Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2012 -00700
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Date Issued: 12/12/2012
Parcel: 1S136CD01500
Jurisdiction: Tigard
Site address: 11660 SW PACIFIC HWY
Project: Tigard Bowl Subdivision: 2006 -016 PARTITION PLAT Lot: 3
Project Description: (5) branch circuits
Contractor: OLIVERS PRECISION ELECTRIC COMPANY Owner: POWERS PEARL LLC
17035 SW HIGH HILL LN 11660 SW PACIFIC HWY
BEAVERTON, OR 97007 TIGARD, OR 97223
PHONE: 503 - 579 -7747 PHONE
FAX: 503 - 579 -5907
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo /Purchase 12/12/2012 $85.86
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/12/2012 $10.30
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $96.16
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 - -00 /090 ou may obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issued By: ,r / Permittee Signature: 0A/ ' /��G/P�TZdf�
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.
Dec 11 12 04:26p Diana Oliver RECEIVED 503 579 -5907 p.1
•
Electrical Permit Application FOR OFFICE (sr ONI.
City of Tigard
13125 SW Hall Blvd., Ti DEC 1 1 2012 Received �
DatelBv:
Tigard, OR 9722}� /°t' Permit N ��I� -a / Od
■ Phone: 503.718.2439 Fax 503.5981¢ OF
Dateigv Other Permit.
T 1 Ci A R t, Inspection Line: DIVISION
503.639.4175 BUILDING DIVISIO ga Ready/By: ,�� El See Page 2 for
Internet www.tigard-or.gov Notified/Method: �� Supplemental 1 • • ` ation
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition /alteration /replacement Please check all that apply (submit a sets of plans wirtems check below)-
❑ Demolition ID Other: ❑ Service or feeder 400 amps or more ❑ Building over th - 1 , ones.
where the available fault current ❑ Marinas and ho • ,
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
❑ 1 - and 2 - family dwelling ® Commercial/industrial less to ground, or exceeds 14,000 ❑ Commercial - lase :. :, turat
❑ Accessory building amps for all other installations. batldmgs.
❑ Multi- family ❑ Master builder ❑ Other ['Fire pump
❑ Installation of 75 K A or •
JOB SITE INFORMATION AND LOCATION ❑ "n system. larger separately _ d system.
Q Addition of new motor load of j3 'A ^, °E ^, - 1 - 2 ", "I ; ",
Job no.: I Job site address: 11660 SW Pacific Highway IOOHP or more occupancy.
❑ Six or more residential units. ❑ Recreational vehicl... ks.
City/State/ZIP: Tigard, OR 97223 ❑ Health-care facilities. ❑ Supply voltage for core than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: 77 Cog \ atrivi___ ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: D•serlptloa 10,,, I Fee. I Tai 1 •
■ New residential single- or multi- Ihmily dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. f or less 168.54 t 4
Tax map/parcel no.: l a add' 1 500 sq. R or portion 33.92 '
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq ft.)
Limited energy, mufti - family 75 2
Add circuits residential (with above sq. ft.)
Services or feeders installation. alteration, and/or reloition
200 amps or less 100.70 2
❑ PROPERTY OWNER _ ❑ TENANT 201 amps to 400 amps 133.56 1 2 ,
Name: 401 amps to 600 amps 200 34 t 2
601 amps to 1,000 amps 301.04 h 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders Installation, alteration, indlor
relocation
Phone: I, ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that 1 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
Brandt circuits — new, alteration, or extension, per pa
Owner signature: Date: ' A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 4 7 42 yg 68 2
each branch circuit
Business name: B. Fee for branch circuits without '
service or feeder fee, first 1 l3 *18 2
Contact name: branch circuit
- Each add'l branch circuit 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
E-mail: Pump or irrigation circle 67.84 2
Sign or outline lighting 67 84 2
CONTRACTOR ' Signal circuit(s) or limited- energy
Business name: Oliver's Precision Electric Company Panel alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 17035 SW High 11111 Lane Additional inspection (1 hr min) 6625/ hr
City /State /ZIP: Beaverton, OR 97007 Investigation (1 hr rein) 66.2 / hr
Industrial plant (1 hr min) 7818/ hr
Pho : (503) 579.-7747 I Fax: (503) 579 -5907 Inspections for which no fee is 90.001 hr
specifically Listed (Y2 hr min)
CCB Lic.: 186112 3I3d Electrical Lic.: 34-5 r/ I Suprv. Lic.: 25395 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: IJ � ./ /0 /� / Subtotal: 85 36
� 'l "� Plan review (25% of permit foe):
Print name: Wm. Oliver Date: 12/11/12 State surcharge (12% ofpermit fee): 104,0
h
Authorized signature:
TOTAL PERMIT FEE: 96..16 1/
This permit application expire, if a permit is sot obtained wifja IN
Print name: I Date: days after It has been accepted as complete. �� t / I n
• Number of inspections allowed per permit, t /�
11 :∎BmidhaglPamrtMEl.C- Perm aApp.doc 07101/10 440-4615TO1005/cOM WEB