Permit r! CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00434
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/23/2012
TIGARD Parcel: 2S115BA02600
Jurisdiction: Tigard
Site address: 16230 SW PACIFIC HVVY 140
Project: House of Bread Subdivision: 2004 -015 PARTITION PLAT Lot: 2
Project Description: (20) branch circuits for TI
Contractor: HOTWIRE ELECTRIC INC. Owner: SN PROPERTIES PARTNERSHIP
7435 SW 240TH PL. 1121 SW SALMON ST
BEAVERTON, OR 97007 PORTLAND, OR 97205
PHONE: 503- 848 -6823 PHONE:
FAX: 503 - 848 -6823
FEES
Quantity Description Date Amount
20 crt Branch Circuits wo /Purchase 07/23/2012 $197.16
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/23/2012 $23.66
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $220.82
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 95 001 -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: o' tf L 6 e_09 - 7 7 O
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.
Jul 19 12 04:20p Hotwire Electric 503 - 848 -6823 p.1
Electrical Permit Applica D colt Oil i .l: 1 SE 0:1,1
City of Tigard it 11 1 g ' ti )- 721742r4= Permit No.: sz 1/ -e2? 93
. 13125 SW [-Tali Blvd, Tigard, OR 97223 Plan Review Other,/1,, e� ���
Phone: 503.718.2439 Fax: 503 t.IGARD DateEty: J�K./
T I C A F. D Inspection Line: 503.639.4175 Date ReadyiBy: Si See Page 2 for
Internet www.tigardor.gov BUILDING Notified/Metbod NM supplemental Infotmatioa
TYPE OF WORK PLAN REVIEW •
❑ New construction (ja Addition /alteration/replacentent Please check an that apply (submit a sets of plans wlitcros checked below):
❑ Service or feeder 400 amps or more ❑ Building over throe stories.
❑ Demolition ❑ Other. where the evadable fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION , exceeds 10,000 amps at ISO volts or 17 Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I - and 2- family dwell a Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION O Addition of new motor load of ❑'A ", "E", "1 -2". "1 -3 ",
Job site address: r ,,"� , 100H Porm ore. agcy.
4 Job no.:
I 6 Z3 C Sit; Par 1 CI G I'�i. 1 _ _ ___ ❑ six or more ne i ial unit O Recreational vehicle parks.
City/State/ZIP: - �; ('� ❑ Health-care facilities. O Supply voltage for more than
�' �� e 9 ZZ ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: lib Project name: pit, a fit'li , ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross streetidirecti job site: tJfion I Q. I F. I Teal 1 '
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: I 1,000 s4. ft or less 168.54 4
Ea. add' 1 500 sq. R or portion 33.92 1
Tax map/parcel no.: Limited energy, residenval
(with above sq. ft) 75.00 2
DESCRIPTION OF WORK
Limited energy. multi- family 75.00 2
'Ten eon -1-- r on Fj(o v4+�
(= nf C1/ it fe z r b l residential (with above sq. It.) ,
1 Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 13366 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, and/or
City/State/ZIP: 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 1 own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits- new, alteration, or extension, per panel
Owner signature: Date: _ A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
B. Fee for branch circuits without
Business name: 1 56.18 S-iiii, IS 2
service or feeder fee, first
Contact name: tvenoh circuit p
Each add'I branch circuit i 1 7.42 I (r l� 2
Address: Misecllaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City /State/ZIP: dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-energy
Wiwi' (r {{ panel, alteration, or extension. Page 2 2
Business name:
ire 1 et 'T r I L. I h L Each additional inspection over allowable in any of the above
Address: "' Additional inspection (1 hr min ) 66.25/ hr_
Investigation (1 hr rein) 66.25/ hr
City/State/ZIP: -( 6e u; fr - 0 R- q 700 Industrial plant (1 hr min) 78.181 hr
( 4 7 —f 3 (0 3 ) IS ( -- to S 2 3 Inspections for which no fee is
Phone: SO o) $ Fax: S specifically lived (K hr min) 90.0W hr
CCB Lic.: i Li(p klectrical Lic.: 34— S 1 F Snprv. Lic.: �l y ELECTRICAL PERMIT FEES
� � Subtotal: 19 q. !r
Suprv. Electric �i d required: „._ 7� /Dli I fee): — P
Plan review ( 25% of permit fee )
Print name: r
7� e (e IL / J tl ip Date: 7// 7/ 1/ f Z permit Stare surcharge (12% of p fee): x 3 , (O
/
TOTAL PERMIT FEE:
Authorized signature k' t „4 . — This p ermit application expires if a permit is not obtained within 180
> „u(,1 �v�� 7/i days it has ow d p p eer pmiKd as complete ^ „D iP�
Print name: Dat e: / Z r Nu mber of inspections snowed permit ,
BBu;taingtermtts' GPes,n IApp.doo 07101/10 440.46157(1 uovcatv(vea