Permit o CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00452
T [GA.RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/31 /2012
Parcel: 2S 101 BB01500
Jurisdiction: Tigard
Site address: 12232 SW GARDEN PL, BLDG# 1
Project: Apex Lab Subdivision: CROW PARK 217 Lot: 3
Project Description: (1) 200 amps or less and (41) branch circuits for TI
Contractor: SALAR ELECTRIC Owner: WALTON CWOR PARK BC 8 LLC
19645 SE WOODED HILLS DR BY CTMT - WALTON RE TAX
DAMASCUS, OR 97089 4678 WORLD PARKWAY CIR
ST LOUIS, MO 63134
PHONE: 503 - 351 -3730 PHONE:
FAX: 503 -665 -2817
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 07/31/2012 $100.70
Specifics: amps or less
41 crt Branch Circuits w /Purchase 07/31/2012 $304.22
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 07/31/2012 $48.59
Electrical
Type of Const:
Occupancy Grp:
Total $453.51
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. ( hose rules are set forth in OAR
952- 001 -0010 through OAR 95 -0 1 -0090. ou may obtain a copy of the rules or direct questions to OUNC by calling $ 3.232.1987 or :00.332.2344.
Issued By: Perm /1 ittee Signature: l_ a I/
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.
Electrical Permit ApplicationRED FOR OFFICE USE ONLY
City of Tigard Received
Dam : 3 i 1 / Z — Permit No.: 6 - Le ., ao i a _ U p j6.7
III 13125 SW Hall Blvd., Tigard, OR 97223 JUL 3 1 2012 Plan Review
• Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit: a u (Caap(a -0940
T 1 t, A I . I Inspection Line: 503.639.4175 (�j'�J G± p D Date Ready /By: : /1 ® See Page 2 for
Internet: www.tigard- or. �i8 a � ��IJIAIIIll Notified/Method: ' p Supplemental Information
BUB,a'I'MDIMON
TYPE OF WORK PLAN REVIEW
1:1 New construction ❑ Addition/alteration/replacement Please check all that apply (submit a sets of plans w/itcms 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.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ 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.
of n
❑ Addition of new w motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: /I�� //)� �Q G_\ 10011P or more. occupancy.
�/`/s� l�li� —b�.J ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP:- 7 ❑ Health -care facilities. ❑Supply voltage for more than
l l CoA27� ❑Hazardous locations. 600 volts nominal.
n 0 ) ��
Suite/bldg. /apt. no.: Project name: r'f r l.- J ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. 1 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'( 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
a�� Y My ��.� a o iq. 75.00 2
ri0i! SfArt ` W TY( Limited energy, mu residential (with above ily ft.)
Services or feeders installatio a n, and/or relocation
200 amps or less , 100.70 2
❑ PROPERTY OWNER I TENANT 201 amps to 400 amps 133.56 2
Name: /� /� / ff � 401 amps to 600 amps 200.34 2
f'1 Pa >t l 4'YI i ' 601 amps to 1,000 amps 301.04 2
Address: Z Z 3 Z S uJ H(C12ry 1 Over 1,000 amps or volts 552.26 2
p i ts Temporary services or feeders installation, alteration, and/or
City/State/ZIP: TI: nrd r Ott 97223 relocation
Phone: ( 503 ) 7 / 8.. 13 7 3 Fax: (503) 7 l9 0333 zoo 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 401 amps to 599 amps t 68.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits —new, alteratiopre ' 4tension, 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
Business name: 11 pcx La, i__ B se or o fnch circuits
i 56.18 2
D thout
Contact name: - � L branch circuit Aruba T� II ' hro Each add'( branch circuit 7.42 2
Address: 2 232 S t tJ GAn�ke p Miscellaneous (service or feeder not included)
Each manufactured or modular
Ci 67.84 2
hr / State/ZIP: Tivoi r og 9T2 ZS dwelling, service and/or feeder
Phone: ( 3 03 ) 71 ` 2 z Fax :: (S43 ) 7 16- 0 333 Reconnect only 67.84 2
Z 3 Pump or irrigation circle 67.84 2
E - mail: d}6o k4•t 0 Ni1c ( . rc,rvl Sign or outline lighting 67.84 2
cn 1 l I Q CONTRAAC Signal circuit(s) or limited - energy
-
Business name: � ^ . E lt:efn G LL G panel, alteration, or extension. Page 2 2
r /�� Each additional inspection over allowable in any of the above
Address: ! �¢� 1 �� CT^,_. Additional inspection (I hr min) 66.25/ hr
City/ State/ZIP: 11-4 /f Va,(S OIZ rocf9 Investigation (l hr min) 66.25/ hr-
/!/� / �p Industrial plant (1 hr min) 78.18/ hr
Phone: (,j 3) 337 ... 37 3r0 Fax: (J 3) CO — 28! / 7 inspections for which no fee is
Np0
��//���� specifically listed ('V2 hr min) 90.00 / hr
CCB Lic.: 7,5 8 Electrical Lic.: C/8 uprv. Lic.: f0 q¢ S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: V�� o Subtotal: 404-k 92-- (�� , t Plan review (25 /o of permit fee):
AI
Print name: h ag Set, f Date: G8 (v State surcharge (12% of permit fee): 44 g.S - 9
Authorized si ature: TOTAL PERMIT FEE: Ind th g
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
N umber of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.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:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ 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
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
❑ Instrumentation
El Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\Building\Pe mits\ELC- PermitApp.doc 07/01/10