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Permit CITY OF TIGARD ELECTRICAL PERMIT • COMMUNITY DEVELOPMENT Permit #: ELC2013 -00248 T [GA RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/30/2013 Parcel: 2S102AB05800 Jurisdiction: Tigard Site address: 12345 SW MAIN ST Project: Symposium Coffee Subdivision: 1996 -026 PARTITION PLAT Lot: Project Description: (10) branch circuits and (1) 200 amps or less for TI Contractor: WILLAMETTE ELECTRIC INC Owner: TIGARD AREA CHAMBER OF COMMERCE PO BOX 230547 12345 SW MAIN ST TIGARD, OR 97281 TIGARD, OR 97223 PHONE: 503 - 624 -3631 PHONE: FAX: 503 - 624 -2938 FEES Quantity Description Date Amount 10 crt Branch Circuits w /Purchase 04/30/2013 $74.20 Specifics: Service or Feeder 1 ea 12% State Surcharge - 04/30/2013 $20.99 Type of Use: COM Electrical Class of Work: ALT 1 ea Services or Feeders - 200 04/30/2013 $100.70 amps or less Type of Const: Occupancy Grp: Total $195.89 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 5 -- 00011 -090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ,( Issued By: F Permittee Signature: c . P,e_re4/ /OA 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. 04/30/2013 TUE 10: FAX 5036242938 Willamette Electric Ij002 /002 Electrical Permit ApplicatiaRE �� EJVED FOR Orricl, USE ONLY Received 3;/3 �: City of Tigard 0 13 Date/By: 30 /3 ' PermitNo.: c2.14 Q 13125 SW Hall Blvd., Tigard, OR 9722 PR 3 O 7 Plan Review L. W� �o�, 3 — C.10CXo1� Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: TI GARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: 'y • Sec rage 2 for Internet: www.tigard•or.gov RUILDINfa DIVI ION Notified/Method: S upplemental Information - TOE PE OE;'1VOt0{ Prl R �' ❑ New construction Add ition /alteration /replacement 0 Please check all that apply (submit 2 sots vI of p lans 1 w /items shot ked below): Service or feeder 40 0 amps or more ❑ $wilding over tM ee stories. ❑ Demolition [ - _ - ] Other where the available fault cu ❑Marinas and boatyards. C,tT1 O volts CONSTRUCTION exceeds 0,0000 amps at 150 vo or Floating buildings, . less to ground, or exceeds 14000 0 Commercial-use agricultural ❑ 1- and 2- family dwelling [3 Commercial /industrial ❑ Accessory building amps for all other installations. buildings. a agricu tuna ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. 0 Installation of 75 KVA or i] Emergency system. system, JO S ITE INEOfllt'IA't1O A , OCA , larger separately derived ,. ,. ::., . ; motor load of �.. ❑ Addition of new © ,. A „ I00HP or more, occupancy. Job no.: 13 �5 ? Job site address: • y � `�. 5 ... -, - Yy , 4 /71/4 s 7 0 Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: ', // G % s; K c � 0 9 C' .2`� ^t ❑ Health -cart facilities. ❑ Supply voltage for more than Cit r Y / � ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: c /) < - •. ❑ Service or feeder 600 amps or more. . ,"/ ,r' a e o. ,. C e, r P r' 1k;; •St uditru. Cross street/directions to job site: Dderiptien 1 Q ty. l Fee. Totiil • I " New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. fl. or less 168.54 4 Ea. add'! 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: - Limited energy, residential 'DESCRIPTION OF WORK (with sq. ) 75.00 2 with above s fi, Limited energy, multi- family '� ,, residential (with above sq. ft.) 75.00 2 �' `�''' . / ' 1 � ' '' `'' - - " y ' T Services or feeders installation, alteration, and/or relocation 200 amps or less / 100.70 ,G, e ?.:3 2 ❑ PROPERTY OWNER 1 'ENANT 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 ^ 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 ex tension, r panel Owner signature: Date: A. Fee for branch circuits with above service or feeder fee, /U ~ , 7 4 . APPLICANT - 1 El CONTACT PERSOI\ . .. each branch circuit 2 r 2 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 7.42 2 Address: Miscellaneous (service or feeder not included) _ City/State /ZIP: Each service a d/ nd/o r feedmodular 67.84 2 ece ar feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E -mail: 2 Signor outline lighting 67.84 0N_'ti+_C_.Oia ..: Signal circuit(s) or limited- energy Business name: Willamette Electric Inc. panel, alteration, or extension, Page 2 2 Each additional inspection over allowable in any of the above Address: P.O. Box 230547 Additional inspection (1 hr min) 66.25/ hr City/State /ZIP: Tigard, OR 97281 Investigation (l hr min) 66.25/hr , Industrial plant (I hr min) hr • Phone: (503) 624 - 3631 Fax: (503) 624 - 2938 Inspections for which no fee is 90.00 / hr specifically listed (A he min) CCB Lic.: 75059 l Electrical Lic.: 34-283C .__, Suprv. Lic.: 4226 -S ELE .1.LUCAl PERMIT D '�' :•,:;..!. ' �--- -- Subtotal: / '7 % ?% Suprv. Electrician signature, requi ' Plan review (25% of permit fee): / Print name: David Fife Date: /. (')//-e: State surcharge (12% of permit fee): ,?-' ' --- - TOTAL PERMIT FEE: 1,5 ,5 ---- Authorized signature: This permit application expires if a permit is not obtained within ISO days after it has been accepted as complete. Print name: Date: • Number of inspections allowed per permit. r:l BuildinglPermils 1ELC-PermitApp .doc 07/01/10 440.4615T(i 1105 /COM/WED