Permit ' ' ' v CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00659
I : ' Date Issued: 12/15/2009
AEGARL? 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S135DD03301
Jurisdiction: Tigard
Site address: 11945 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Joann
Project Description: (6) branch circuits for TI
Owner: FEES
TIGARD PLAZA LLC Quantity Description Date Amount
8320 NW HWY 99
VANCOUVER, WA 98665 6 crt Branch Circuits 12/15/2009 $93.28
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 12/15/2009 $11.19
Electrical
Contractor:
STAR ELECTRICAL SERVICE
PO BOX 1784
BEAVERTON, OR 97075
PHONE: 503 - 579 -9201
FAX: 503- 579 -4581
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $104.47
Required Items and Reports (Conditions)
This permit is ' - subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don accordance with`approved ans. 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 r it you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 01 -0010 th ugh OAR 952 -00 100. / Yo}j / may obtain a of the rules or direct questions to OUNC by calling 503.246 or 1.800.332.2344.
Is ed By: _�'w .Qi 1 Permittee Signature: )C 4i ; / __ __ ,,, ��
pDv/
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' Ci%�ii��li�i / /i1�1- ■A , ,,, Date: ; ®D
A. LICENSE NO. ''d 3 5
Call 503.639.4175 by 7:00 ..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.
Elect Permit Application ,� 4 - Y , : . l ()R O1 S i _ � �
3 : _ *-- - • vet4s fit txw r�;� a'', . ;awl &.!.
'i . City of Tigard Received /A AC 07 Permit No.: exeAp 7 1,57
13125 SW Hall Blvd., Tigard, OR 97223
g n
Phone: 503.639.4171 Fax: 503.598.1960 DatPlaeBRevy: iew Other Permit:
' Inspection Line: 503.639.4175 Date Ready /By: Juris: El See Page 2 for
I ,
1- <c Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction [4 Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CO NSTRUCTION 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 Igl Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
. JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I- 2 ", "1 -3 ",
Job no.: Job site address: ligLis sa.) i� 100HP or more. occupancy.
6.� C Flu ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: / ['Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: i/r P2euf AjI /L ❑ Service or feeder 600 amps or more.
�"� / 4 LL— FEE SCHEDULE
Cross street/directions to job site: SK/ Pa c.,./ '� /y
il, B Al - Description I Q.V. I Fee. I Total I "
' New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential
• DESCRIPTION OF WORK (with above sq. ft.) 67.84 2
Limited energy, multi - family 67.84 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER Et TENANT 201 amps to 400 amps 133.56 2
Name: c s-A j 4,-/(
401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: //q.Lic 7 . .. ,i #-04:," Over 1,000 amps or volts 552.26 2
z ,
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: //
�j pr 7 d/L ei 3 relocation
Phone: (5b3) 7y0 L/6 3 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, lease, 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: 1 2-7- 0? A. Fee for branch circuits with
pa APPLICANT I ® CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: L
L pQ 12 V - e - /,// ;2_ B. Fee for branch circuits
Contact name: without service or feeder fee, 56.18 , � ' (g 2
(�F/ // O S"A"`L T first branch circuit �q
Address: / / 4` y 3- PA_ e `� i4 , #- z 01 Each add'I branch circuit 5 7.42 r 7. 0 2
Miscellaneous (service or feeder not included)
City /State /ZIP: 7 A r /Z j 2 2 3 Each manufactured or modular 67.84 2
Jr dwelling, service and/or feeder
Phone: ( g20 - 06 38 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: / ,/ Signal circuit(s) or limited-
ly� 15• /�i/ 4/ �•P,/ �j6 C. energy panel, alteration, or
Address: ,j/. /� / (�li extension. Describe: Page 2 2
City /State /ZIP l / f/a / / r 760 Each additional inspection over allowable in any of the above
l� / Per inspection 66.25
\ D Phone: ( f i g 3 )29'� Q / , / O/ Fax: (3'0 ) , ) q Investigation per hour (I hr min) 66.25
CCB Lic.: /� /� !l Electrical Lic.: �e' uprv. Lic.: f ' Industrial plant per hour 78.18
r �� �, 6/ �� /� ELECTRICAL PERMIT FEES j
Suprv. Electrician signature, regmred: fl � d / Subtotal: y, •
Print name: �•"° // Date' Plan review (25% of permit fee): =-&" •
%9 I. it .i G 4 ,,at — — State surcharge (12% of permit fee): /1 . / / c
Authorized signature: TOTAL PERMIT FEE: f 4 7
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit.
1: \Building\Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
n A • udio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ V acuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
H Clock Systems
❑ Data Telecommunication Installation
H Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ L andscape Irrigation Control*
H Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
L\Building\Permits\ELC- PermitApp.doc 10/01/09