Permit a p CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00622
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/30/2012
Parcel: 2S 101 DCO3900
Jurisdiction: Tigard
Site address: 7150 SW SANDBURG ST
Project: Progressive Insurance Subdivision: SALEM FREEWAY SUBDIVISION Lot: 4
Project Description: Build out 1 private office
Contractor: REESE & SON ELECTRICAL INC Owner: PROGRESSIVE CASUALTY
16310 SE RHONE INSURANCE COMPANY
PORTLAND, OR 97236 REAL ESTATE NOTIFICATIONS
PO BOX 89429
CLEVELAND, OH 44101
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 10/30/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/30/2012 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 issuan e, 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 enter. Those rules are set forth in OAR
952- 001 -0010 through OAR - 001 -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 50 32.1987 or 1.800. .234 .
Issued By: �ILaL - L . Permittee Signatu
OWNER INSTALLATION 0
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 Application ::.', i o l2:01 'lCl USE o v, .
City of Tigard Received 16136/12/ Permit No.:04,C.aab• pp(„W"
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 '** Allh-.:
! 1 ?' Date/B . Other Permit: • �1a , 0 0a1
Inspection Line: 503.639.4175 — J ea.. , Date Ready/By: ® See Page 2 for
Internet: www.ei.tigard.or.us Notified/Method: UM Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ddition/alteration/replacement Please check all that apply:
['Service over 225 amps, comm'I ['Hazardous location
❑ Demolition ❑ Other:
['Service over 320 amps -ratio
p rating ❑ Buildng over 10,000 sq. ft., �
CATEGORY OF CONSTRUCTION of I - and 2- family dwellings 4 or more new residential
❑ I - and 2 family dwelling ,Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi family ❑Master builder ❑Other: 0 Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
LL �° �j ❑Health -care facility ['Other:
Job no.: Job site address:
�/J 0 S f WA " �. �/ R.7 5 - Submit 2 sets of plans with any of the above.
City /State/ZIP: 1 ' The above are not applicable to temporary construction service.
///�TTT��,, 5 /Ved Z;45-it �c FEE" SCHEDULE
Suite/bldg. /apt. no.: Project name:
��o5�'�t: neriptioo I Qty. I Fee. I Total ••
Cross street/directions to job site: ✓/� New residential single- or multi - family dwelling unit.
• Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
-A ' � _ J / ) - 3 c '/y dwelling, service and/or feeder 90.90 2
(� f �J /`r 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
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State/ZIP: Temporary services or feeders installation, alteration, and /or
Phone: ( ) I Fax: ( ) relocation
200 amps or less 66.85 1
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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT 1 ❑ CONTACT. PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits •
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'I branch circuit 01 , 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle .53.40 2
Phone: ( ) I Fax: ( ) Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
' . CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2
Business name: (o e �o �S' O K , r ` -�).%G „ ,
Address: /n� �� j � ,� ��o I-/ ,! - / Each additional inspection over allowable in any of the above 2
/6 V Si / 1 / Per inspection 62.50
City /State/ZIP: T 4 a 23 6 Investigation per hour (I hr min) 62.50
O C r I -
) { / (� � .� � f ' ( I Fax � — Industrial plant per hour 73.75
( J 03
Phone: ( ELECTRICAL PERMIT FEES*
CCB Lie. I qg ? Electrical Lic.• W (`1 f
0 4 G S uprv. Lie.: /� / Subtotal •
Suprv. Electr N4re, required:
(d Plan review (25% of permit fee) p r' 9 L �� State surcharge (8% of permit fee)
Print name t A„ ` ( ` es , Date: /9_2 f �
V TOTAL PERMIT FEE -. S -ti,
Authorized signature: This permit application expires if a permit is not obtained ssithin 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Permits\ELC - PermitApp.doc 12/03 440- 4615T(I0 /02/COM/WFB
•
Electrical Permit Application - City of Tigard
Pagel., 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 system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation •
❑ 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 04/03