Permit . ib
CITY OF TIGARD ELECTRICAL PERMIT
-'' ` C ..`.. COMMUNITY DEVELOPMENT Perm #: ELC2012 -00696
' Date Issued: 12/12/2012
T I GAAD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 parcel: 2S101 DD00101
Jurisdiction: Tigard
Site address: 6975 SW SANDBURG ST 100
Project: AT & T Radio Room Subdivision: 1998 -147 PARTITION PLAT Lot: 2
Project Description: (2) branch circuits to install (2) split systems
, Contractor: BATTERY POWER SYSTEMS INC Owner: WESTON INVESTMENT CO LLC
201 FRONTAGE RD N, SUITE A 2154 NE BROADWAY, STE 200
PACIFIC, WA 98047 PORTLAND, OR 97232
PHONE 360- 355 -6721 PHONE:
FAX
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 12/12/2012 $63 60
Specifics Service or Feeder
1 ea 12 % State Surcharge - 12/12/2012 $7 63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
This per i issue. s• • : to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will
be d• e in accordance with a• • oved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
day- ATTENTION Oregon law ••ire you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
95 - 001 - 0010th gh OAR 952 -001 •1•0. Y may obtain a copy of he rules or direct questions to OUNC by calling 503 232 1987 or 1.800.332 234 va
` i ��� _
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Is . ued By: Permittee Signature: �
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.
;i
Electrical Permit Application FOR OFFICE USE ONLY
Received /2 EL n _/ q _ /_ ?
. City of Tigard Receiv Permit No Ow (O!
I N
a 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review Other Permit M�eaoi� DD(��
Phone 503 718.2439 Fax 503 598 1960 Date /B
T I GA R D Inspection Line 503 639 4175 Date Ready /By fans Ei See Page 2 for
Internet www.tigard - gov Notified /Method Supplemental Information
TYPE OF WORK PLAN REVIEW
El 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
El Demolition El Other: where the available fault current ❑ Mannas 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
El I- and 2- family dwelling gi 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 derived system
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job n0. JOb site address: // Q � y � �/� n y�� IOOHP or more occupancy
2 1P C (� - V U V �`-�T 62 ❑ Six or more residential units ❑ Recreational vehicle parks
City /State /ZIP: T' i G p r , 0 /h R C� �J 2'Z ❑ Health-care facilities ❑ Supply voltage for more than
�J [ c ❑Haza rdodous locations 600 volts nominal
Suite /bldg. /apt. no.: Project name: , . T ' V-4 IQ00 y ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: 72 Y)
7 6 5 4N e Description I Qty. I fee. I Total I "
�✓ ' ` (r New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq ft or less 168 54 4
Tax map /parcel no.: Ea add'I 500 sq ft or portion 33 92 I
Limited energy, residential 75 00 2
DESCRIPTION OF WORK (with above sq. ft )
Limited energy, multi- family 75 00 2
rl - r t- r1 C -- o 2 5 o'L / T S % ! 7t-b 5 residential (with above sq ft )
/� ' ' Services or feeders installation, alteration, and /or relocation
200 amps or less 100 70 2
❑ PROPERTY OWNER ❑ 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
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
y 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 401 amps to 599 amps 168 54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701
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
service or feeder fee, first
( 56 18 2
Contact name: branch circuit
Each add'I 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
Pump or irrigation circle 67 84 2
E - mail:
Sign or outline lighting 67 84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name. 6 pTnerw Pa L) E t ___ " / G r z S'._, s- panel, alteration, or extension Page 2 2
Each additional inspection over allowable in any of the above
Address: 20 r Fr" N "T ( 7 , l J \ ) Additional inspection (I hr min) 66 25/ hr
I , �l 79/)6# # r — � t(J 4 C
Investigation hr mm) 78 28/ hr
City /State /ZIP: C -1 Industrial plant ant (1 hr mm) 78 18/ hr
Phone: c 7 C� ) 3$ —6 ( F � 4 y ) Inspections for which no fee is 90 00/ hr
specifically listed (/1 hr min)
CC�jB� c.: l5 y2 Electrical Lie.: 073 Suprv. Lic. �(e/05 ELECTRICAL PERMIT FEES
S / r J ,/jJ L) /o /s // 5 Subtotal. ("6 1p()
Suprv. Electrician signature, required:
Plan review (25% of permit fee)
Print name: i3/ d fL y • C111._ ( c ' Date: /2 — / a / Z State surcharge (1 of permit fee) 7.6' 5
TOTAL PERMIT FEE ') r . d 3
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name Date: days after it has been accepted as complete.
N umber of inspections allowed per permit
I \Building \ Permits \ELC- PermitApp doc 07/01/10 440- 4615T(1 I /05 /COM/WEB