Permit U CITY OF TIGARD ELECTRICAL PERMIT
. . a : COMMUNITY DEVELOPMENT Permit #: ELC2013 00025
TIGARD . 13125 S Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/14/2013
W
Parcel: 21
Jurisdiction: Tigard S10 DB00502 : .:::
S ite address: 7545 SW CRESTVIEW ST
Project: Stickel SubdivisionNASBOURNE COMMERCE CENTER NI Lot: PTS 23 -. ,
Project Description:, (1) 200 amps or less and (2) branch circuits for panel change and repair garage wiring
Contractor: WINNER ELECTRIC INC Owner: STICKLER
5950 SW PROSPERITY PK 7545 SW CRESTVIEW ST
TUALATIN,'.OR 97062 TIGARD, OR 97223
PHONE: 503 - 638 -5028 PHONE:
FAX: 503 - 638 -4242
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 01/14/2013 $100.70
Specifics: amps or less
2 crt Branch Circuits w /Purchase 01/14/2013 $14.84
Type of Use: SF Service or Feeder
' Class of Work: ALT 1 ea 12% State Surcharge - 01/14/2013 $13.86
- Electrical
Type of Const:
Occupancy Grp:
Total $129.40
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 952-001-0 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503,, Q 2332..1987orr 1.800.332.23444.
,
Iss By: IA i4 bk.() a Permittee Signature: DAI n PO 80 L(c / LL
/ 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 503.639.4176 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 ApplicationD�rlE D FOR OFFICE USE ONLY
City of Ti and ����11��,, Received _
`' g Date/B . Permit Nom
a013
, C • 13125 SW Hall Blvd., Tigard, OR 97223 i4 1 0 �3
7 Plan Review D/) o �J
Phone: 503.718.2439 Fax: 503.598.196 0 Dat&B Other Permit:
TI G A R D Inspection Line: 503.639.4175 /� Date Ready/By: r See Page 2 for
Internet: www.tigard- or.gov CITYOFTIGARD Notified/Method: (�/ 0 Supplemental Information
E OF n DIVISION 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 mom ❑ Building over three stories.
❑ Demolition 0 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 KVAor
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: CC d �+ t I00HP or more. occupancy.
,J 5 �7� ` P + V \ p 1.7) ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: —Tt m,a 0--> fi n ❑ Health-care facilities.
0 Supply voltage for more than
K 7 2/ ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project nAme: Sk.k L\ ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:
Description 1 Qty. I Fee. l Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
�� Limited energy, multi - family
_ Q residential (with above sq. ft.) 75.00 2
�� Cp ��, \ _ �� Services or feeders installation, alteration, and/or relocation
\ ' \ 200 amps or less ' j 100.70 100 ,' ) 2
❑ PROPERTY O �V . R ❑ TENANT 201 amps to 400 amps 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
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
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 0 CONTACT PERSON above service or feeder fee
each branch circuit 7.42 '/.f �/� 2
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 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: W ` vN\/4 _ C \'e r panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 'S q \ S 0 \ Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP � )e N A._ k_ ( 1 0 b-1---
Investigation (t (1 hr m) 66.25/ hr
1 Industrial plant (1 hr min) 78.18/ hr
Phone: 50 55) ( 3c, _ 502$ Fax: (503) (.051S _ u Q. y a Inspections for which no fee is 90.00 / hr
specifically listed (Az hr min)
CCB Lic.: i y—k Lk Electrical Lic.:-34_ ks 0 c Suprv. Lie.: -aisQ s S ELECTRICAL PERMIT FEES
Su Suprv. Electrician signature, Subtotal:
p gnature, required: � 7 P 5 S y
A 2 �yc�� Plan review (25% of permit fee):
Print name: Date: i a State surcharge (12% of permit fee):
TOTAL PERMIT FEE: 119. ii
Authorized signature:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date:
• Number of inspections allowed per permit.
l:\ Building1Pcnnits \ELC- PctrmitApp.doe 07 /01/10 440-4615T( I I/05/COM/WEB