Permit CITY OF TIGARD ELECTRICAL PERMIT
!s COMMUNITY DEVELOPMENT Permit #: ELC2012 -00560
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/26/2012
Parcel: 2S 102AA03000
Jurisdiction: Tigard
Site address: 8740 SW SCOFFINS ST
Project: Cosale Office Subdivision: TIGARD HIGHWAY TRACTS Lot: 24
Project Description: (10) branch circuits for TI
Contractor: SQUARE 1 ELECTRIC INC Owner: LANSING, ROB
10117 SE SUNNYSIDE RD., STE. F -216 17237 KELOK RD
CLACKAMAS, OR 97015 LAKE OSWEGO, OR 97034
PHONE: 503 - 867 -2423 PHONE: 503 - 544 -4673
FAX: 503 - 914 -0432
FEES
Quantity Description Date Amount
10 crt Branch Circuits wo /Purchase 09/26/2012 $122.96
Specifics: Service or Feeder
1 ea 12% State Surcharge - 09/26/2012 $14.76
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $137.72
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 52- 001 -0090. You may o copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: J 4._tai Permittee Signature: 011.1. • 19 u 1 7 oU✓" / L1
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 503.839.4175 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.
Sep 2512 03:21p Square 1 ELectri 0 7721 r 5038553516 p.2
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Electrical Permit A licatio tU El
FOR OFFICE. 1 `'I_
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City of Tigard SEP 2 5 2012 os k PermitNo.: �, 5'4,
13125 SW Hall Blvd., Tigard, OR 97223 , i � pt a o q . I Q d
t: Phone 503.7182439 Fax: 503.598.1 l l TIGARD Dal :: Other Permit r✓W DU la.- 10,3-1
TI G,1 R D Internet Li n tigard 503.639.4175 5
BUILDING DIVISION' �Fed/Methad: ®See Page 2 for
Supplemental Information
TYPE OF WORK • PLAN REVIEW
❑ New construction XI Addition/alteration/replacement Please cheek 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.
CATEGORY OF CONSTRUCTION ex«eds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family b Master builder ❑ Other: O Fire pimp. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION O Emergency ystem larger separately derived system.
❑ Atldisro new of new motor load of ❑
Job no.: I lob site address: 8.1 y0 S I) S co f' n S to or or more. aera ion
❑ six or mare residential roils O dual vehicle patina.
City/State/ZIP: •'rf j ✓ r ' 0 9 \ 6 1 - 1 2-2--- ❑ Health-care facilities. 0 Supply voltage for more than
❑ Hazardous tantalum. 600 volts nominal.
Suitc/bldgJapt. no.: Project name: O Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Derlipttna 1 Qty. 1 Fee. F Total I •
New residential single- or multi - family dwelling unit
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. IL or less 168.54 4
Ea. add' 1 500 sq. R or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK ( with above sq. ft.)
Limited enervv, multi - family 75.00 2
residential (with above sq. R)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
ta PROPERTY OWNER I. ❑ TENANT 201 amps m400amps 133.56 2
n n ,," 1.1).„1, 401 amps w600 amps 200.34 2
Name:
C1 (.4 601 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:
Phone: (5b3 ) '1 3 4 • act 10 Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that ] own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
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,
each 7.42 2
ch brands circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first I 56.18 G 2
Contact name: branch circuit /� 5 (o- I a
Each add'l branch circuit (9 I 7.42 1p(p -1 g 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP:
Each manufactured or modular 67.84 2
ty 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.cncrgy '
panel, alteration, ore tension. Page 2 2
Business name:
S G ( , ( �E„„re, e L ► �tl C. Each additional inspection over allowable in any of the above
Address: 1 O I ( Tom'^ 5udy1 I, Side Rd ATE F - zj (d Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Q /� Investigation (1 hr min) 66.25/
el(� '�< �'1'lt. 5 l OR "I 0 I S Industrial plant (I hr min) 78.18 /hr
Phone: (503) J - 2_412 3 I Fax: ( 5D 3 ) GI 1 4 - Q 32, inspections for which no fee is 9Q.00/ hr
�} specifically listed (:S hr min)
CCB Lic.: `q 5 (Dqq Electrical Lic : C. a 2 (o Suprv. Lie.: 5375 ELECTRICAL PERMIT FEES
Subtotal: 1.2..1. . q
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: l.1 1 R+ ?R l- ' — Date: q I .2_5- 1 2 State surcharge (12% of permit fee): 1 LA . - 1 (A
TOTAL PERMIT FEE: 1 31 .1
Authorized signature: ' This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • mamba of inspections allowed per permit
t:lBuitdinglFermits\ELGPermitAl p.doc 07/01/10 440- 4615T(11105/COM/WEB