Permit CITY OF TIGARD ELECTRICAL PERMIT
1 7 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00608
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/24/2012
Parcel: 2S 102DA00401
Jurisdiction: Tigard
Site address: 13125 SW HALL BLVD PD
Project: City of Tigard - Police Department Subdivision: BARNUM PARK Lot: 9
Project Description: Temporary service for modular trailer.
Contractor: ELECTRIC WORKS INC Owner: TIGARD, CITY OF
9122 SE 67TH AVE 13125 SW HALL
PORTLAND, OR 97206 TIGARD, OR 97223
PHONE: 503 - 774 -6444
PHONE: 503 - 639 -4171
FAX: 503 - 775 -6541
FEES
Quantity Description Date Amount
1 ea Temp Services or Feeders - 10/24/2012 $59.36
Specifics: 200 amps or less
1 ea 12% State Surcharge - 10/24/2012 $7.12
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $66.48
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 acc ce wi . .proved 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. ATT ION: Oregon la re• • -s you to follow the rules adopted by the Oregon Utility Notifica •• i Center. Those rules are set forth in OAR
952 -001- 10 through OAR 952 - 001090. ouimay obtain a copy of the rules or direct questions to OUNC by cal;.` .1987 or 1.800.33..2. .2234444,
•
Issue By: a / l Iu _! - • " Permittee Sign ure:
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. 5 ;
Call . .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.
Oct. 24. 2012 12 : 41 PM No. 0519 P. 2
Electrical Permit Applicatio EivED FOR OFFICE USE °NE.l'
Iii City Ci},,, g D of Tigard Date /ates B : Received is ®� Permit No.; &c,?o /A 6d
q
`
13125 SW Hall B ; ' .� 4 lvd., Tigard, OR 9722 Aw Plan Phone: 503.718.2439 Fax: 503.598.1960 c 2 Dates wow
Other Permit' t� ' O��Orq
— OODO
T I e: 1 it T) Inspection Line; 503.639A 175 Date Ready/By: rude: l7 See Page 3 for
Internet: rvww.tigard or.gov CITY OFTIGARD Notiffed/Method: Supplemental Information
TXPE 0 1;1 4 ;411AG DIVISION PLAN REVIEW
El New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plats w/items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories,
❑ Demolition ® Other: Modular unit where the available tault current ❑ Marinas and boatyards.
_ CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
•• - less to ground, edr14;000 rJ -us ag rict'1twat — —
❑ 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ° amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ® Other: Modular unit ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE Iri 1FORIYIATION AND LOCATION El Emergency ayatem. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "B ", "1-2", "1-3",
Job no.: 4388 1 Job site address: 13125 SW Hall Blvd, 100HP ar more. occupancy,
0 Six or more residential units. ['Recreational vehicle parka.
City/State/ZIP: Tigard, OR 97223 ❑Health - care facilities, 0 Suppl voltage for more than
❑ ldamrdaua locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: Tigard Police Department ❑ service or feeder 600 amps or more.
FEE SCHEDULE -
Cross street/directions to job site: DMtrlauoe I Qtr. I Fen I Told I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. R 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
DESCRIPTION OF WORK _Jwith above sq. ft.)
Limited energy, multi - faintly
75.00 2
Temporary feeder for modular unit. residential (with above sq. (t.)
Services or feeders Installation, alteration, and/or relocation
200 amps or less 100.70 2
® PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56, 2
401 amps to 600 amps 200.34 2
Name: Tigard Police Department 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:
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 1 59.36 $59,36 1
Owner installation: This installation is being made on property that I 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, . er 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: B. Fee for branch circuits without
service or feeder fee, Brat
Contact name: branch circuit 56.18 2
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not Included)
City /StatelZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) I Pax: : ( ) 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- energy
Business name: Electric Works Inc, panel, alteration, or extension. Page 2 2
Each additional inspection over allowable In any of the above
Address: 9122 SE 67 Ave. Additional inspection (1 hr this) 66.25/hr
City/State /ZIP: Portland, OR 97206 r Investigation (1 hr min) 66.z5/ hr
78.18/ hr
Industrial plant (1 hr min)
Phone: (503) 774 - 6444 j Fax: (503) 775 -6541 Inspections for which no fee is
specifically listed ('r5 hr min) 90.00/ hr
CCB Lie.: 48251 q'ar ‘ Electrical Lie.: 26 - 484C r il Suprv. Lic.: 5240s I I l '1) ELECTRICAL PERMIT PEES
Suprv. Electrician signature, required: 1 IaI Subtotal: $59.36
1 \�
Plan review (25% of permit fee)
Print name: Jeremy C. Loraas Date: 10 -24 -2012 State surcharge (12% of penult fee): $7.12
TOTAL PERMIT FEE: $66.48
Authorized signature: This permit application expires it a permit Is not obtained Wilbur, 180
days after it has been accepted es complete. M
Print name: Date: • Number of inspections allowed per permit, u
r: tBuild ing\PennitAwLC-PennIlApp.doc 07/01/10 4ao 16lsrp1/os/cosvwEa