Permit CITY OF TIGARD ELECTRICAL PERMIT
11 • COMMUNITY DEVELOPMENT Permit#: ELC2013-00586
T WARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/02/2013
Parcel: 2S 102AC00700
Jurisdiction: Tigard
Site address: 12550 SW MAIN ST 110
Project: NW Framing Subdivision: BURNHAM TRACT Lot: 1
Project Description: Electrical for TI: (1)service and(12)branch circuits.
Contractor: REESE&SON ELECTRICAL INC Owner: DOLAN&CO LLC
16310 SE RHONE BY FLORENCE T DOLAN
PORTLAND,OR 97236 4523 NE DAVIS ST
PORTLAND,OR 97213
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 10/02/2013 $100.70
Specifics: amps or less
12 crt Branch Circuits w/Purchase 10/02/2013 $89.04
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 10/02/2013 $22.77
Electrical
Type of Const:
Occupancy Grp:
Total $212.51
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 sus ded for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificatiy' Center. Those r es e set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a co• • .= les or direct questions to OUNC by calling 32.1987 or 1. 0. 2. 34 .
g .t� - 1.
C°°i�-Q
Issued By: `ermt'e= i nature: �S`
OWNER INSTALLATION ON
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 CO � 1 012 OFFICE USE ONLY
Received
City of Tigard ', Datem . IO - Permit No.: L
" 13125 SW Hall Blvd.,Tigard,OR 972 t'` 1'5 Plan Review zit
Phone: 503.639.4171 Fax: 503.598.1960 0 Date/B , Other Permit:A I�/ _ co, 1
T I G A ti D Inspection Line: 503.639.4175 ppppppon Date Ready/By: !aria. RI See Page 2 for
Internet: www.tigard-or.gov l��®� lc)k I " Notified/Method: �(o Supplemental Information
TYPE OF WORiC9 �1�kp., Vv' J PLAN REVIEW • .
t acement Please check all that apply(submit 2 sets of w/items checked below):
❑New construction 0 Addition/alterat
❑Service or 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 buildings.
❑ 1-and 2-family dwelling `g(Commercial/industrial ❑Accessory building
less amps for other a exceeds 1 ns, ❑Comings. -use agricultural
Y g 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",
i or more. occupancy.
Job no.: Job site address:/24122 S�£ /� � I ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: ` ❑Health-care facilities. ❑Supply voltage for more than
��-� ❑Hazardous locations.
600 volts nominal.
Suite/bldg./apt.no.: Project name:Ni �/�/ F-a/4 1 1.4 ❑Service or feeder 600 amps or more.
/' r' ' FEE SCHEDULE
Cross street/directions to job site: Dewlption I Qty. I Fee. I Total I •
New residential single-or multi-family dwelling unit.
Includes attached garage. _
Subdivision: Lot no.: 1,000 sq.ft.or less 145.15 4
Ea.add'I 500 sq.ft.or portion 33.40 1
Tax map/parcel no.: Limited energy,residential 75.00 2
. DESCRIPTION OF WORK .. '- (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Services or feeders installation,alteration,and/or relocation
200 amps or less j 80.30 2
, ❑ PROPERTY OWNER • ,I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
relocation
Phone:( ) Fax:( ) 200 amps or less 66.85 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 133.75 2
Branch circuits—new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with /Z
. '-`,❑ APPLICANT - •- I , . . -❑ CONTACT PERSON - - above service or feeder fee, t
each branch circuit 6.65 2
Business name: B.Fee for branch circuits
• without service or feeder fee,
Contact name: 46.85 2
first branch circuit
Address: Each addi branch circuit 6.65 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling,service and/or feeder 90.90 2
Phone:( ) Fax::( )
Reconnect only • 66.85 2
E-mail: Pump or irrigation circle 53.40 2
•
• • -CONTRACTOR - - Sign or outline lighting 53.40 2
Signal circuit(s)or limited-
Business name: R ee s e eif--c, it/'/ G/:Taco energy panel,alteration,or
Address: /63/O 6', "Q doge S/i extension.Describe: Page 2 2
City/State/ZIP:4 r.1'Lao/�.r q 7�3� Each additional inspection over allowable in any of the above
( rig) '?q_ . 1I/q / Fax:( ) Per inspection 62.50
Phone: !J Investigation per hour(1 hr thin) 62.50
CCB Lic.:'48lf3 Electrical Lic.: .,-606 e. Suprv.Lic./ q 1—S Industrial plant per hour 73.75
ELECTRICAL PERMIT. FEES
Suprv.Electrician signature,required:/- r �` ��� Subtotal:
/ Plan review(25%of permit fee):
Print name:-a ga r i 4'• 7�6 e Dater—go_13
State surcharge(8%of permit fee):
Authorized signature: TOTAL PERMIT FEE: jA Id.S J
Print name: This permit application expires if a permit is not obtained within 180
Date: days after it has been accepted as complete.
• Number of inspections allowed per permit
I:tBuilding\Permits\ELC-PeanitApp.doc 05/23/06 440-4615T(11/05/COM/WrB
Electrical Permit Application - City of Tigard
Page 2- Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: •
Fee for all residential systems combined ... $75.00
Check Type of Work Involved: .
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating,Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY: - =
Fee for each commercial $75.00
system
(SEE OAR 918-260-260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\Building\Permii\ELC-PermiiApp.doc 03123/06
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12550 SW MAIN ST 110, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
2013-12-18 00:00:00
ELC2013-00586
PASS - No C of O
Violation Summary:
Inspector Contractor