Permit k. �tl r -CITY OF TIGARD ELECTRICAL PERMIT
0 " ,4. COMMUNITY DATE ISSUED: UNITY DEVELOPMENT PERMIT ISSUED #: E
� : 5/22/2007 /2007 00296
,,0
"AGA 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 102AC -01100
SITE ADDRESS: 12566 SW MAIN ST ZONING: CBD
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: KARATE
Project Description: (1) branch circuit to provide power for sign lighting.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HMI SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
ROGER PAUL SORG TRUST K & M ELECTRICAL
24 AQUINAS 2900 SW CORNELIUS PASS RD
LAKE OSWEGO, OR 97035 HILLSBORO, OR 97123
Phone: Contact #: PRI 503 259 - 9941
FAX 503 - 649 -5836
FEES
Description Date Amount Reg #: ELE 34 - 594C
[ELPRMT] ELC Permit 5/2/2007 $46.85 LIC 150852
[TAX] 8% State Surcharge 5/2/2007 $3.75 SUP 44595
Total $50.60 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than days. ' -•• ENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 95 - 001 -0010 throug •AR •. -101 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800. 32.2344.
Issued y: , , / / // ./ t P ermittee 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 INSTAL . TION ONLY
SIGNATURE OF SUPR. ELEC'N: _ .naG/� 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.
•
Electrical Permit Application ,, -, :„ <FORoFFICEusEtoivl,Y,k A } 'U4,40 4 4.
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`J g Date/By: / � 7 EL e,� /
City Of Tigard Received
Permit No.:
i lig i '' - ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
rr , Other Permit:
{ Phone: 503.639.4171 Fax: 503.598.1960 Date/By:
r " 4 ; Inspection Line: 503.639.4175 Date Ready /By: .mri / ® See Page 2 for
T I : c A R D , Notified/Method: �u:�l- �= e�ww+t� Internet: www.tigard- or.gov C Supplemental Information
TYPE':OF WORK
PLANkREVIEW.
❑ New construction ❑ 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 stones.
❑ Demolition J Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY,. OF CONSTRUCTION; 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 - ommercial /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 - ", "1 - ",
Job I OOHP or more. occupancy.
ob no.: Job site address:
�Z S E / A' t t /' ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 'T/ > , f4 d j 9,222 3 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: i4/,qA -`._ ❑ Service or feeder 600 amps or more.
•FEE.SCHEDULE
Cross street/directions to job site: Description I Qty. 1 Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
• Ea. add'I 500 sq. ft. or portion 33.40 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
S7 `y µ C t,. C.. L r '- — residential (with above sq. ft.) •
Services op.- fe ; 3ers installar n, alteration, a:-? /or relecarior
200 amps or less 80.30 . ' z '
.0, PROPERTY OWNER ❑ .TENANT . 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601' amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange; according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
. 0 : APPLICANT'.' 0 CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: • without service or feeder fee,
first branch circuit 46.85 2
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included).
City/State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR,. • , Sign or outline lighting 4- 53.40 yy ieD 2 • Signal circuit(s) or limited -
Business name: Ake ,,/R C /` rC / energy panel, alteration, or
Address: 2 7..45 ,5 C' / e S extension. Describe: Page 2 2
Ca r". � , � ASS � ��
City/State /ZIP: ,4` //S 4, f t, (5 9'/ 2 3 Each additional:inspection over allowable in any of the above
(.. 3) zS7 5 S 4I / F ax: ). < 'C' 5' 3 ' Per inspection 62.50.
Phone: (5 T,
Investigation per hour (1 hr min) 62.50
CCB Lic./ 5 Y S Electrical Lic.: c - Suprv. Lic.: Industrial plant per hour 73.75
/ r f sign required: Y C p �5�ij '�'S
7 /� / ELECTRICAL PERMIT FEES` ; ;.. "��g,
Subtotal:
Suprv. Electri ' _ , gn e, /�� ���� / G j t �,� --
Print name: / p ` , ' �Q � ` / � Date: "----/.2_ Plan review (25 % of permit fee):
'�f r State surcharge (8% of permit fee): 5.r
Authorized signature: TOTAL PERMIT FEE: ,- -„ 6
This permit application expires if a permit is not obtained within Q80
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit.
I: \ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 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 ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OA ,1 918 - 260 -2(.6)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
• Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 03/23/06