Permit CITY OF TIGARD ELECTRICAL PERMIT
4
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00485
T [GA R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/16/2012
Parcel: 2S 102DA00200
Jurisdiction: Tigard
Site address: 8720 SW BURNHAM ST
Project: City of Tigard Subdivision: BARNUM PARK Lot: 9
Project Description: Low voltage and branch circuit for suppression system in Niche.
Contractor: BERGELECTRIC CORP Owner: TIGARD, CITY OF
13650 NE WHITAKER WAY 13125 SW HALL BLVD
PORTLAND, OR 97230 TIGARD, OR 97223
PHONE: 503- 255 -1818 PHONE:
FAX: 503 - 255 -1919
FEES
Quantity Description Date Amount
1 ea Limited Energy 08/16/2012 $75.00
Specifics:
1 crt Branch Circuits wo /Purchase 08/16/2012 $56.18
Service or Feeder
Type of Use: COM 1 ea 12% State Surcharge - 08/16/2012 $15.74
Class of Work: ALT Electrical
Type of Const: VB
Occupancy Grp: B
•
Total $146.92
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 through OAR 952-001-0090. 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: Sk A■erH U R. s Z
•
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.
From: Marylou Derk Fax: (503) 255-1919 Fax: +1 (503) 598-1980 Page 2 of 4 8115/2012 4:44
PU
Electrical Permit A licatio E! 1�( f1/ • FOR OFFICE USE ONLY
City of Tigard AUG 1.5 2012 R N q'(6- >7 Permit No.: a a 1x- 00LisS
i PT
u 13125 SW Hall Blvd., Tigard, OR 97223 n Re
Plan Review
g Pl p , Other Permit:
Phone: 503.718.2439 Fax: 503.598.I Date/By:
T I G ARE) Inspection Line: 503.639.4175 �y VV . 11 �I TT Date Ready /By: flair. HI See Page 2 for
Internet: www.tigard- or.gov
WILDING Notified/Metfiod: Supplemental Information
1 -_
J" '.i'- - i`Ltj rx;:•:. •� _ T .11���-- '::S °„?t z-. Irv.'.
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:_ -.. �5=.', Y '<'te"- .:e:Y`Y:��`:c:�3-;� +.__� �....:. �..: -�.. _S' -µ: - �, w.•. v_4..�^;�;���iv.�e,*-._SJ.��:`5 _��'i ��_if:' = "ry?'�::W.- ^-v, -. , -E+- n- '_ i .� �-
❑ New construction Addition/alteration /replacement Please check all that apply (submit b sets of plans w/rtems checked below):
❑ Service or feeder 400 amps ur mule ❑ Building over dune moults.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
ceeds 10,000 am
{ '-F1 . t nrg: 6 t4_4.`,°_:,." `rd - - - �cV ` -� �^`'�srtI V—' ex ex s at 150 volts or ❑ floa buildings.
- %' -l': __ .-; •••• , : ''•" ' " O Y, ; OF FI Y-- 1O1J= v . -- ' - ' ` "'r:Z ''':. _...e • ;;,�` `. - 6f :.true :ia :�ti, i
-- - �'�` {� l �'' T- (p( "" - �� ' less to ground, or exceeds 14,000 ❑Commercial -use agriculture!
[=I 1- and 2- family dwelling ,`�' CommerciaUindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
'?,( -r <`_^ '�-y w - - .,�, •.r.: _ „ `_r - ; :{_._ : „M�: �; ❑ Emergency system. larger separately derived system.
7tli �"Sli =;1Nkit TIQiV. _A r ` LION= .4 _iY*: : r ''r Addition ofnew mater load of "A” "E" '
ya r ,;..,<. � ra\,,__t. _.�... 10011P or more. occupancy.
` Job no.: � <547 z7 Job site address: 5LO Bl — ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP : -�Z ❑ H azard cu sl facilities. ❑Supplyvoltageformorethan
"1 L ` ❑ 600 volts nominal.
l Hazardous ca
Suite /bldg. /apt. no.: Project name:(' c411-pt 1 _ ncrUl,/iSi • 'CI) ❑ Srrvire nr feeder 6M1 amps nr more mil' -• v
Cross street/directions to job site: Description y . I Fee. 1 Total l^ I
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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no..
