Permit (3) CITY OF TIGARD ELECTRICAL PERMIT
Per
i COMMUNITY DEVELOPMENT Permit#: ELC2014-00530
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/17/2014
T[C;A R L) 9 Parcel: 1 S 136DA02400
Jurisdiction: Tigard
Site address: 11123 SW 68TH PKWY
Project: 68th Non-Accessory Parking Lot Subdivision: WAY LEE Lot: 1
Project Description: (1)service and(1)branch circuit for a non-accessory parking lot.
Contractor: THE POWER WORKS Owner: WAY W LEE GENERAL CONTRACTOR INC
4233 SE 182ND#202 5210 SE 26TH ST
GRESHAM, OR 97030 PORTLAND, OR 97202
PHONE: 503-310-9745 PHONE:
FAX: 503-622-6612
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 09/17/2014 $100.70
Specifics:, amps or less
1 crt Branch Circuits w/Purchase 09/17/2014 $7.42
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 09/17/2014 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
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 ar set forth in OAR
952-001-0010 through OA 952-001-0090. You may obtain a c•• • - • ect questions to OUNC by calling 503.232.1987 orn1.8800.332.234
Issued By •: mittee 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.
1 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 1112 OF'FI(f I `F.O\LI
City of Tigard ,� Received
II • tY g nale/B - i� Eli
13125 SW Hall Blvd.,Tigard,OR 972 ^ ��� _
p1 ( 2 Plan Review ems'
* Phone: 503.718.2439 Fax: 503.598.1960 StA Date/B_y; Other Permit: Tph (3-( 0 3.t
Inspection Line: 503.639.4175 1( e, Date Ready/By: kris: a See Page 2 for
TIGARD \\1J�'"'
Internet www.tigard-or.gov CAI testified/Method: 9wrpleae-W Iafortnatioe
•TYPE a ,y PLi4■ REVIEW
El construction ®Addition/alteration/ !eminent Please check all That apply(submit 2 sets of plans w/items checked below):
❑Other: ❑Vice or feeder 400 amps or more ❑Building over three stories.
Demolition❑ where the available fault current 0 Marinas and boatyards
CATEGORY:i( � TRUCTION 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 ®Colmlercial/industrial ❑Accessory building amps for all other installations, buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑installation of 150 KVA or
❑Emergency system. larger separately derived system.
,10B'iiTE:;114FORMATION AND 1. ,t ,- -+ac ,�,_. ❑Addition of new motor load of ❑ A' F '1.2^°t_3°
Job no.: Job site address: (( [ Q(y1 100HP or more occupancy.
1' [(1 J (0 O ' ?(.1.02.6a-2, ❑six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: 1 `/to f/ 09_ �y 22. ❑Health-care facilities. ❑Supply 00 o voltage for more than
`.'t3l L' F� 1 otaG✓ ❑Hazardous locations. 600 molts nominal.
Suite/bldg./apt_no.: Project name: ❑Service or feeder 600 amps or more
Cross street/directions to job site: Descriptive i Q7..SCHEDULE
J E
i Fee. 1 TM/ I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.R or less 168.54 4
Ea.add'I 500 sq.It or portion 1 33.92 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
\ e.t/) 3 - `C e v(ct residential(with above sq ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
DiPERTY OWNER ❑ 'TENANT 200 amps or less _, 100.70 InDnD 2
201 amps to 400 amps 133.56 2
Name:
401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) 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.
Owner signature: 401 amps to 599 amps 168.54 2
Sire: Date: Branch circuits—new,alteration,or extension,_per panel
`' t :1 A.Fee for branch circuits with•'IC111VT =° above service or feeder fee,
Business name: each branch circuit \ 7.42 ,t-t?• 2
B.Fee for branch circuits withmu
Contact name: service or feeder fee,first 56.18 2
branch circuit
Address: Each add'i branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not Included)
Each manufactured or modular 67.84 2
Phone: dwelling,service and/or feeder
( ) Fax::( ) Reconnect only 67.84 2
E-mail:
Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:The Power Works Signal circuits)or limiter energy See
Address:4233 SE 182nd Ave, 202 EEaach alteration, 1OR Page 2 2
e, inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Gresham,OR 97030 Investigation(1 hr min) 6625/hr
•Phone:(503)310-9745 Fax:(503)622-6612 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lie.: 184278 "Electrical Lie.: C444 Suprv. hr
.Lie.: 5389S specifically fisted('h hr min)
£i.ECIgAL,PERMIT FEES
Suprv.Electrician signature,required:
—. ,Q�
— Subtotal:
—
Print name: Eric C.Martin Date: 5/30/13 Plan review(25%of permit fee):
State surcharge(12%of permit fee):_ \a,q,11-
Authorized signature: TOTAL PERMIT FEE: `a,w flcf
Print name: Date: This permit application expires if a permit is act obtained within 180
days after it has been accepted as complete.
0 Number of inspections allowed per permit
l:1Auildineerrnits1ELC PermitApp_ELR_ERE doe Rev 05/21/2013 440-4615T(11/05/COM/WEB