Permit .11 CITY OF TIGARD ELECTRICAL PERMIT
a • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00411
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/16/2012
Parcel: 1 S135DD03301
Jurisdiction: Tigard
Site address: 11945 SW PACIFIC HWY 246
Project: El Porvenir Subdivision: METZGER ACRE TRACTS Lot: 9
Project Description: (10) branch circuits for TI
Contractor: JM3 ELECTRICAL & CONSTRUCTION LLC Owner: COMMERCIAL ENTERPRISES LLC
10500 SW CLYDESDALE TERR 8320 NW HWY 99
BEAVERTON, OR 97008 VANCOUVER, WA 98665
PHONE: 503 - 961 -3537 PHONE: •
FAX: 503- 718 -7268
FEES
Quantity Description Date Amount
10 crt Branch Circuits wo /Purchase 07/16/2012 $122.96
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/16/2012 $14.76
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
•
•
Total $137.72
Required Items and Reports (Conditions)
This permit is ' bject 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 ccordance vin approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is sus •ended for more the 180
days. A ENT • N: Oregon ` aw re• uires you to follow the rules adopted by the Oregon Utility Notification Center. • e rules are set • • , in OAR
952 -001 0010 t 'rough OAR 952 ,t• -0' •�•u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1 =;P7 ,.00.3 .2344.
Issu d By: _ �'�'Z� iC.d{ -/l' Permittee Signature: • �IL '' �
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:
CONTRACT• - INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' x Ire 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.
Electrical Permit Application
I y
City of Tigard DateJBv. Received '� /v Permit No.: V � /� //
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I G n R D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www. Tar or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction g Addition/alteration/replacement Please check all that apply (submit a 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.
I less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
El �v
1- and 2- family dwelling ,►mil 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 ", "I -2 ", "1 -3 ",
Job no.: Job site address: �j !� / I OOHP or more. occupancy.
• C L 5 C �/ e //mil' 17/14/ ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 774 Q4 2 L 3 ❑ Health -care facilities.
❑ Hazardous locations. ❑ Supply voltage for more than
600 volts nominal.
Suite/bldg. /apt. no.: '1, Project name: /✓ P -1/en , y ❑ 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 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family
/P� r 4" 'Q/ � '
� ( residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ 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 to 400 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
a APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
NTH , T each branch circuit
Business name: `�( /l�J T e7 c , ,� /�d��� , ac B. Fee for branch circuits without
1 service or feeder fee, first 56.18 2
Contact name: c r&cet y) A-69/ -enQ branch circuit
/ / Each add'l branch circuit 9 7.42 2
Address: l� 5--DD 5 � ('/ 4 ' ,f Miscellaneous (service or feeder not included)
City/State /ZIP: iPQV ' /_ 1/1 O 7 Y q 4»5 C' `7 Q r t! J Each manufactured
service service e a c or nd/or r feeder er er 67.84 2
/, T " a
Phone: (57)3) 9‘/.-- 55 Fax:: ( � f) 7i8 ^ 72 jg Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
fir, 3 e le&f /'7Ct /A OM Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name:
panel, alteration, or extension. Page 2 2
. Each additional inspection over allowable in any of the above
Address: Additional inspection (I hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City/State /ZIP: I Industrial plant (1 hr min) 78.18/ hr
,4, Phone: ( ) // 3 7 / l 1 Fax: ( ) /0////4 Inspections for which no fee is 90.00 / hr
[� / specifically listed (%z hr min)
CCB Lic.: / (' 2 8 ,2 Electrical Lic.: C i 2 uprv. Lic.: 5 i8 ELECTRICAL PERMIT FEES
Suprv. Electric signature, required: �
i fr - a Subtotal:
/ Plan review (25% of permit fee):
Print name: tiva' �Orep/2 O Date: ./ /6 /2 State surcharge (12% of permit fee):
((( TOTAL PERMIT FEE:
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
N um b er of inspections allowed per permit.
1: \ Building \Permits\ELC- PennitApp.doc 07/01 /10 440- 4615T(11/05 /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:
El Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
•
El Vacuum Systems*
El 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
El Boiler Controls
El Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
El Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control* .
El Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
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