Permit CITY OF TIGARD ELECTRICAL PERMIT
• a.. COMMUNITY DEVELOPMENT Permit #: ELC2009 -00169
T E G A R D GA Ft. D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/17/2009
Parcel: 1S134BC00200
Jurisdiction: Tigard
Site address: 12196 SW SCHOLLS FERRY RD
Subdivision: Lot: 0
Project: Greenway
Project Description: Install (2) branch circuits to reconnect rooftop gaspack.
Owner: FEES
GREENWAY CENTER LLC & Quantity Description Date Amount
ANA KALAKAUA CENTER, 2155 KALAKAUA 2 crt Branch Circuits 04 /17/2009 $53.50
AVE #602
PHONE: wo /Purchase Service or
Feeder
1 ea 12% State Surcharge - 04/17/2009 $6.42
Contractor: Electrical
PRO CIRCUIT ELECTRIC LLC
PO BOX 3948
WILSONVILLE, OR 97070
PHONE: 971 - 563 -8211
FAX: 503 -266 -1349
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.92
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 t oug 952 -091 -0100. You may • stain a • py of the rules or direct questions to OUNC by calling 50 - 6699 or 1.800.332.2344.
Issued By: �ri1 t i. • • . \_ • _ . A _ Permittee Signature: -■■ 1 ari,
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'N Date:
LICENSE NO.
can 503.839.4175 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.
e- • "l a
Electrical Permit Applicati EC EIV Received
FOR OFFICE USE ONLY
I _ City of Tigard 1 1 ° . 09 FA MMo r ax e'�Ii.'1
II 13125 SW Hall Blvd., Tigard, OR 9 P an Review
Phone: 503.639.4171 Fax: 503.598.1 8R 16 2009 Date/By: Other Permit:
TIC A 1:'J Inspection Line: 503.639.4175 Date Ready /By: Allis: ®See Page 2 for
Internet: www.tigardor.gov CITY OFTIGARD^1 Notificd/Method: ' 1 `01 Supplemental Information
TYPE OFNG DIVISION PLAN REVIEW
^ ❑New construction ddition/altcration/replacement Please check all that apply (submit 2 sets of plans s /items checked below):
❑ Demolition ❑Other: ❑Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marina and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -tae agricultural
❑ I- and 2- family dwelling iii?"..Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder p Installation of 75 KVA or
❑Other: ❑Fi pomp. ❑ Inst
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ', 'E "1.2' , "i -3 ^,
Job no.: Job site address: Vi c n !�� �J ,� IOOHP or more. occupancy.
1 1 +' Sv`) .1 ` D (. fly ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: l ` m LSD c — ❑ Health -care facilities. 0 Supply voltage for more than
1 ❑ Hazardous locations. 600 volts nominal
Suire/bldg. /apL no.: I Project name: ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Description I Qtr. I Fee. I Tool i •
New residential single- or multi- family dwelling unit. j
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R or less , 145.15 4
■
Tax map/parcel no.: Ea add'1500 sq. R. or portion 33.40 1
Limited energy, nsidential
DESCRIPTION OF WORK • (with above sq. ft.) 75 2
., ` i 5 _,.!' , A , i
Limited energy, multi-family r at -4..C! C.1.7t- ( f mil(. residential (with above sq. ft.) 75.00 2
Services or feeders installation. alteration, and/or relocation 1
ROPERTY OWNER I ❑ TENANT 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
Name: GN4i4 LJA Q -T C ` 401 amps to 600 amps 160.60 2
Address:
I 601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts 454.65 2
City /Slate/ZIP: • Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less _ { 66.85 , i
Owner installation: This installation is being made on property that I own which is not 201 amps l0 400 amps I 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 1 133.75 2
Owner signature: Date: Branch circuits— new, alteration, or extension, per panel
A. Foe for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, / 6.65 6,65' 2
Business name: each branch circuit I
B. Fee for branch circuits
Contact name: without service or (ceder fee, 46.85 to '�> 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
Phone: dwelling. service and/or feeder 90.90 2
( ) 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: p4�o /' ik r — E, e.. .��� Signal circuit(s) or limited-
��4 v.W F�.ti~t: -[�tiF energy panel, alteration, or
- Address: i.e.?) 31 9 extension. Describe: I Page 2 2
City/State/ZIP: o _ ` f (Qr O k s 757, Each additional inspection over allowable in any of the above
t ,Yry
Phone: (TX ) 51,3 O �^ Fax l 7 1 / cOtn t 341 _ Per inspection 62.50
r b O Fax: ( Investigation per hour (1 hr min) 62.50
CCD Lie.: II1(6 3 a7 .;--( Lie.;--( L ' Suprv. Lie.: 5107.- 5 Industrial plant per hour 73.75
Suprv. Electrician signature, required: ELECTRICAL PERMIT FEES
{ Subtotal:
Print name:. F . {���/ Plan review (25% of permit fee):
� .
/v ! State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: 5 ' t C 'L.
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it ben been accepted as complete.
I: • p.zmrtAppder 03/27r06 • Number of inspections allowed per permit.
440.4615T(11 f US/COMAVEB
£'d 617£699Z£09 °!jPel3 l!paJ1C old d9V :80 60 Sl idV