Permit 'V ' �
CITY OF TIGARD ELECTRICAL PERMIT
`'1 I ' . . COMMUNITY DEVELOPMENT Permit #: ELC2012 00677
TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/28/2012
Parcel: 2S 102AD03450
Jurisdiction: Tigard
Site address: 8777 SW BURNHAM ST
Project: City of Tigard Subdivision: TIGARD HIGHWAY TRACTS Lot: 18 & 20
Project Description: Installation of car charger, (1) service and (4) branch circuits.
Contractor: JARMER ELECTRIC INC Owner: TIGARD, CITY OF
5105 SW 45TH AVE #200 13125 SW HALL BLVD
PORTLAND, OR 97221 TIGARD, OR 97223
PHONE: 503 - 246 -5381 PHONE:
FAX: 503 - 244 -8037
FEES
Quantity Description Date Amount
• 1 ea Services or Feeders - 200 ' 11/28/2012 $100.70
Specifics: amps or less
4 crt Branch Circuits w /Purchase . 11/28/2012 $29.68
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 11/28/2012 $15.65
Electrical
Type of Const:
Occupancy Grp:
Total $146.03
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 ordance wi - pproved 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. AT NTION: Oregon I. re. ' -s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001- 10 through OAR 95 11 1 ' You may obtain copy of the rules or direct questions to OUNC by callin. • 13.232.1987 or 1.800.332.2344. •
Issue y: 1 Permittee Signature: �! /' 1_ ��0
— - 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' . - ./ ` i 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.
11/28/2012 16:27 5032448037 JARMERELECTRIC PAGE 01
Electrical Permit Application RECEIVE '' a t I oj l tt I 1 -I I r\l
City of Tigard Q l df „ ,
13125 S W Hall Blvd., Tigard, OR 97223 NOV 2 8 2 012 Phan envies
P hone: 50 3.718.2439 Fa 503.598.1960 OF TIG • p gy: Otaor tlrnnk:
Inspection line: 503.639.4175 CITY Of 1 Ill a I pat° :4).' ' a Ssa Page 2 ror
laternet www tigard-ur gov a otlfiodlMotbed: Supplemental rdores duet
.1 Ill. Ii II,1 g7;:":111: � L 1 rf z7A' R 7Y �- ' ... r ) h ! - .. :,' r . - :; ` .r if. ''U r , l( .;]IR 1l c� , {� J fir': x r . , tl r M f1 k ti., ` r ,.":;g.',, c t . „ . ;r ry r y. ' l r, . :, 7 :.. lr 4 ,5"---; , { '-. r : , , /, "
.
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❑ New construction tt4 Addition/alteration/replacement Please chock all that apply (submit Z sets ofpuna wlftems checked b :
❑ Demolition p�� ❑ Service or feeder 400 amps or more ❑ Building ever throe stories.
where the available auk cum= ❑ Marinas and boatyardD.
7 , . ! e .rSrv1 .`,:%'),,-:'-'4'11,01..:* N r
r p ' Yr< ,4 ,;, ∎ w y 1 ` t r t ( , 't � ' r i^ exceeds 10 r 0o0 eats et l50 volts Or ❑ Floating buildings
s. �. *.' ti. o..hek rJ. _r� te , ' t.:1. -' ' : t . ,.. F ?� r,.•vfic. { Y. r w • ,u l -1 r0 or agricultural
El 1- and 2- family dwelling t ComrnercialMdustrial E] Accessory building am ❑ Corom rcial- 13eagricu
rY �$ aatps !hr all other matallatloaa. but7diaga.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Pine pump. El installation of 75 KVA or
7 1> I r_ r; `JO a „, :;.' - ' 1, '''',. , ' ,.. > I ''''''',.'' r .'' r.' �? 1 r� k S r x i y cy system. latter separatety derived sysmm.
t
ii.', .0 .r ., y e. ' 11V., ..,r, < J m» .rFou mr,w,„ 4, qr . , d ..-,r ,; : ,. � ,, � ",, ,,. i :,ThPtl,r. , ash o i-,..!:1.;.::,' Li �aa
❑ Addition of new motor load of ❑ .. "E... "1-2”. "1 -3", .
AA
Job no.: Job site address: ` 1 P • t 100HP or more.
❑ Six or more residential s occ
its. ❑ iteaendeosl vehicle parks.
