Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00112
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/22/2012
Parcel: 2S115BA02500
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY X
Project: Marshall's Subdivision: 2004 -015 PARTITION PLAT Lot: 1
Project Description: Reconnect (3) HVAC rooftop units.
Contractor: WINNER ELECTRIC INC Owner: SN PROPERTIES PARTNERSHIP
5950 SW PROSPERITY PK 1121 SW SALMON ST
TUALATIN, OR 97062 PORTLAND, OR 97205
PHONE: 503 - 638 -5028 PHONE:
FAX: 503 - 638 -4242
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 02/22/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/22/2012 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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' 952- 001 -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: � j� � � Permittee 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.
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 C ) FOR OFFICE t I_ O N1,1
City.of Tigar � �ALIM t No.: Giz , / x.9142
13125 SW Hall Blvd., Tigard, r:• ":e i 1, „
Phone: 503.718.2439 Fax 51 C �� ��w Other Permit:
I 1 G :� R t� Inspection Line: 503.639A175 G`� \ �,. ,,,, Dare Ready/BY hair III See Pie 2 for
lr temct: www.tigard- or.gov ` O�� Notified/Method: Supplemental information
TYPE OF WORj otv� - PLAN REVIEW
❑ New construction [ Addition/altetatioi Please all that apply (=twirl sets of plats Winans checked below):
D Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition Other: where the available fault =COI 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 vols or D Floating buildings.
less to gmmid, or exceeds 14,000 0 Commercial-use agricultural
❑ 1 - and 2-family dwelling IN Commercial/industrial ❑ Accessory building amps for all other buildings.
❑ Multi- family ❑ Master builder ❑ Other: 0 Fire pump. 0 Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION
0 Emergency system. larger separately "� system.
D Addition of new motor load of 0 "A ", "E', "I -2 ", "1 -3 ",
Job no.: I Job site address:kW a 100HP or moue. .
' �� 2 U a d i4 Cf Sir m more residential units. D Recreational vehicle parks.
City/State/ZIP: -p� °I-1 D Hazardous locations. CI Supply voltage for more than
rh' 7/b� `rO ✓ SQ G ' f C"- { . { 2.1 ( 0 Hazar 600 volts nominal.
Suite/bldg./apt. no.: I Project name: / AR g� f js D Service w feeder 600 amps or more
FEE SCHEDULE
Cross street/directi to job site: newipiioe I ot,. I Fen 1 Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. R or less 168.54 4
Ea add'l 500 sq. IL or portion 3392 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
Re Nook V P k 1/vi I- (), s p,J'd J residential (wan above sq. tt)
p /f Services or feeders Installation and/or relocation
ke-us G exi T /0-. cl� 'rir 200 amps or less 100.70 2
❑ PROPERTY OWNER - I ❑ TENANT 201 atlas to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP:
Temporary services or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) 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, l ease, 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
❑ APPLICANT I ❑ CONTACT PERSON branch or feeder ' A 7.42 t 2
each Business name: B. Fee for branch circuits without p
service or feeder fee, first / 56.18 5 O 2
Contact name: branch circuit I
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City /State/ZIP: manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Li!: Ntvl°iL- g l c,144/4- panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 595o s (Ai F a G4 /'/ OK lc fa Additional inspection (1 hr mm) 6625/ hr
City/State/ZIP: .77, pit_ ot 7(J6 Z -
Investigation (1 min) 6625/ hr
Industrial plant (1 br min) 78.18/ hr
Phone: ( 6 63g 6 g �/ I Fax:( 6 )3) 659- Li; t/) Inspections for which no tee is
�] 1 • 7/
CCB Lic.: I y74 specifically listed (54 hr rove) 90.0W hr
Li 13l Eledaical Lim: 4 AcOr— Suprv. Lie.: 51 I P 8 S ELECTRICAL PERM TT FEES
Suprv. Electrician signature, required: ` i ; COO is, / ?, Subtotal: '7 f_ ® a
Plan review (25 % of permit fee):
Print name: , // I Date: a,_ 7 _ft— Plan
surcharge (12% of permit fee): _ $ a
Authorized signature:
TOTAL PERMIT FEE: ' ej , 64
This permit application spires If a permit is not obtained within 180
Print name: I Date: days after it Ins been accepted as complete.
• Number of inspections allowed per permit
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