Permit •
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00455
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/01/2012
Parcel: 2S115BA02500
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY X
Project: Marshalls Subdivision: 2004 -015 PARTITION PLAT Lot: 1
Project Description: (6) branch circuits for TI adding offices in stockroom
Contractor: WILLAMETTE ELECTRIC INC Owner: SN PROPERTIES PARTNERSHIP
PO BOX 230547 1121 SW SALMON ST
TIGARD, OR 97281 PORTLAND, OR 97205
PHONE: 503 - 624 -3631 PHONE:
FAX: 503 - 624 -2938
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo /Purchase 08/01/2012 $93.28
Specifics: Service or Feeder
1 ea 12% State Surcharge - 08/01/2012 $11.19
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $104.47
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 OAR 9 2- 001 -009 . You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 (
2.1987 or 1.800.332.2344.
Issued By: Permittee Signature: c» � r"P�f / l� / i 0
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.
08/01/2012 WED 9:29 FAX 5036242938 Willamette Electric a 002 /002
Electrical Permit Application : FOR OFFICE USE ONLY
City of Tigard Date/By: '' w�a
v Permit No r��p�1 (amt ` r te '
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review T J — _,
gUN 0 2.012 Dat : Other PemOt2P V �
Phone: 503.639.4171 Fax: 503.598.196 uP o� �- Q� `____
TIGARD Inspection Line: 503.639.4175 DateReady/By: - M See Page 2 for
Internet: www.tigard•or.gov c O *TIc ARD Notified/Method: Supplemental Information
❑ New construction Addition/alteration/replacement
Please check all that apply (submit a sets of plans w /items chocked below):
D Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current D Marinas and boatyards.
. ..:.. , pi hoot ' .. T Fl • ting
.:. :- •. .c ta' . �, ,�;. f•`i _ ■ - •• , .• less to ground, or exceeds 14.000 0 03 exceeds amps a vo
tso
::.u_.:,,,. •
❑ 1 and 2 family dwelling ��d Commercial /industrial ❑ Accessory building mttterc' - use agricultural
amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: ['Fire pomp. 0 Installation of 75 KVA or
t
_ ❑ Emergency system. larger separately derived system.
- ,.: [�� i - ? �Ea , 14441 • ,�1 "��- , -. ;l1��. _ . ❑ Addition of new motor load of 1
_ .... .. ....... �. , . .. _ , : ,a:_�tl , . e • - i' � i �.:' ' '.:` . °;. ,; ; �.. „ -2 ,... ,
/ ) I OOHP or more
occupancy.
C Job site address: / Zp & l -. 0 1 p °y'
Job no.:
7 / i. [ } n rTL 14' ❑S or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: ❑ Hazardous locations. 600 volts nominal.
/ DHealth -care facilities. D Supply voltage for more than
y / l e- .( / D� 9 0- --
Suite/bldg. /apt. no.: Project name: R /5 ‘c-C1 / ,_( O service or feeder 600 amps or MOTO.
.
Cross street/directions to job site: Dereriplion Oty. 1 Fee. I total . •
l
..
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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
(with above sq, ft.) 75.00 2
70.LSCRP`I>�itei. 'OF . _WOltft - •. ' : (
Limited energy, multi - family 2
X ' ! � �1 „(—,( P s 1 ,4 . x?1 f i 4.. residential (with above sq. ft.)
75.00 •
j �>'jl ��( I 'J ` / ' / � �� 1 Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
ID PItOPEt3' ;ZAAtT amps to 400 amps 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 volts 552.26 - 2
relocation m ary services or feeders installation, alteration, and /or
City/ State/ZIP:
Phone: ( ) 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 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits— new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
t1 .A1tPLICA'QTI ' ::. _'ICONx gr;O is. cheorfee feeder , 7.42 2
• above fee
each bran
Business name: B. Fee for blanch circuits without
service or feeder fee, first 56.18
Contact name: branch circuit
. Each add'l branch circuit , 7.42 ?.77 1�2
Address: Miscellaneous (service or feeder not included)
City / State/ZIP: ddw service and/or feeder 67.84 2 manufactured Or modular
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
t Pump or irrigation circle 67.84 2
E-mail: ' Sign or outline lighting 67.84 2
_ �, -• -. - - . _ . ., ” :.,..
.•. ._.. .: :...::;.:.,� :,. -._':<_:' �:".- .- .:;..;.:.r.i ;
.�, =' . ��,: °'.,:_:.,.., Signal circuit(s) or limited-energy
Business name: Willamette Electric Inc. panel, alteration, or extension. Page 2 - 2
Each additional inspection over allowable in any of the abov
Address: P.O. Box 230547 Additional inspection (1 hr min) 66.25/hr
Investigation (1 hr min) 66.25/ hr
City /State/ZIP: Tigard, OR 97281 Industrial plant (1 hr min) 78,181 hr
•
Phone: (503) 624-3631 I Fax: (503) 624 - 2938 Inspections for which no fee is 90.00 / hr
specifically listed (14 hr min)
,,CCB Lic.: 75059 } - Eecctrical Lic.: 34 -283C ✓Suprv. Lic.: 4226 -S t� '`' ''`' �' .. .. i�` r" ` '$ ''
Subtotal:
Suprv. Electrician signature, req ' Plan review (25% of permit fee): e5
Print name: David Fife Date: ' f / / t7� State surcharge (12% of per it fee):
/
—
(( TOTAL PERMIT FEE: ,/ 4
Authorized signature: This permit application expires if a permit is not obtained wi bin 180
Print name: I Date: days after it has been accepted as complete.
N um b er of inspections allowed per permit.
1: \DuadingWermiulELGPermllApp.doc 07/01 /10 400- 46157(11/OS /COM/WES