Permit CITY OF TIGARD ELECTRICAL PERMIT
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F COMMUNITY DEVELOPMENT Permit #: ELC2013 00033
T [ G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/16/2013
Parcel: 2S102DA00401
Jurisdiction: Tigard
Site address: 13125 SW HALL BLVD PERMITS
Project: City of Tigard Subdivision: BARNUM PARK Lot: 9
Project Description: (2) branch circuits for remodel permit center office
Contractor: MOUNTAIN F ENTERPRISES INC Owner: TIGARD, CITY OF
25973 S MOEHNKE LN 13125 SW HALL
BEAVERCREEK, OR 97004 TIGARD, OR 97223
PHONE: 503 - 313 -0761 PHONE:
FAX: 503 - 632 -5521
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 01/16/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/16/2013 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
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Total $71.23
Required Items and Reports (Conditions)
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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 0 ' :52 -001 ' 090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
�{ I
Issued By: �f • L - Permittee Signature: O,' A/PL_ CA- /�`
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.
01/15/2013 09:48 503 - 632 -5521 ALAN FITCH ELECTRIC PAGE 02/02
Electrical Permit Application RFEEW i i.1 , ,, ,... i ';, ; \ L . , .
1,10, City of Tigard ,I ( /f(1) / 3 '—/— Perm;trb�/ 3-000 33
13125 SW Fall liivd„ Tigard, OR 97 a" 223 JAN 1 5 :p Review '�'"
Phone: 503,639.4171 Fax: 503.598,1960 Date/B': Other Pe nivc3U P c ) f - 000/3
.. = ; .. i Inspectii0n Line: 503.639.4175 i l z : R."4/Sy: heir Et see pupa for
Internet: www.tigard -or , thod. stipyaemeatat rezormatton
•... : ... :
:::.. t :rA .�: ...
. -o-u, a ‘':,:r.-:I .1._.�a Vii,.. ti ..a
I.[.1�INGD ,,.. y
El New coushvetion RrAddition/alteratlon/mplaccmerot Please Cluck all that apply (submit 1 seta of glens wlitemscherked below):
['Service or foeder 400 amps or moss O 19uiiding over doe* stories.
in Demolition 0 Other: where the •ao t)able Ann citrate ❑ Merinat and boatyards.
.i ' i 4., . (O 4 J exocede 10,000 enfpg at 150 ells or ❑ 8 bmililmgs
" ' , Imq to g ow4 or exceeds 14,000 0 Commercial-use agricultural
Q 1- and 2- family dwelling 'Commercial/industrial 0 Accessory building amps for all other installations. buildings-
0 Multi- family 0 Master builder 0 Other: D Piis Pump. I7 Insaalladon of 75 KVA or
� ,. , .0.***** syatero• larger separately derived system.
... �` A'1(5( • , ;•:.'r: -- ::, � f]AdditiDnoraewtnatorMadof G} "A ", °E', "1 -2 ", " -3',
Job no,: 1 Job site address: \';∎25 �,a�LSw 1 or atom Cy'
SW t [] Sisk or mote residential writs 0 occupan Recreational vehicle pada,
City/State/ZIP: - * „e_ `. DE "t '7iZzj 0 kleanh -care facilities. 0 supply voltage for moan than
3 ST C. l C.P . ° Servi Hazardous or 60 P 600 molts tigpfigal,
Suite/bldg./apt QD•: (! 1st Cl'L ItArrre: C v ❑ 5erviae or reeds 600 am or rose.
. g n",: ..' i!.. i-. . >:, : fi bp; n'it ' t . " ...a l G.Y: : ? F . dil_ £° i7(j: H " •j;,C k
.'
Cross streeVdirectious to job site: lsaytp l Q s, tee. Ti T
New residential single- or multi - family dwelling unit.
includes attached garage. _
Subdivision: I Lot no.: 1.000 sq. ft or less 168.54 4
Tax map/pxrecl no.: Ea. add'i 500 sq. ft. or portion 33.92 1
Limited energy, residential
;.;£ ; ;.r �y . .� ....i. ` , ; . 67.84 2
".. . . :. _ .. : - ., , '!,FI•1 ,`f '.: 4 ,;. J; i - ,,. , :. .1 , : v, ? (with above 2 ft) - ,
n Limited energy, amulti•family 67,84 2
* 1' +-) V,Y.AsinNG. LI rt-t I'T% . — PcD 1TI cr3 KL._ reaWeatial � h above ant• a)
C� • Services or feeders i stailation, alteration a relocatio
l.n1R 200 amps or less 100.70 2
,U :*bit) ! ' a," ii '.. . . Q:.1l ti('':.: :.'; :' __ 201 s w 400 atslps 133.56 2
. . , F. .- _ .
Name: 401 amps to 600 amps 20034 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, lad /or
relocation -
Phone: ( ) I Fax: ( ) 200 amps Or less 5936 I
Owner installation: This installation is being made on property that I 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 16&54 2
Branch cireuite - new, alteration, or extension, , r panel
Owner signature: Date:
A. Poe for branch circuits with
. a5 . 1CAI'i' : ` "o above sorvieo or tbeder foe, 2
' eachbralc circuit
Business name: B. Fee for braxb circuits '
Contact name: without service or feeder fee, j 5638 P.1 F7 2
- first branch Citcitit
Address: Each edd'I branch circuit I 7.42 i' .e.1-7... 2
Miscellaneous (service or feeder not included) _
City /State/ZIP: Each mamufaclured or modular
dw service and/or feeder 67.84 2
Phone: ( .) Fax: : ( ) Reconnect only - 67.84 -
E- mail: Pump or irrigation circle 67,84 2
,,.;,- ;' ' :...; : 'x ' _ 6784 2
Sign or outline
Business name: IMIA f �±fS. "wJC _ 1 A .�1 C signet cirouit(s) or limited-
energy pmtel, mttrratlott, or - '
Address: 2.9311-." , 4Y1D tSk1E• et. extension. Describe: Pa5c 2 2
City /State/ZIP: 4, J,V - 1, ,Y,,,, C>k (=II-m. 4 Eaeb additional inspection over allowable in any of the above
Phon d 1\ l;aX: (Sp,3) (. z- tS' -� Per inspection 6625
Investigation per bona for min) 66
CCI Lie.: \t� q Z, Electrical Lie.: 3-2,,11. Supry. Lk.: 51:24 S Industrial . la - st . hour 78. ,
2/ � 1 3 * E ✓� iw '// Suprv, Electric n s required: Subtoml: ' LA.
Print mime; 4\L' F G .�.I C I Der: \ -) ] \ Plan revisor {Z5% of fie):
Authorized signature: A State nut rge (12% of permit bee): . (0'5
-� , _ A-At.•." TOTAL PERMIT FEE: A 1 . 2-5
Inds parole apply eduo expires if a permit Is am obtained within 180
Print name: Date: days alit it was bass accepted as eoeaptete.
' )lumber of impaction allowed per pmreit.
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