Permit CITY OF TIGARD ELECTRICAL PERMIT
e COMMUNITY DEVELOPMENT Permit #: ELC2013 -00408
Date Issued: /2013
07/18
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 7 900
Jurisdiction: Tigard
Site address: 14058 SW MILTON CT
Project: Transcat Subdivision: BONITA INDUSTRIAL PARK Lot: 7
Project Description: (2) branch circuits for new outlets.
Contractor: A & J ELECTRIC Owner: GOODHEAD, DAVID D & JAN M
PO BOX 330 9846 SW PEPPERTREE LN
FOREST GROVE, OR 97116 TIGARD, OR 97224
PHONE: 503 - 359 -5891 PHONE:
FAX: 503 - 359 -1981
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 07/18/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/18/2013 $7.63
Type of Use: COM Electrical
Class of Work: ALT •
Type of Const:
Occupancy Grp:
Total $71.23
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 0 R 9 - 001 -0090. 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: Permittee Signature: t141
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 603.639.4176 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.
Jul 18 13 11 :22a A &J Electric 5033591981 p.2
Electrical Permit Application RFE RE C E IVE D
FOR OFFICE. USE ONLY
- City of Tigard Received
o E3125 SW' Hall Blvd., Tigard OR 97223
IN m , 1 S L 7 8 '1
Da tear. 7 //f 0,3 4i r Permit No5(0 3 Y
Phone: 503.718 2439 Fax: 503.598.1960 il 13 . Plan Review
U JUL `
Date/By: Other Permit:
T 1 G A R D Inspection Line: 503.639.4175 TIGARD Date Ncady /By: 4 I
Internet: www.tigazd or.gov CI I �, o � in , 165 See Page 2 for I
LHHr1 DIVISION (�f Supplemental Intormedon J f
TYPE OF W PLAN REVIEW
❑ New construction ® Addition /alteration/replacement Please chock all that apply (submit 2 sets of plaits wl tems checked below): i
❑ Service feeder 400 amps or more ❑ 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 building.
El 1 - and 2- family dwelling ® Commerciallindusiria] ❑ Accessory building i less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ Multi-family ❑ Master builder ry g amps for all other installations buildings. Other: ❑ Fire pump. ❑ Installation of 150 KVA or
❑ Et°e�0 "c" system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION
['Addition of new rooter load of ❑ "A" "E ", "Ia ^, "1 - 3"
Job no.: 13074 Job site address: 14058 sW NAItct t M 14T ]00He°rmos . occupancy.
C
ij
❑ six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard, OR 97224 ❑ Health - care facilities 0 Supply voltage for more than
❑Hazardous locations. 600 volts nominaL
Su itc/bldg./apt. no.: I Project name: r/j T ,JS C,9...7-- C,9...7-- ❑ Service or feeder G00 amps or more.
Cross street /directions to job site: � FEE SCHEDULE .
Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: - I Lot no.: 1,000 sq. fl. or less 168.54 4
Tax map /pane! no.: Ea. add'l500 sq. ft. or portion 33.92 I
Limited energy. residential '
DESCRIPTION OF WORK (with above sq. ft.) 75.60 2
Add Outlets - Limited energy, multi - family
residential (with above sq. ft.) 75 ' 2
Renewable Ener , ❑ See Page 2
Services or feeders installation, alteration, and/or relocation
❑ PROPERTY OWNER , ® TENANT 200 amps or less 100.70 ' 2
Name: Transeat 201 amps to 400 amps 133.56 2
! 401 amps to 600 amps 20034 2
Address: Same 601 amps to 1,000 amps 301.04 2
City /State /ZIP: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
Phone: ( ) I F ax: ( ) relocation
Owner installation: This installation is being made on property that I own which is not 200 amps or I I i9 36 l
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 201 amps 10400 amp t 25.08 2
Owner signature: 401 amps to 599 amps 168.54 2
Date: Branch circuits —new, alteration, or extension, i r panel
❑ APPLICANT I 0 CONTACT PERSON A. Fee for branch circuits with
above service or feeder fee,
Business name: each branch circuit 7.42 2
B. Fee for branch circuits without
Contact name: service or feeder fee, fi rst 1
56.18 56 2
Address: branch circuit
Each add'l branch circuit 1 7,42 7.42 2
City; State /ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular
Phone: ( ) I Fax: : ( ) dwelling, service and /or fader 67.84 2
E-mail: Reconnect only 6784 2
Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84
Business name: A &J Electric
Signal circuit(s) or limited- energy S
Address: PO Box 330 panel• alteration. or extension. Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP: State. /LLP: Forest Grove, OR 97116 Additional inspection (1 hr min) 66.25/ hr
Investigation (I hr min) 6625/ hr
/ Phone: (503) 359 -5891 ; Fax: ) 389 _ Industrial plant (1 hr min) 78.18/ hr
(// CCB Lic.: 959 7 inspections for which no fee is
I Electrical Lie.: 34 Suprv. Lic.: 57965 90.00 /hr
specifically listed (Vs hr min)
Suprv. Electrician signature, required: 0`1/43 ELECTRICAL PERMIT FEES
! ..' ° Subtotal: 63.60
Print name: Jesse Peterson I Date: 7/18/2013 Plan review (25% of permit fee):
Authorized signature:
State surcharge (12% of permit fee):
TOTAL PERMIT FEE: 71.23
Print name: a Date: This permit application expires if a permit is not ubta bled within ISO
days after it bas be® accepted as compete.
" Number of inspections allowed per permit.
L DoildLg1P mit$P.LC_PenuitApp ELR_EREdoe Rev O5212313 4'0- 4615T(11/05 /COMNPEf