Permit q CITY OF TIGARD ELECTRICAL PERMIT
az COMMUNITY DEVELOPMENT 8v ' Permit #: ELC2012 00465
T I G A.R O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/06/2012
Parcel: 2S 101 BD00103
Jurisdiction: Tigard
Site address: 7835 SW HUNZIKER RD
Project: Madison Furniture Subdivision: 1994 -025 PARTITION PLAT Lot: 2
Project Description: (3) branch circuits for TI 8/8/12, reprinted to correct address from 7805 SW Hunziker to 7835 SW Hunziker.
Contractor: WILLAMETTE ELECTRIC INC Owner: H G M CO
PO BOX 230547 BY NORRIS BEGGS & SIMPSON
TIGARD, OR 97281 ATTN: BLAKE HERING
121 SW MORRISON #200
PORTLAND, OR 97204
PHONE: 503 - 624 -3631 PHONE:
FAX: 503 - 624 -2938
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 08/06/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 08/06/2012 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 .•rdance wi 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. A NTION: Oregon =w - •uires you to follow the rules adopted by the Oregon Utility Notifica • enter. Those rules are set forth in OAR
952 -00 - 0010th ;ugh OAR 952 s 1 -00 •u may obtain a •py of the rules or direct questions to OUNC by 987 or 1.800.332.234+►
Iss ed By: •
y �� _z�I Permittee Signatur . r
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.
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00465
TIGARD- 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/06/2012
Parcel: 2S 101 BD00103
Jurisdiction: Tigard
Site address: 7805 SW HUNZIKER RD
Project: Madison Furniture Subdivision: 1994 -025 PARTITION PLAT Lot: 2
Project Description: (3) branch circuits for TI
Contractor: WILLAMETTE ELECTRIC INC Owner: H G M CO
PO BOX 230547 BY NORRIS BEGGS & SIMPSON
TIGARD, OR 97281 ATTN: BLAKE HERING
121 SW MORRISON #200
PORTLAND, OR 97204
PHONE: 503 - 624 -3631 PHONE:
• FAX: 503 - 624 -2938
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 08/06/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 08/06/2012 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 001 -0090. You may o fain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: G1 4PPu C4-fl
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 503.639.4176 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.
•
08/03/2012 FRI 13:52 FAX 503624229338Willamette Electric a002 /002
Electrical Permit ApplicatioRECEIVED a oR orrice use ONLY::
AO I A D
City Tigard Date/By: • , i i y • Permit No.:Ci
h' g n i l G 0 6
Date/By:
13125 SW Hall Blvd., Tigard, OR 97229' 20 Plan Review
' g : Phone: 503.639.4171 Fax: 503.598.1960 Date/By; Other Permit:
T I G A R D Inspection Line: 503.639.4175 CPTY OF TIGARD Date Ready/By: tar 1 RI See Page 2 for
Internet www.tigard•or.gov BU DRNCiDiViSION Notified/Method: `� Supplemental Information
..
, .:C1F:'- Y1rU* . :p i�#N:
❑ New construction rig Addition /alteration /replacement Please check all that apply (submit 2 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.
CW'iti ,o ttibit-± ,,,,--•-• l RUd ot'1 . , exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
...: ' . ....;: . ..:.. .....::..:..: .. t less to ground, or exceeds 14,000
❑ 1- and 2 - family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. ❑ buildings. ia1 -use agricultural
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or
❑Emergency system. larger separately derived system.
4 0 * t t *gW ; AN' ' : 'A 6 • ' t ❑ Addition of new motor load of
Job no.: Job site address: ! ��
100HP or more. occupancy.
7 �/ `z' 411 7.✓/1 Jr t' i ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: U f,4, / 22-2 - ❑Haz ❑Supplyvaltagefarmore than
/ ( 3 ❑ Hazardous locations. 600 volts nominal.
/SUlt4bldg. /apt. no.: z,s^ I Project name: 11:1'7 0 %'1 / 4 , /1,.,, ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: Description ( Qty. ( .Pee. I Total
New residential single- or multi - family dwelling unit.
includes attached garage.
Subdivision: I Lot no.: 1.000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. it. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION:' OF WORE (with abovesq. ti.)
- n Limited energy, multi - family
�/� C�.� / r/ ' ✓t of � , J — residential (with above sq. ft) 75.00 • 2
.! Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2 • OW!'IER .. . I ... ; D': Ewer - 201 amps to 400 amps 13356 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: ( ) i Fax: ( ) 200 amps or less 59.36 1 1
201 amps to 400 amps 125.08 I 2
Owner installation: This installation is being made on property that I 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
r above service or feeder fee
.,AT!P.L1lZ'ANC.: ;I. [J 7.42 2
•
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first / 56.18 , c-Z, 4 2
Contact name: branch circuit
Each add'I branch circuit 7.42 j 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or
City/State/ZIP: dwelling, service modular and/or feeder 67.84 2
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
E - mail: • Pump or irrigation circle 67.84 2
Signor outline lighting 67.84 2
. .. :715,1 '[a # 4-f?1t ... Signal circuits) or limited- energy
Business name: Willamette Electric Inc. panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: P.O. Box 230547 Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/ State/ZIP. Tigard, OR 97281 Industrial plant (l fir min) 78.18/hr
Phone: (503) 624 -3631 i Fax: (503) 624 -2938 inspections for which no fee is 90.00/ hr
specifically listed ('4 hr min)
✓ C C B Lie.: 75059 Electrical Lic.: 34 -283C Viprv. Lic.: 4226 -S : , . . : 1 . :-: ` `iLE = , ' . . '- :::'`' `i r` ` .
Subtotal: '7 �� .
Suprv. Electrician signature, req ' Plan review (25% of permit fee):
Print name: David Fife Date: State surcharge (12% of permit fee): 6
Authorized signature: TOTAL PERMIT FEE: 2 9 r
This permit application expires if a permit is not obtained within 180
Print name: i Date: days after it has been accepted as complete.
N um b er o inspections allowed per permit.
t:' BuildlnitTennIu \EL•PeneltApp.doc 07/01/10 440.4613T(11/03/COM/WEB