Permit ': 4; ELECTRICAL PERMIT
, ; CITY OF TIGARD
71
2 COMMUNITY DEVELOPMENT Permit #: ELC2010 -00227
,T1GARD; 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/07/2010
Parcel: 2S114A001500
Jurisdiction: Tigard
Site address: 17005 SW 92ND AVE
Subdivision: Lot: 0
Project: Cook Park
Project Description: (1) 100 amp panel and (2) branch circuits for dugouts and outbuildings at fields #1 and #2.
Owner: FEES
TIGARD, CITY OF Quantity Description Date Amount
13125 SW HALL BLVD
TIGARD, OR 97223 1 ea Services or Feeders - 200 05/07/2010 $100.70
amps or less
PHONE: 2 crt Branch Circuits w /Purchase 05/07/2010 $14.84
Service or Feeder
1 ea 12% State Surcharge - 05/07/2010 $13.86
Contractor: Electrical
MR ELECTRIC OF CLARK COUNTY
14300 NE 20TH AVE. D102 -313
VANCOUVER, WA 98686
PHONE: 360- 574 -7200
FAX: 360 - 546 -2158
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 OAR 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
a —. , :As
Issued By: / /--L • - Permittee Signature: 0/V /_/ / ,' ��� (�,
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 603.639.4176 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.
May. 6. 2010 11:40PM r No 3611 P, 1/2
r '�F, l i' � +. . ., �i3 ��fNTNIk�i5. .. l r tr +�S�s �} °' ,
Electrical Permit Applicati t' i �� . ,# (;'It OH t , t , O
a
• Tra 6 Recei
M C � i141 City of Tigard MAY - p 2010 Date/B : - 7 a 4 Penni[N CIC c2O /O — O r 1 2
W i - 13125 SW Hall Blvd., Tigard, OR 97223 Han Review
ti , ! Ill ' Phone: 503.639.4171 Fax: 503.598. D Other Permit:
C��tY OF TIG ARD ate/9 ;
III j1 (m Inspection Line: 503.639.4175 DaleReady/By; Judy; BI See Page 2 for
sI Internet; wwW.ligard- or,goy BUILDING DIVISION Notified/Method: '( Supplemental Information
• TYPE OF WORK ...... PLAN REVIEW
p New construction RAddition/altcration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more A Building over three stories-
111 Demolition ❑ Other: where the available fault current
❑Marinas and boatyards.
. CATEGORY OF CONSTRUCTION exceeds 10,000 amps al 150 vole or ❑ Floating buildings.
Less to grouttd, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling )f Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of75 KVA or
Q Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION
❑ Addition of new motor Toad of ❑ "A ", "E ", `9 -2 ", "1 -3 ",
Job no.: I Job site address: 1'1(j U S W CI 2. C I ix or or roe. R occupancy, Recreational ❑Six or more residential units. ❑ Recreational vehicle parks -
City /State /Z1P: - Ct, f-. ( N� C , 2ZL1 ❑ Health -pare facilities. ❑ Supply voltage for more than
� ❑Hazardous locations, 600 volts nominal.
Suite/bldg. /apt. no.: Project name; C001,4_ PeAwk_ ❑ Servioe or feeder 600 amps or more. _
FEE SCHEDULE
Cross street/directions to job site: 5 -,..„) (n,)C,‘(,2f (1 Description 1 Qty. I Yee. I Total i •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq, ft. or Icss 168.54 4
Ea. add'I 500 sq. ft, or portion 33.92 1
Tax map /parcel no.:
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 67.84 2
t Limited energy, multi- family 67.84 2
w-
I OD i1 p p ck.11.e) I�I.rtd FLe..D ` er Ain d 2- residential (with above sq. R.)
Services or feeders Installation and /or relocation
C ' .r U1 v'tS 200 amps or less 1 100.70 (OO • jc 2
12 OWNER I ❑ TENANT 201 amps to 400 amps 133,56 2
1 401 amps to 600 amps 200.34 2
Name: to 0� — ��rd tc�
601 amp9 to 1,000 amps 301.04 2
Address: (--1 Lb S std c Z 1 , \ d, Over 1,000 amps or volts 552.26 2
` 'Temporary services or feeders installation, alteration, and /or
City /State/ZIP: 1.-R s C,..,r4 (V- GI - 1 'L 2 1 relocation
Phone: (5ZP) ) 1$ — 2. Ca 05 Fax: ( ) 200 amps or less 59.36 I
Owner installation: This installation is being made on property that 1 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: A. Fee for branch circuits Ivith
' - APPLICANT I (] CONTACT PERSON above service or feeder fee, 742 1 CI , 8 4 1 2
each branch circuit
Businessname: q-d�G�.IRC�dlQ L LA Ctx, 10/r (y R for branch ef ee s tvlthorrf
service or fl'eder f ee,, first 56.18 2
Contact name: I
V f M Each add'I branch circuit 7.42 2
Address: L M C'1 (� k.1�1G �1(� - s I12, r Miscellaneous (service or feeder not included
City /State /ZIP; �w � Each manufactured or nodular
V owIc J3.1) ( n 0 dtvelling, service and/or feeder 67,84 2
Phone: (3(, ) S 7L(_ 7ZOO Fax: : (3(00) 5 -, 2./S-1 Reconnect only 67.84 2
Pump or irrigation circle MI 67.84 111111111111 2
E -mail: t e.l lL. t. a Mr Q_t I.L- C. C. L , L \ Sign or outline lighting 67.84 2
CONTRACTOR ` Signal circuit(s) or limited- energy
Y tanei. alteration. orextension. Pa:e2 2
Business name:
1 C l ' • , .J 0 A / , U '' Ili C- I nch additional inspection over allowable in any of the above
Address: / ' .A, E ,` Yn V '". ` 53 is OF' C (-fr / K Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: V Om L ) I l V`& • do G( /J 7N investigation (1 hr min) 66.25/ hr
/ Induslnal plant (I hr min) 78.18/ hr
Phone: ( 3(ed) c 7y- IWO Fax: ( cad 5 6_'. i inspections for which no fee is -
— � G $ ; i , ply%' ( p rv. Lic.: s Magi listed %, hrrota
�
90.00/ hr
r CCB LIC.: E le ctrical L Su �S S ELECTRICAL PERMIT FEES v Suprv. electrician si nat �e requ 6 r '� (e 1 'i Subtotal: i j$ , S'�`
1� / / Plan review (25% of permit fee):
Print name: `\ ¢s3 1,.ck2 (, •' Date: 611 / I 0 State surcharge (12% of permit fee): 13. gb
TOTAL PERMIT RE;
Authorized signature: I This permit applicatloo expires if a permit is not obtained within 180
Print name: C1N�.< LS (( l �-Qt I hate: ��'"7 CJ days after it has been accepted as complete,
• Number of inspections allowed per permit.
1:I Building ■Permib0ELC- PermilApp.doc 10/01/09 440.4615T(11/05/COM/wee