Permit CITY OF TIGARD ELECTRICAL PERMIT
)11 Permit#: ELC2013-00685
COMMUNITY DEVELOPMENT Date Issued: /2013
11/14
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 11 14/2013 801
Jurisdiction: Tigard
Slte address: 12615 SW 72ND AVE
Project: Lowe's Subdivision: BEVELAND NO.2 Lot: 18-19,P
Project Description: (1)branch circuit to reset front end of racking for display.
Contractor: BERGELECTRIC CORP Owner: TIGARD-TUALATIN SCHOOL
13650 NE WHITAKER WAY DISTRICT 23J
PORTLAND, OR 97230 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE:
PHONE: 503-255-1818
FAX: 503-255-1919
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 11/14/2013 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 11/14/2013 $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 OA' CU-0190 You may obtain a copy of the rules or direct questions to OUNC by calling 503.2232.19�87jorr1 1�.800.33322�.2344. ,, /
• /V 47 /-U C �/ 7O'V
Issued By: L/G� '^ Permittee Signature: d
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.
EEIV
4�
Electrical Permit Application - • FOR OFFICE USE ONLY .
City of Tigard Datc/Bea /� 7 Permit N '219/3-49 6,
tt NOV 1 2 2013 i �0.
- ° 13125 S W Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/Bv. Other Permit:
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: iuris I El See Page 2 for
Internet: www.tigard-or.eov BUILDING DIVISION Notified/Method: Supplemental Information
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
❑ 1-and 2-family dwelling 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 "I-2 "I-3",
Job no.:f♦/.{,ZSq-,2c, Job site address: 1 2.101 S I Six or or more. occupancy.
Q e� [�N� I iVti ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: —ft (- 14. � ❑Health-care facilities. 0 Supply voltage for more than
J J) I ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:Levou cif T 1 hpp# ` ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:
J Description I Qn• I Fee. I Total I "
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1.000 sq.ft.or less 168.54 4
Ea.add]500 sq.ft.or portion 33 92 1
Tax map/parcel no.: Limited energy.residential
2
DESCRIPTION OF WORK (with above sq.ft.) 75.00
Limited energy.multi-family
75.00 3 L KQT - --�b - �
Fine_ D i.p > residential(with above sq.ft.)
�� n �`,�� (! / Services or feeders installation,alteration,and/or relocation
/-7f C4 200 amps or less 100.70 2
DK PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: � 'S 401 amps to 600 amps 200.34 2
Com , .P-At...N1 601 amps to 1.000 amps 301.04 2
Address: I Zyrp 1AWE 5 1 )LV fl Over 1.000 amps or volts 552.26 2
U i uz, ',lc, 7 C` L-4-
Temporary services or feeders installation,alteration,and/or
City/State/ZIP: O
relocation
Phone: (104)'+S — L 0-0-0 I Fax:( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation:This installation is being made on property that I own which is not
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
El APPLICANT above service or feeder fee.
❑ CONTACT PERSON 7.42 2
each branch circuit
Business name:Bergelectric Corp B.Fee for branch circuits without
service or feeder fee.first i 56.18 S(.0.(O
{�\1. W1055 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: 13650 NE Whitaker Way Miscellaneous(service or feeder not included)
City/Statc/ZIP:Portland Oregon 97230 Each manufactured rr feeler 67.84 2
dwelline.service and/d/or feeder
Phone: (503)255-1818 Fax: :(503)255-1919 Reconnect only 67.84 2
E-mail: $PAULSEA) Pump or irrigation circle 67.84 2
® {��Ac.c 0 1 t Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s)or limited-energy
Business name:Bergelectric Corp panel.alteration.or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 13650 NE Whitaker Way Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Portland Oregon 97230 Investigation(1 hr min) 66.25/hr
Industrial plant(1 hr min) 78.18/hr
Phone:(503)255-1818 Fax:(503)255-1919 Inspections for which no fee is 90.00/hr
specifically listed(/hr min)
0/C CB Lie.: 1105211 c I Electrical Lie.: 37-682C
Sup .Lie.: 5485S 55 ELECTRICAL PERMIT FEES
Su rv.Electrician signature, Subtotal: 0(� -
p g e,required: Plan review(25%of permit fee): (o, 34
Print name: v_ .-N Tt u Date: ////13 3 State surcharge(12%of permit fee):
Authorized si na -..4 TOTAL PERMIT FEE: (p'2 u 9 Z ✓
t a. This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: - •- .■ Date: it/11) 12 • Number of inspections allowed per pennit.
I:\Building\reimits\ELC-PenniiApp.doc 07/01/10 440-46155TI II/05/COM/\EB