B 3 Plan review (25% of permit fee): — �
Print name: � r j/ O z � // I ate: / z j - - State surcharge (12% of permit fee): 7, 6 3
( / t° TOTAL PERMIT FEE: 7/ 1
Authorized signature: , t
This permit application expires U a permit is not obtained within II
Print name: fie // S • days after it has been accepted as complete.
Ip Z� L s Number of inspections allowed per permit
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