Permit (4) CITY OF TIGARD ELECTRICAL PERMIT
.11111 o COMMUNITY DEVELOPMENT Permit #: ELC2010 00554
T l GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/08/2010
Parcel: 2S101 BB00401
Jurisdiction: Tigard
Site address: 11880 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Russ Chevrolet
Project Description: TI
Owner: FEES
KNAUSS, WAYNE ET AL Quantity Description Date Amount
C/O HUMBERSTON, RUSSELL D, REVOCABLE
TRUST, PO BOX 4300 9 crt Branch Circuits 10/08/2010 $115.54
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/08/2010 $13.86
Electrical
Contractor:
STONER ELECTRIC
1904 SE OCHOCO
MILWAUKIE, OR 97222
PHONE: 503 - 462 -6500
FAX: 503- 659 -4968
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $129.40
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 0 52- 001 -0100. You ma f the rol or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
/ '
Issued By: Permittee Signature: I
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 an inspection that business day.
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.
Oct. 6. 2010 12:33PM Stoner Electric Group No. 4916 P. 1
Electrical Permit App t -ipat- 4 , , ', Jilt/ (lrrtcl: utih oNLY
City of Tigard a / . Received
j - U 13125 SW Hall Blvd., Tigard, q1. 223 , 20.1 view , e • L .
a Phone: 503.639.4171 Fax: 503. 598.1960 D : otherPennit:
TG A R D Inspection Line: 503.639.417k, • 4 i t (- Notified/Method: www.ligard-or.gov . ' -' ' °'?. i', k i p Dote Ready/8y: % See Pop for
Internet vr p \'4i°�
'" "q -,' 'O Supplemental Information
d .'. A_ :.� V yy &„- - _.!:j..-.,J� �, --t �r�'��+ycagkp��p�YrL
,_ ... . T v a 59 ::' ✓;?5+�.. r= :. •! :• : . . - �fn= :.L�4:'*�rsGdnc6r= ,- . -'.' :0 ,. -':. ... •.::.:,':•:
❑ New construction Addition/ alteration /replacement Please check alt diet apply (submit 2 sets of plans w/ironn checked below):
❑Serviceor feeder 400 amps ormore ❑ MAMMA over three modes.
❑Demolition El Other: where the availoblefoult CIMasinas and boatyards
' M' exceeds 10,000 amps of 150 volts or [] Floating buildings.
" t'" " less to ground, or exceeds 14,000 Q Commercial -use aarieultural
I �
❑ 1 - end 2- family dwelling E6 Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. CI lestallation of /5 KVA or
�� , - _ "'VP. y - .V .�h S - c .,:. - ,,
0 ralem. larger separately derived syunn.
<< : 3 j :. Ui rG: IT , -irlii ;i D LOCATXOIV ,., c_ Addition of new motor load of
Job no.: 4 Z7e. Job site address: /6J"g3a�, J d .4 c _ ❑Six otmore J1 100HPoorre. R Qecreadonon
al vehicle parks.
City/State/ZIP �� 0> R Q ❑ Health -care fbcilines. 0 Supply voltage for more than
y s t7 El Haamdous locations. 600 volts nominal
Suite/bldgJapt. no.: I Project name: /Q C v a ❑ Service or feeder 600 amps or more.
Tins' -::'. .. )FEE elOtb ;E yW _}
Cross street/directions to job site: Destrretsoa 1 Qty. 1 Fee 1 Total 1
New residential single- or multi - family dwelling unit
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. it. or less : 168.54 4
Tax map/parcel n0.: Ea. add'1500 sq, 11. or portion 33.92 1
Limited energy, residential 2
; ;A 1 k; <' :rc3�: x n CRYY'fYON OF 9VOYtIC. - -- -- �f (with above sq. ft.) 75.00
Limited energy, multi - family 75.00 2
AJ4 /j,, , 4.4Ca ,1../ A / residential (with above sq. ft.)
Services or feeders instal latlon and/or relocation
200 amps or less 100.70 2
> > + + ' ✓ - t ° 4 ° ° 13336 2
401 amps to 600 amps 200.34 2
Name. 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or voles 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) 1 Fax: ( ) 200 amps or less 59.36 1
O wner Installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.01 2
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 - now, alteration, or extension, per panel _
Owner signature: Data: A. Fee for branch circuits with
'1'4!''.L::1„.4,: :; t• • r; , e eder fee
'�'' <❑ .ApP YCnt?IT __ : -" . C ONTA PERSO 7.42 2
. ..., ?��._ :r' :. N; :_ - s r? c= above service or feeder
Business name: sn.,,v� tt' /Ci l/ex B. Fee for branch circuits without
service or feeder fee, first / 56.18 5zp.i8 2
Contactnames.� L,
branch circuit
' Each add/ branch circuit a 7.42 - fir 34, 2
Address: Miscellaneous hen or feeder not included)
City /State/ZiP:
Each
dwelling. service and/or feeder 67.84 2
Phone: (5 ) 'tl42 -sz /e3 I Pax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67,84 2
B - mail: Sign or outline lighting 67.84 2
'. . r: A!- ; ; ,°;? 4° li a: 91 E : CQNT1tACCOYi : 'S3 :, Signal circuits) or limited -energy '
I3usincssname: STONER ELECTRIC, INC. , pmel,aheration, orextension. _ Page 2
Each additional Inspection over allowable in any of the above
Address: 1904 SE OCHOCO Additional inspection (1 hr min) 66.25/hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: M(LWAUKIE, OR 97222 Industrial plant (1 hr min) 78.18/ hr
Phone: ( 503) Fax: ( 503) 659 -4968 Inspections for which no tee is 9000 / hr
specifically limed eh hr min),_ _ `_._......__.._. ..
CCB Lie.: 44823 Electrical Lie.: 26 -122C Suprv. Lc.: 3496S EJ rittcA -I!El Mttai 'I : •
Suprv. Electrician signature, required: P1. c •C H-e � Su fee): / i . - .
_ P een review (259'a of fee): •�.
Print name: MICHAEL FALCONER Date: /pito !/D State surcharge (12% of permit fee): 13, 8 t,
TOTAL PERMIT FEE: 12 p, 4- 0
Authorized signature: This permit appllcadon expires if ti perrmle is not obtained within 180
Print name: Date: days after it bas been accepted at complete.
Num o f inspections allowed per permit.
L1DuildinglPennin 1ELC- PnmitApp.doe 07 /01/10 440- 44i5T(IINS/COMM'La
5+0 Et -'' 1) le-C.-