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Permit
n CITY OF TIGARD ELECTRICAL PERMIT I ' COMMUNITY DEVELOPMENT Permit #: ELC2013 00133 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/25/2013 Parcel: 2S112AD00501 Jurisdiction: Tigard Site address: 14600 SW 72ND AVE Project: Rogers Machinery Subdivision: BONITA GARDENS Lot: 4 Project Description: (1) 200 amps of less to replace main breaker Contractor: TEAM ELECTRIC Owner: UNION CENTRAL LIFE 9400 SE CLACKAMAS RD. TREASURY SERVICES CLACKAMAS, OR 97015 ATTN: DIANE THOMAS PO BOX 888 CINCINNATI, OH 45240 PHONE: 503 - 557 -7180 PHONE: FAX: 503 - 557 -8201 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 02/25/2013 $100.70 Specifics: amps or less 1 ea 12% State Surcharge - 02/25/2013 $12.08 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $112.78 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 •r• 001 -009*. You may obtain a cop of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. �y Issued By: / / _ Permittee Signature: ©k1 04-0 �4 I I O 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. 02-22 14:26 ;Team Electric ;503.557.8201 # 1/ 3 RECEIVE Electrical Permit Application FOR 014l( E I SI: O\1.1 City of Tigard FEB 2 5 2013 Daft Received o'L aS fl sr PermitNo.: Ce_e_ 6)/ 3 - 33 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review I Phone: 503.718.2439 Fax: 503.598.196(CITY OF TIGAR Dal : • Other Permit: ' ° ° lntemec� tigard or gov 503.639.4175 BUILDING DNISI t I ti e S pp a n mi iu %rmaana • TYPE OF WORK 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 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. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ I - and 2- family dwelling IS 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", "1 -2 ", "1 -3 ", Job no.: 6540 I Job site address: 14600 SW 72nd Six 10011P or more. m�cr• ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: 97224 ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: I Project name: Rogers Machinery ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Bonita Description I Qty. I Fee. 1 Total I • 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'l 500 sq. ft or portion 33.92 1 Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi- family 75.00 2 Replace Main Breaker residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 1 100.70 100.70 2 ❑ PROPERTY OWNER I ❑ 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 Temporary services or feeders installation, alteration, and /or City/State/ZIP: relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 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 168.54 2 Branch circuits— new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT I ❑ 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'l branch circuit 1 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: ( ) I 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: Team Electric panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: 9400 SE Clackamas Rd Additional inspection (1 hr min) 66.25/ hr — City/ State/ZIP: Clackamas Or 97015 Investigation (1 hr min) 66.25/ hr Industrial plant (I hr min) 78.18/ hr Phone: (503) 557 - 7180 I Fax: (503) 557 - 8201 Inspections for which no fee is 90.00 / hr specifically listed ('h hr min) CCB Lic.: 173043 (k \k� Electrical Lic.: 3 -225C Suprv. Lic.: 4416S ELECTRICAL PERMIT FEES Subtotal: 100.70 Suprv. Electrician signature, required:7 .-----„, Plan review (25 %of permit fee): Print name: Michael Trusheim Date: 2/22/13 State surcharge (12% of permit fee): 12.08 TOTAL PERMIT FEE: 112.78 Authorized signature. y This permit application expires if a permit is not obtained within 180 Print name: Michael Trusheim Date: 2/22/13 days after has been accepted as complete. • Number of allowed allowed per permit. ; 02-22 ;Team Electric 503.55 8201 # 2/ 3 . . . " • ,e,, Request to Energize an Electrical Installation ,,, ::.: : - ..i, ..)::; l'urisdibtion address: '....,,„::.. :., • Name of supervising electrician: Michael Trusheim Date of request: 2 /22/ 13 Supervising electrician's license number: 4416S Date installation was completed: 2 p2/ 13 Electrical permit no.: Applying If a temporary permit is posted at the job site, please include a copy of it with this form. i Name of electiical contractor: Team Electric Company License no.: 3-225C Business address: 9400 SE Clackamas Rd City: Clackamas St z 97015 Phone: 503='557-718/0 Faxs03-557 8201 E-mail: dougw@teamelectricco . com 1 iZqfi'lt-1- 0l `i T. il'i- r74 7 ,7 7 Z WA.:IA* il.i&i. :::#:;:4K Z.k 't.?,...:::Pivig Customer's name: Rogers Machinery Customer's address: 14600 SW 72nd 1 City: Tigard state:OR rp Address of installation if different than customer's address: City: State: ZIP: 4 7' - "i . "..'"•" -r i , l',''.. 11137 7 -6- l' 7 6F7 -. ' - '?" 67 7:'''T' 7 T 51. ‘" : ,;:142:-%;'. - P....iivii.: , . '''-':'. i;.;.f.,. . Authority having jurisdiction to inspect: City of Tigard Phone: 503-63-9-4171 Address: 13125 SW Hall City: Tigard State: Or ZIP: 97223 •••:',...: 'i'?,,!.:t . '• :4, ',"7' : • ,.. 1 1 Name of electric utility receiving request PGE Phone: 503 5450 Address: 7800 SW Mohawk St City: Tualatin State: Or ZIP: 97062 . . 1 SYMk:iii:EVONTEMESIONEWLEZal=i1r=1 A. Restoring electrical service that was interrupted or disconnected because of either a: 0 Service change or gi Uncontrollable event, such as fire, flood; or severe weather; 1 1 B. Electrical service at a remote location needs to be: 0 Initialized 0 Restored :?.:-'1.s.: 'iriEgaTEMEMEME.a21. Supervising electrician Electrical contractor Please note — After sending this form to the electric Please note —By close of business on the first business utility named above, you must send a copy of this form to: day, following energizing of a completed installation in (1) the electrical contractor, (2) the customer, and (3) the response to the above request you must: (1) notify the inspecting autho • . authority having jurisdiction that the installation has been 9n energized, and (2) request that the authority inspect the 2.12-2-/ t I completed installation. SwervIsing electrician s signature Date v, 0 440-0948-COM (9/OB/COM Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 14600 SW 72ND AVE, TIGARD, OR, 97224 Commercial - Electrical 199 Electrical final 02/26/2013 00:00 ELC2013-00133 PASS - No C of O Violation Summary: Inspector Contractor