Permit CITY OF TIGARD ELECTRICAL PERMIT
.• COMMUNITY DEVELOPMENT Permit#: ELC2013-00525
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/04/2013
Parcel: 1S 136DA00700
Jurisdiction: Tigard
Site address: 11530 SW PACIFIC HWY
Project: Lu's Sports Bar Subdivision: PFAFFLE PLAZA CONDO Lot: 2
Project Description: Relocating(2)exit sign lights.
Contractor: TRINITY ELECTRIC Owner: HI HAT INC
13422 SW 128TH PL 11530 SW PACIFIC HWY
TIGARD,OR 97223 PORTLAND,OR 97223
PHONE: 503-235-6481 PHONE: 503-460-7434
FAX: 503-579-3929
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 09/04/2013 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 09/04/2013 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You 1. •• • : •• of the rules or direct questions to OUNC by calling 503.232.1987 or 1. 0.332.2344.
Issued Bye ��� ��� Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
Electrical-Permit Application FOR OFFICE USE ONLY
City of Tigard Received
• 13125,SW Hall Blvd.,Tigard,OR 97223 Plan Review ��• - ' i/� n I o
'� Phone: 503.718.2439 Fax: 503.598.1 Date/B : Other Permit: C2,1 j ,_ • ( —I,_ 1
Inspection Line: 503.639.4175 �� Date Ready/By: H See Page 2 for
1 I<< K D Internet: www.tigard-or.gov �O Notified/Method Supplemental Information
TYPE OF WORI Q G�S1O� PLAN REVIEW
❑New construction ❑Addition/altcrationit ] ql` Please check all that apply(submit 2 sets of plans w/items checked below):
�11 �' ❑Service or feeder 400 amps or more ❑Building over three stones
❑Demolition xt Other: C-`,`,' where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONST$ ON exceeds 10,000 amps at 150 volts or ❑Floating buildings.
VVVV less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling tSrcommercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 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.: I Job site address: I 2 0 w ra t+t C 1�1�/� 100HP or more.
❑ occupancy.
❑
3 / / Six or more residential amts. Recreational vehicle parks.
City/State/ZIP: J 4-k_ (}K S Z3 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal
Suite/bldg./apt.no.: I Project name: LA. `S i P e of ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 7/ s AV t. _ _ _ Description I Qty. J Fee. •
I Total
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: ' Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
k//�� J Limited energy,multi-family
C C.Lk \ 2--)17-t S( Ct vl L J j t!'fj residential(with above sq.ft.) 75.00 2
Renewable Energy I ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER I ,TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: /k j:, Li.. 401 amps to 600 amps 200.34 2
Address: //1-3., Sw fa c(if c /(t 601 amps to 1,000 amps 301.04 2
City/State/ZIP: Over 1,000 amps or volts 552.26 2
ty 7( V) 1 ZZ3 Temporary services or feeders installation,alteration,and/or
(GGr
Phone:( .5- ) Le- o 7q-,c Fax:( ) relocation
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
Owner signature: Date: _ Branch circuits—new,alteration,or extension,per panel
❑ APPLICANT I ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first
branch circuit / 56.18 4./g 2
Address: Each add'l branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular
Phone:( ) I Fax: :( )
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: '"7.- , / Signal circuit(s)or limited-energy See
�7/� �r/�. _ panel,alteration,or extension. Page 2 2
Address: l3 4 y C, / /� fx p� Each additional inspection over allowable in any of the above
7�/V Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: 7-40,01 O R L�jf-'1 a - Investigation(1 hr min) 66.25/hr
Phone:(,l/)—�3‹= � a/ I Fax:( 3y ,--39.=� /Austria!plant(1 hr min) 78.18/hr
'/�/ / Inspections for which no fee is 90 00/hr
CCB Lic./, n Electrical Lic.��, 3-3 C✓Suprv.Lic. ,Aaas specifically listed(%hr min)
/ ELECTRICAL PERMIT FEES
Suprv.Electric 4t 1/e,required:,( Subtotal: 5(p• (S/
/ /3 Plan review(25%of permit fee):
Print name: � Date:� � /
/'r1 State surcharge(12%of permit fee): _j,79'
Authorized signature: r / TOTAL PERMIT FEE: .q.9"-- ✓
i This permit application expires if a permit is not obtained within 180
Print name: r I Date: ��j �3 a4„e oft..if hoe tom., t...t se emmnta.a
1