Permit CITY OF TIGARD ELECTRICAL PERMIT
Ie COMMUNITY DEVELOPMENT Permit #: ELC2009 -00168
Date Issued: 04/17/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S102BA00303
Jurisdiction: Tigard
Site address: 9806 SW TIGARD ST
• Subdivision: Lot: 0
Project: Barrier
Project Description: Install (2) branch circuits to reconnect rooftop gaspack.
Owner: FEES
ANDREWS MANAGEMENT LTD & Quantity Description Date Amount
TIGARD INDUSTRIAL LLC, 5805 JEAN RD 2 crt Branch Circuits 04 /17/2009 $53.50
LAKE OSWEGO, OR 97035 wo /Purchase Service or
PHONE:
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 through OAR 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 1� j)SnaknO XA / Permittee Signature: 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.
Call 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.
Electrical Permit Applicati EC �I FOR OFFICEa SE ONLY
N D Received •
City of Tigard 16.0 -
• ,. `, ` , N
f "t 13125 SW Hall Blvd., Tigard, OR 9722, P R 1 6 2009 Date./Date./13 e '
0 Phone: 503.639.4171 Fax: 503.598.1 60 Plan Review Other Permit:
IThtrJBv
TI A E. D
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: luris el See Page 2 for
Internet www.tigard- or,gov ((���� Notified/Method: T l �' Supplemental Information
TYPE OF � DIVISION PLAN kEVIEW
Ptunse check at that apply (submit sets of plans eidexns clucked below):
❑ New construction A .Addnion/alteration/replacement
❑ Demolition Other: El Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault currant ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
Commereial/mdustrial less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling
` ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pomp. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION
ID Emergency system. larger separately derived system.
❑ Addition of pew motor load of ❑ "A ", "E , "1.2 ", °1 -
Job no.: Job site address: { WL 5,1 ( 3T IOOHP or more. oe�y.
❑ Six or more residential units. ❑ Recrecre vehicle parks.
City /State/ZIP: ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:
Description I Qty. I rte. I Thiel I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R or less . 145.15 4 .
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. 0.)
n � ,�� �" n /� Limited energy, multi-family ) 75 00 2
ELOfi ! lJ P � CY � - residential with above ft.) t
Services or feeders installation. alteration, and/or relocation
200 amps or less 80.30 2
• PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: N9C- .- c r P 401 amps 10 600 amps 160.60 2.
Address:
1� 601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts 454.65 2
City / State/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 to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 1
Business name: each branch circuit 6.65 �r (� - 2
B. Fee for branch circuits t, r QQ,,�
Contact name: without service or feeder fee, 1 46.85 — 1 b 't/1 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: f dwelling. service and /or feeder 90.90 2
( ) 1 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: ppo Ck -- E Signal circuit(s) or limited -
^ r energy panel, alteration, or
Address: (j) Ll , V 3 r L l b� extension. Describe: Page 2 2
City / State/ZIP: t ,Y{-1 i `L J A , V ,t1 Q --7�%h Each additional inspection over allowable in any of the above
Phone: (c"� {) ✓ 51 7 3 b s Fax: ( g ) 3 4.t� �7 / V 1 Per inspection 62.50
OC, l 3`71 Investigation perhour(t hr min) 62.50
CCB Lie.: Ill - Electrical Lic.: S —' j L Suprv. Lie.: 5107- 5 Industrial plant per hour 73.75
Suprv. Electrician Signa required: ELECTRICAL PERMIT FEES
Subtotal: . 3, x-5
Print name: , t���/ Date: Plan review (25% of permit fee):
` !� [ State surcharge (12% of permit fee):
Authorized Signature: TOTAL PERMIT FEE: 51 r 1Z
Print name: I Date: This permit application expires if n permit is not obtained within 180
days after it has been accepted as complete.
l: laudldinePermitslEt .C Permitgpp.doe oi?3/06
• Number of inspections allowed per permit.
940 4 6151'(11IO5ICOauwEB
Z 617£199Z£09 oiTOelB lmonO aid db17:80 60 Sl -Idy