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Permit (46) CITY OF TIGARD ELECTRICAL PERMIT 14. COMMUNITY DEVELOPMENT Permit#: ELC2016-00623 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/09/2016 Parcel: 2S 102 BD02000 Jurisdiction: Tigard Site address: 12885 SW PACIFIC HWY Project: Texaco Subdivision: NORTH TIGARDVILLE ADDITION Lot: 38 Project Description: (4)branch circuits for replacement of 4 fuel dispensers. Contractor: SCOTTCO INC Owner: EARLYOIL LLC PO BOX 92 BY WSCO PETROLEUM#225 BORING, OR 97009 2929 NW 29TH AVE PORTLAND, OR 97210 PHONE: PHONE: 503-729-9544 FAX: 503-618-1752 FEES Quantity Description Date Amount 4 crt Branch Circuits wo/Purchase 08/09/2016 $78.44 Specifics: Service or Feeder 1 ea 12%State Surcharge- 08/09/2016 $9.41 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $87.85 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. ATTENTIO • •regon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are spriciRhn OAR 952-001-0010 t. ough OA' 95 -.41-0090. 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: 1 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. 3/ 5C5 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 R licati City of Tigard IXECE/VY_EI) Received FOR 01-F1(1. l 5F: O\1,1 13125 SW Hall Blvd.,Tigard,OR 97223 Date/BR : C e Permit#: +tl tom`/_�r &X3 Phone: 503.718.2439 Fax: 503.598.1,L,Q 6) Plan Review Ov llJ(.tJ 1.i k u Inspection Line: 503.639.4175 7 Q 1 Q Date/B :III Related permit#: Internet:spetsLine:ga 3.63 .41gov Ready Date/By: Iuris: , Notified/Method: ® See Paget 2l nr Supplemental Information t:. .S: , PLAN REVIEW ❑New construction T. =dditio��rf� r - ` „t". .rj Please check all that apply(submit 2 sets of plans w/items checked): ❑Demolition ❑Other: ❑Service or feeder 400 amps or more CATEGORY OF CONSTRUCTION where the available fault current 0 Marinas and boatuilding over yards.stdories. exceeds 10,000 azes' ❑ 1-and 2-family dwelling 0 Commercial/industrialamps at 150 volts or ❑Floating buildings. 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use ❑Multi-family ❑Master builderamps for all other installations buildings. agricultural JOB;SITE INFORMATION0 Other: ['Fire pump. AND LOCATION 0 Installation a oe l5d KVA or Job#: 0 Emergency system. larger separately derived f i C�Z� Job site address: Z g S 1 0 Addition of new motor load of • system. City/State/ZIP: ^ e ` 100HP or more. ❑ d 1 3>, 7 • 7 Z Z 3 t,tiL ❑Six or more residential units. occupancy. 0 Health-care facilities. 0 Recreational vehicle parks. 0 Supply voltage for more than Suite/bldg./apt #: Project name: 0 Hazardous locations. Cross street/directions to job site: C.,04-) 1.1 ❑Service or feeder 600 amps or more. 600 volts nominal. 4 FEE SCHEDULE meters tion IMII Each Subdivision: SE New residential single-or multi-family dwelling unit Total Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 1111111 168 168.54 DESCRIPTION OF WORK Ea.add'l 500 sq.ft.or portion 1111 33.92 _gi Limited energy,residential III with above •.ft. 75.00 -© ak Limited ,mmIIIresidentialenergywith aboveulti-fa •.ily ft. 75.00 -© Renewable Ene 0See Pale❑ PROPERTY OWNER ❑ TENANT —. Services or feeders installation,alteration,and/or relocation 200 amps or less - 100.70 _© Address: 201 amps to 400 amps 1111 City/State/ZIP: 133.56 _© 401 amps to , am 0 0 11111200.04 =© Phone:( ) 601 amps to 1,000 amps 301.04 Fax:( ) Over 1,000 amps or volts _ 552.26 _© Temporary services or feeders installation,alteration,and/or relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 11111 59.36 _El Owner signature: 201 amps to 400 amps 1111 125.08 _© Date: 401 amps to 599 amps - ❑ APPLICANT 168.54 _© 0 CONTACT PERSON Branch circuits—new,alteration,or extension, 1 r 'and Business name: A.Fee for branch circuits with above service or feeder fee, Contact name: each branch circuit 7.42 ■© Address: B.Fee for branch circuits without service or feeder fee,first1111 lilt! City/State/ZIP: branch circuit 56.18 Each add'1 branch circuit mil 7 42 'r Phone:( ) Miscellaneous service or feeder not included 4's3i� Each manufactured or modular dwellin:,service and/or feeder III 67.84 -© CONTRACTOR Reconnect only 1111 67.84 _© Pump or irrigation circle 111111 67.84 _© Business name: 3,c..0 c.) � Sign or outline lighting 1111 67.84 _© Address: • ,. 2_, Signal circuit(s)or limited-energy • el,alteration,or extension. 0 See Page 2 © City/State/ZIP: * ®� ( d Each additional ins ction over allowable in an of the above Phone:O Additional • S ' inspection(1 hr min) 66,25/hr 1111 Email: _ ' 7 Investigation(1 hr min) - • i . 90.00/hr _■ y yli Industrial plant(1 hr min) - 78.18/hr _■ CCB Lic.: Electrical Lie. Inspections for which no fee is IIISuprv.Lic.: 156S s ificall listed %z hr min 90.00/hr -. Suprv.Electrician signature,required: -, fl" Print name: Subtotal: �j k b Date: v • m 0 Plan Review Required(25%of permit fee): Authorized signature: I State surcharge(12%of permit fee): 111107151111 TOTAL PERMIT FEE: Tres if a Print name. This permit application expires P� permit is not obtained within 180 days after it has been accepted as complete. I:\Building\Permits\ELC_Permitgpp ELR _doc 17/2015 * Number of inspections allowed 440-4615T(11/OS/COM/WEB per permit. Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 12885 SW PACIFIC HWY, TIGARD, OR, 97223 Commercial - Electrical 199 Electrical ﬁnal PASS - No C of O ELC2016-00623 Jeff Grove Violation Summary: Inspector Contractor