Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00684
r Rp 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/05/2012
Parcel: 2 S 101 AA04900
Jurisdiction: Tigard
Site address: 12300 SW 69TH AVE
Project: Corliss Subdivision: WEST PORTLAND HEIGHTS Lot: 9 -14
Project Description: (1) branch circuit for upgrading existing lamps and ballasts, light fixtures & add occupancy sensor control in office
Contractor: E C COMPANY Owner: CORLISS - LLC
PO BOX 10286 • PO BOX 23970
PORTLAND, OR 97296 TIGARD, OR 97281
PHONE: 503 - 224 -3511 PHONE:
FAX: 503 - 295 -3012
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 12/05/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/05/2012 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 /• 001 -00•0, You may obtain a
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copy of the rules or direct questions to OUNC by calling 503.232.1987 or Q 1.8800.332 2. .23 g 44. `l
Issued By: � - - Permittee Signature: O \ , r 4-464 / ! 0 AlJ
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:
r.`
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.
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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.
Dec, 5. 2012 . 8:32AM „ No. 1795 P. 1
�I
. Electrical Permit Application DEC 0 5 201 r(Ill ()N1,1
City of Tigard Received '
✓ s Da te/B _ Permit No.: G Le-�l, .. j1 , t
. ° 13125 SW Hall Blvd.. Tigard, OR 97223 CITY OF TIG • 1 . . ,
Phone: 503.639.4171 Fax: 503.598.19 I _, r Other Permit:
Ins ion $03.639,4175 ILDING con Sec Page 2 for
Yll ;Altl> p 1.te Y
Internet: www.tigard- or.gov NatiifedMethod: E Supplemental Information
TYPE OP WORK PLAN REVIEW
0 New Construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets of plans whims checked below);
❑ Senice or lbed 400 amps or more L7 Building over duce stories.
D Demolition ❑ Other: %hero the available fault crnrenl
❑ Marinas and baa[yetds.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
less to ground. or exceeds 14,000 ❑ Commercial -use ogricullural
Q I - and 2-family dwelling Eg Commercial/industrial ❑ Accessory building amps for all mho buildings,
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. O Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emerg�ysysien' larger separately derived system.
❑ Addition of new motor load of ❑ "A ",`E', "1.2" ^I -3" •
J°1) n°'' Job site ad dress: 12300 S W 69th Ave IootlPoe occupan`y.
lo
74723 -07I I] Six or more residential units. ❑ Recreatioeal vehicle parks.
Cit)'/State/7IP: Tigard, OR ❑ Health-cam Malin. ❑ Supply voltage for more than
• ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt.no.: Project name: Corliss Office ❑Service or feeder 600 amps ce more.
FEE SCHEDULE
Cross street/directions to job site: Deirr 140 I Fee. I Twat I
New residential single or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. O. or less _ 169.54 14
Ea. add'I 500 sq. ft or portion 33.92 1
lox map /parcel no.:
Limited energy, residential
DESCRIPTION OF WORK (with above sq. f.) 75 2
Limited energy, multi- family
Upgrade existinjamps and ballasts_ light residential (witb above sq. ft) 75.00 _ 2
Services or feeders ins tnllanon, alteration, and/or relocation
fixtures & add occupancy sensor controls in offices 200ampsorlrs ' 100.70 2
PROPERTY OWNER I ❑ TENANT 201 amps to 400 mnps 133.56 2_
Name:
401 amps to 600 amps 200.34 2
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
201 amps to 400 amps 125.09 2
Owner installation: This installation is being made on property That 1 own which is not 401 amps to 599 amps 166.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 70I.
Branch circuits — new alteration, or extension, ter panel
Owner signature; Date: A. Fee for branch circuits with
® APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: EC Company B. Fee for branch circuits w•ithara
service or feeder the, first 1 56,19 56 . 18 2
Contact name: Kath Kelle — _ branohcircuit
Each add branch circuit 7.42 2
Address: PO Box 10286 Miscellaneous (service or feeder not Included)
Cit /State/ZIP: Each manufhctured or modular
Y Portland, OR 97296 dwelling, service and/or feeder 67.84 2
' Phone: ( 50 3) 22 4- 3 511 I Fax:: (5 03 ) 2 9 5- 3 012 Reconnect only 67.84 2
Pump or irrigation circle 67,94 2
&nna l: lea thyk @e , C - CO . C Om Sign or outline lighting 67.84 2
CONTRACTOR Signal circuits) or limited -energy
Business name: EC Company panel, alteration, err oxtonsion. - Page 2 2 •
Each additional Inspection over al - able in any of t above
• Address: PO Box 10286 — Additional inspection (I hr min) 6625/ to - I
City /State/ZIP: Portland, OR 97296 I n du s t r i ation(l hr hr min) 66.25/ hr
Industrialpladi(1hrmin) 78.18/hr
Phone: (5 0 3) 22 4 - 3 511 I Fax: (5 0 3) 295-3012 Inspections for which no fee is 90,00 / hr
specifically listed (�Vv hr min)
CCB Lie.: 49737 I Electrical • - 6- 4 5 I Suprv. Lie.: ELECTRICAL PERMIT FEES —
Suprv. Electrician signature, required: t u 3 , 5 - Subtotal: 56.16
Plan review (25% of permit fee):
Print name: Ron Co f an Dale: 12 / 5 / 2 012 State surcharge (12% of permit fee): 6.74
Authorized signatu
li ,�i, TOTAL PERMIT FEE 62,92
r . This permit ap9Ileattoa expires ifa permit is nor Obtained within 180
W w days after It has been accepted as complete.
Print na Le l , Grayum Date: 12/5/2012 • Number of inspections allowed
per pemciL
' • 1:∎ 8tuildicq' Prmir3'5LC- FeneitAppdoc /10 440- 46137(11(05 1COFbWCf