_ _ Limited energy, residential 75.00 2
- - ;i ?s > :e > t _ - 2a., -- : �v. " S?f,;, -i , '`�;: 7`' h above sq. ft.)
- - - - 's " = `T��r'F�' ��. �L�t01V'± �t)4M17�3 ._ . -�= ::_ :� x ": �a.._'cax� �s� ±. (wit
Limited energy, multi - family 75.00 2
irr)tnll d -Rice. wppreytnn e ciicl� residential (with above sq.ft,)
0 Services es o feeders installation and /or relocation
200 amps or less 100.70 2
gos <_:- v =`= '=� : .ate - ti `, • , _ - .? � y ra 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name, l' f 1y of /I t a c 1 l 601 amps to 1,000 amps 301.04 2
Address: t 1 j 3) xcs (-1 ) t) fin a! II i2 i t/r; Over 1,000 amps or volts 552.26 2
V Temporary services or feeders installation, alteration, and /or
City/State/ZIP:
1 / JCi ;prl /-,A? 9-7-2...-2) relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59,36 I
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 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. -
Brandt circuits- new, alteration, or extension, per panel
Owner signature: Date: _ A. Fee for branch circuits with
; ' v= ; :�; ;_ :1 ='x;,' .e _K.c ab ove service or feeder fee, .42 2
:__ ` =,KY. _,„'-, :._ .. _ : .,__.a_.,, :_�. A' :�.,. -._�� �_, ; .,�.� - :.. .� �-- - ?( each bran ch circuit 7
Business name: Bergelectric Corp B. Fee for branch circuits wuhour
service or feeder fee, first I 56.18 .5LD .I't) 2
Contact name: //1 i her. ') r i d nvis.. v l branch circuit ,
Each add'I branch circuit 7.42 2
Address: 13650 NE Whitaker Way Miscellaneous (service or feeder not included)
Each City/State/ZIP: Portland Oregon 97230 dwelling, s a or r feeder 67.84 2
y g dwelling, service and/or feeder
Phone: (503) 255 -1818 I Fax: : (503) 255 -1919 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
- L
E -mail: } i_ 11nnJ1e. r (�fcit - , corn Sign or outline lighting 67.84 2
= _ _ "v' . A r,;"!it£ , ter:: = v' _s ; --= -- -`.t -a w %'
'416 : 'a e.le, 1>AP -- SN . :,.� : - _ -s- �7 4' ?-} air or limited �� „, { = - .��i -�. �'� =� `= �= , c� : �= � , . �....... Sig cite s ()
Business name: BergelectriC panel, alteration, or extension. 1 Page 2 15 2
• Each additional inspection over allowable in any of the above
Address: 13650 NE Whitaker Way Additional inspection (I hr min) ' 66.25/ hr
City /Slale/ZIP: Portland Oregon 97230 In du str ial p i n (I hr min) 66.25/ hr
Industrial p lant (1 hr min) 78.18/ hr
Phone: (503) 255 - 1818 I Fax: (503) 255 - 1919 Inspections for which no fee is 90.00 / hr
specifically listed %, hr min)
CCB Lic.: 110521 Electrical Lic.: 37 -682C i Suprv.. J.ic.: 5485S ~'s -A :g 4< tekEr I s '=tai
Suprv. Electrician signature, required: Subtotal: �A . \ tu
J Plan review (25% of pelmil fee):
Print name ( i i / ( p , , Date: fy // /2 State swchatge (12% of pcuuit fee): V .74-
I ► `� ! / TOTAL PERMIT FEE: I, 4- •i( ,,G12
Authorized signature: This permit application espires if a permit is not o rained within 180
f _ �r ��� //// days after it has been accepted as comp
Print name: /V(' 4J • J� idmnn Date: Ail j2 * Number of inspections allowed per permit.
Mudding \Pcmtitn'ELC•PermilApp.doc 07/01 /10 ` 4 440- 4615T(11/05 /COM/WEB
From: Marylou Dark Fax: (503) 255 -1919 To: Fax: +1 (503) 598 -1960 Page 3 of 4 8/15/2012 4:44
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
PICOTWOMAMORMOVAIROMMIAVA
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:
NO . .......004,�+:.. �Q 't?.. -. _Mn`�ih`lvlii;;. g ih;;;t�miiEk-a�.�'> r al
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
N I Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I.\ Building \Permits\ELC- PermitApp.doc 07 /01/10