Ciry/5tate/ZIP: 0 Health-tae 8cli ❑ Supply Nonage far more than
t1'1'�� I ❑ liaasdom koadbns. 600 wits mmIi aL
Suite/bldg. /apt. no.: Project name: ill Li di ,i - ., • t O Service or iheder 600 or more
Cross street/directions to job site: i a a„ ,.,, ; e,, , ..,,,
Yee. Total " •
New residential tingle- or multl- family dwelling unit.
Inelndes attached garagt-
Subdivision: 1 Lot no.; 1,000 sq. IL ar lass I 168.54 , 4
T { ax map/parcel no.: Be. add'l 500 sq. ft. orgwtiam 33.92 1 energy, residential
f ` t, 5 , � ,,� 7 t , I,r i ./ fi V'i' -�-.Po Vl, '. r t m Oq I L) 75.00 2
h ,ii ..,,a.s,... e.Pb M .,,, .,,. iaa,u ,.,..t . t,.9 Y. / K : ,(. t m. t _
.. , .;. , : , : „>„ .. :., Limited
.�� . reefda (with above e 8.) 75.00 z
- ... Services or feeders fmutallatlon anion, and/o
200 amps or lass % 10030 1 r 2
, N';' ,
.":',:,:i.' . . s a \ r 1 l > : t ,,..: i . tix 1.n t x ; r ,' i 201 amps to 400 amps 133.56 2
,. :�: '.,. K e, u. r. .. „..,,;w,J ,, ., : . . t , a.;, .,.ti „,.'..:.:.':'.,,,S,',,,.",=,':;!!"::':, . t i t r
Name: 401 amps to 600 amps 20034 _ 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 55226 2
City/State/ZIP: ��� services or feeders installation, alteration, and/or
Phone: ( ) , Fax: ( ) - 200 amps or 1® 59.36, 1
Owner installation: The installation is being made on property that I own which is not 201 tags to 400 amps 123.03 z
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 z
Branch circuits — new, alteratioR, or extension, r panel
Owner signanue Date A. Fee for broach circuits with
7 • ' 1 ■ f \ I v. • , , r ‘-'''':'''''.:;(-,''':;11.'5-1 above service or theta fee )-) 742 1 ¢ 5 2
.rti. ,..'�a]".” „io - „, ,K... ,.4:,:, .7l.,. �;
` , : :',: ,,, a,1„r:ki , : :;.,.1x..i.-. :.ter !.t., „.e .Y:a.,'„”
..s.
.... , ',If. .., ouch bmor3a circuit 1
Business name: B. Fee Or branch circuits w(dw1Q
eervloe or Seder fee, first 36.18 2
Contact name: breach theme
Each add'I branch circuit 7A2 2
Address: Miscellaneous (service or feeder not included)
Each mami8sctued or modulo 67.84 2
City /State/ZIP: dwelling. service mayor Seder
Phone: ( ) I Fax : ( )
ltecomsoct only 67.84 2
Pump or Irrigation circle 67.84 2
E-mail: t ( t r e $ or outline 67,84 2
, ' v, , .i! {. .... t ,"'C'',.'
,, %,` � r, � j .` . i , +.aw _ � , 4 t1[ fie .41 Cyvwga)CR lhnitad-em
Business name: , j / c-� ,4 6 ' 4 � € 2 �, , L A ' ► per, alteration, l i speed 4 I Page 2 2
G- Bach additional Inspectlon over allowable In any of the above
Address: "'" 49, .r( z. irG- Additional mepeadon (1 hr min) 66.25/1a
City/State/ZIP: r. 7 �
Investigation (I 1st a ado) 6625/ hr 1
City/State/ZIP: r 1 i ", r�Y. i 0 4. 7 T' c industrial plant (1 hr min) 78.18/ hr
Phone: (34 i ) L + , G " .i ./ 1 Fax: (,f e) rl — %'& Inspections fir which co fbe is . 90.00/ hr
,/ pry . 7 x listed hr
CCU Lie.:. '1 2 1 Electrical Lie.: p4. /*/4re Su. Lic.: 5/Cs r/ � _ v :... 1 ' ..; ; ... 3 . _ `', I
Subtotal: ,., 'Wi 0
Suprv. Electrician signature, required: Plan review (25% of ... fee): r
� x , per: 1 • 0....
State surcharge (12 o permit fee):
Print name: 714 `7-c� % 1 /at ref 4 v ! MIT 4 . •
Authorized si TOTAL PERFEEubtai
: This perms appulatiee expires ira permit b not witida 190 i , /
Print name: Date: days after It Wu bees accepted u complete �/
• Number of inspections allowed per permit.
B 07A1/10 eao4e1Sr(l aros/COmewita