Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00706
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/13/2012
Parcel: 2S 102AA00490
Jurisdiction: Tigard
Site address: 12085 SW HALL BLVD 120
Project: Arellano's Market Subdivision: TIGARD HIGHWAY TRACTS Lot: 13
Project Description: (7) branch circuits to change lighting, change hood,(3) installation of food refrigeration units
Contractor: OREGON ELECTRICAL REMODELS Owner: ARELLANO, OMAR
8047 SE 134TH DR 12085 SW HALL #120
PORTLAND, OR 97236 TIGARD, OR 97223
PHONE: 503-810-1240 PHONE. 971 - 645 -6825
FAX
FEES
Quantity Description Date Amount
7 crt Branch Circuits wo /Purchase 12/13/2012 $100.70
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/13/2012 $12 08
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112 78
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 Notrfication Center Those rules are set forth in OAR
952- 001 -0010 through OAR 5 -001-009 You may obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issued By: iC (,( f Perm ittee Signature: _eYY!o-v—
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 503.639.4175 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.
BOPZO 1 L-0c a43
Electrical Permit Application RECEV FOR OFFICE USE ONLY
City of Tigard Received eceived / _ i/ lid" No . � �
a) 1,,, _ DO_?O
° 13125 SW Hall Blvd., Tigard, OR 97223 DEC 1 3 20 elan eiv Review e �j/
0 : Phone: 503.718 2439 Fax: 503.598.1960 Date/B Other Pennit15u pai, I - 00 4 ,) t f.3
T I G A R D Inspection Line' 503 639.4175 CITY OF TIG • . 6 -te Ready/By Juris Vi See Page 2 for
Internet: www.tigard- or.gov �� 1 1 v' �� led/Method. / 02 Supplemental Information
YPE OF WORK BUILDING DIV1
PLAN REVIEW
❑ New construction Addition/alteration/replacement
Please check 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 exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building amps for all other installations buildings
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately denved system
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
100HP or more occupancy
Job no.: Job site address: I 'L S S W 14 a t1 g tU .
_ ❑ Six or more residential units ❑ Recreational vehicle parks.
City/State /ZIP: ` l ry (^ if Q 93- 223 ❑ Health -care facilities ❑ Supply voltage for more than
J o ❑Hazardous locations 600 volts nominal.
Suite/bldg. /apt. no.: i Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq ft or less 168.54 4
Ea add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq ft ) 75.00 2
l � Limited energy, multi - family
•
C (1 T In ) CIA 401 ` 11 g-- k 0J ' , residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
i V\ S4 - a. 1 'CO_ c e er I ekkk 1 .2v∎ °W�t S l 3 ) j j ) 3 200 amps or less 100 70 2
❑ PROPERTY OWIIR ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200 34 2
Name:
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: ( ) Fax: ( ) 200 amps or less 59 36 1
201 amps to 400 amps 125 08 2
Owner installation: This installation is being made on property that I own which is not
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 ❑ CONTACT PERSON above service or feeder fee 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without I
service or feeder fee, first 56 18 2
Contact name: branch circuit
Each add'I branch circuit W 7.42 2
Address: Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 67 84 2
dwelling, service and/or feeder
Phone: ( ) 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- energy
panel, alteration, or extension Page 2 2
Business name ° 1Ze(rpp,1 CLECTIRACA(, aMCDELA
Each additional inspection over allowable in any of the above
Address: F P. Q o X. 26 13 Additional inspection (I hr min) 66 25/ hr
Investigation (1 hr min) 66 25/ hr
City/State /ZIP: C(a.cliG yee p,s 2 9 S Industrial plant (1 hr mm) 7818/hr
Phone: (6a3) 81 t 2 -4 0 Fax: ( ) Inspections for which no fee is 90 00/ hr
specifically listed (/z hr min)
CCB Lic.: I 5 I S i '3 Electrical Lic.: C6 i$ Suprv. Lic.: 5543. S' ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 1 ,4 Subtotal.
Plan review (25% of permit fee):
Print name: z H , &� r SS ate: I Z, — — I L State surcharge (12% of permit fee):
TOTAL PERMIT FEE: I ON _ /3
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Date: i days after it has been accepted as complete.
Number of inspections allowed per permit
I \ Budding \Permits\ELC- PermitApp doc 07/01/10 440- 4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - 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 $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
Fl 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
1 \Bmldmg\Permrts\ELC- PermuApp doc 07/01/10