Permit u CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00063
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/29/2013
Parcel: 1 S136CD01001
Jurisdiction: Tigard
Site address: 11747 SW PACIFIC HWY
Project: Chevron /Cain Petroleum Subdivision: 2006 -016 PARTITION PLAT Lot: 3
Project Description: (1) branch circuit to replace leaking submersible turbine pump. No break out seal off.
Contractor: BOYLES ELECTRIC INC Owner: CAIN PETROLEUM INC
PO BOX 1227 BY CAIN, RON
BORING, OR 97009 4512 SW KELLY
PORTLAND, OR 97239
PHONE: 503 - 663 -2628 PHONE:
FAX: 503 - 663 -9048
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 01/28/2013 $56.18
Specifics: Service or Feeder
1 ea Plan Review Electricial 01/28/2013 $14.05
Type of Use: COM 1 ea 12% State Surcharge - 01/28/2013 $6.74
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $76.97
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 accor ce 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. ATTE ON: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0 0 through OAR 9 01- 09�` may obtain a copy of the rules or direct questions to OUNC by calling 50 32.1987 or 1.800.332.2344.
Issu By: k, C C�I�z 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.
Electrical Permit Applica ' i' n � D FOR OFFICE USE ONLY
City of Tigard I ll ¢1 Rrved / peit N 646467
Plate/By: a� �I rm o.:
III
13125 SW Hall Blvd., Tigard, OR 97223
N Plan Review
C Phone: 503.718.2439 Fax: 503.598.1;:4 2013 Date/By: /�y �.e r _ Other Permit
Inspection Line: 503.639
l i G:� R D Date Ready/By( 9/ , Juris: H See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGA" 1 Notified/Method: �/� / " Supplemental Information
TYPE OF -PLAN REV7ER'
❑ 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.
El 1 - and 2 - family dwelling ommercial/industrial less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE 1NI ORMATION AND LOCATION - ❑ Emergency system. larger separately derived system.
_ _ _ - _ - . _ _ - .. _ . _ . El Addition of new motor load of ❑ "A ", "E" "1 -2" "1 -3"
Job no.: Job site address: nil"? I00HP or more. occupancy.
e I � c 11 ' ( C i s ❑Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: /GA � -1 G ��� / ❑ Health -care facilities. ID Supply voltage for more than
0 _1 &Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: i ✓ Project name:
CA4. ❑ Service or feeder 600 amps or more
A� �CrI"R -O L.tw� FEE SCHEDULE . • Cross street/directions to job site: 1 k'1 Description l Qty. l Fee. Total I •
I T New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: i 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.: I Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
R e pL44, - L e At le Ai g Sftib pi-en s`.oto 74,440,00 residential (with above sq. ft.)
`` '' I n Services or feeders installation, alteration, and/or relocation
� (� ;1hJ �{, ^ N,o {� G� Cl S&es Q /l F - 200 amps or less 100.70 r 2
PROPERTtl OWNER I' ' ❑ . TEN 201 amps to 400 amps 133.56 2
Name: CA el P-t ^_
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 1 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: Tliis 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: I Date: A. Fee for branch circuits with
❑ APPL . :. I = Q CONTACT PERSON _ above service or feeder fee,
each branch circuit 7.42 2
..
Business name: I B. Fee for branch circuits without /
service or feeder fee, first / S � 2
Contact name: I branch circuit 56.18
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
i - CONTRACTORi ' _ ' . Signal circuit(s) or limited- energy
Business name: `i O I y L s s L L- r r ` panel, a ddit i o n, na l or inspection extension. Page 2 2
Each addit inspection over allowable in any of the above
Address: P d 6 a - t A 5...1 Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: • odc e �• as Investigation (1 hr min) 66.25/ hr
j3 p � 1 �j
Industrial plant (1 hr min) 78.18/ hr
Phone: Lc*) to 63 - d4 2-S Fax: (0) 663_ 7 d 4 d Inspections for which no fee is
specifically .00 / hr
ecifically listed ('A hr min)
CCB Lic.: X3,00 2 Electrical Lic.: 3_ tt (,g c Suprv. Lic.: 3 Lays .. .- ELECTRICAL: PERMTI` FEES
J Subtotal: S6i
Suprv. Electrician signature, required: Plan review (25% of permit fee): / OS
Print name: ,,; g 11,‘5 Le) Date: / , as _ 1 3 State surcharge (12% of permit fee): Z
/ TOTAL PERMIT FEE:
Authorized signature:
This permit application expires if a permit is not obtaiterwithin 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I: \ Building \Pennits\ELC- PennitApp.doc 07/01/10 440.4615T(11/05/COM/WEB
v • • • • S • • • • • • • • •
BOYLES ELECTRI O1 YN
John Boyles Office: 503- 663 -2628 Fax: 503 - 6639048 PP BOX 1227 ,,,
Electrical Contractor ccB #137002 .. •:• • T3 rihh i9700P
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CITY OFF / TIG / ARD
Approved ..eaCT7:.Sfc.L [ ]
Conditionally Approved [ ]
See Letter to: Follow [ ]
Attached [ ]
Permit Number: 6 - "EW
Address: A. • 7
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By: Date: EMI
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OFFICE COPY
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