Permit r x ELECTRICAL PERMIT
CITY OF TIGARD
� n
:; COMMUNITY DEVELOPMENT Permit #: ELC2010 -00135
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 03/30/2010
Parcel: 2S102BD02000
Jurisdiction: Tigard
Site address: 12885 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Texaco
Project Description: Remove and replace gas dispensers.
Owner: FEES
COMET CORPORATION Quantity Description Date Amount
BY WSCO PETROLEUM #225, 2929 NW 29TH
PORTLAND, OR 97210 4 crt Branch Circuits 03/30/2010 $78.44
wo /Purchase Service or
PHONE: Feeder
1 ea Plan Review Electricial 03/30/2010 $19.61
Contractor: 1 ea 12% State Surcharge - 03/30/2010 $9.41
Electrical
NORTHWEST PUMP & EQUIPMENT CO
2800 SW 31ST AVE
PORTLAND, OR 97210
PHONE: 503 - 227 -7867
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $107.46
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done ' accordance • • approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. TENTION: Oregon -.w r' • r'res ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0 1 -0010 through OAR 952 -0a -010$ Y may obtain a copy of the rules or direct questions to OUNC by calling 503.246.66• or 1.800.332.2344
Issu d By: 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' , am ` !�T i CJ�� Date:
i
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 RECEIVE ,1 > „,..,..,,,,,..,, 1 b '-', -' _ HOIi o o N_l* ”` + r , '
, t V.'cll' • a i -1 0: 2 44 0 .Y' f. ^M 1t 0 . 1 r � ,�.
Received
lif SC Ci of Tigard � „ , t . DatE � IQ Permit No. E�aO f0_ co 13 5-- ° 1312 SW Hall Blvd.. Tigard. OR 97223 MAR G C (i '! Plan Review
CA c c Other Permit:
Phone: 503.639.4171 Fax 503.5 )8.1960 Date /By:
1Z "` Inspection Line: 503.639.4175 Date Read /13 t
l�l c�'R�n P � CITY OF TIGARD Ready /13y: (�
:;iiiF'li'3iaitl Internet: www.tigard or.gov BUILDING DIVISION Notified /Method: � ' a , � p' 1,0 '' ( ( Co ® See Page 2 for
Supplemental Information
. TYPE OF WORK PLAN REVIEW
❑ 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 stories.
❑ Demolition ❑ 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- fancily dwelling 'Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of75 KVA or
JOB SITE INFORMATION AND LOCATION Addition ❑ A dn system. larger separately derived system.
❑ AddiBOn of new motor load of ❑ "A' "E° "I - "I -
Job no.: Job site address: (� /4' '
I001IP or more. occupancy.
lU� / ac 6.5c5 5 L „ ..) ��Lt I l `�/� ❑Six or more residential units. ❑ Recreational vehicle parks.
"f
Cit /State /ZIP: - ?(:,,,t, `� l ( � � - l'7 .Z Z Oytealth -care facilities. ❑ Supply voltage for more than
1 ` `�ylazardous locations. 600 volts nominal.
Suite /bld g j ect name: T ' "l v `' r . ' t \ (.j .� 'fi� } CX . - ^ ❑ Service or feeder 600 amps or more.
Suite/bldg./apt. no.: Pro "
FEE SCHEDULE • ,
Cross street /directions to job site: Description 1 Qty. 1 Fee. 1 Total 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. It or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
67.84 2
DESCRIPTION OF WORK (with above sq. 0.)
1 /J ~L� t Limited energy, multi - family 67.84 2
j � „ 1 t �� q r� s d t S 5�,6 tL v residential (with above sq. 0.)
Services or feeders installation, alteration, and /or relocation
�Q PI G ILL 1,./1 1 ! -( vt AO S lo(/(g'to 200 amps or less 100.70 2
. ❑ PROPERTY OWNER i ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Narne:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( ) 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
2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
above service or feeder fee.
• �APPLiCANT ❑ CONTACT PERSON 7.42 2
each branch circuit
B. Fee for branch circuits without
Business name: r�� �� �, �/�l' 1 s ervice or feeder fee, first ,/
U � �`� 1 56.18 �� -lO '-
Contact name: - F ✓e t !�6 v. branch circuit
W ^ Each add'I branch circuit 3 7.42 as _.(r:. 2
Address: a , 6 , m „.._, .-, I s r 1 nl o Miscellaneous (service or feeder not included)
City/State/ZIP: goo- L 0 1 2 a Each ing d/ modular 67.84 2
Phone: dwelling , , service serv e a and /or feed
i Fax: : ( 3 ) p�U S - Llr a Reconnect only 67.84 2
: ) �� ���
/� 'Pump or irrigation circle 67.84 2
E -mail: ,n.2 We
_ .g.ZC IiW PL,,,wr , CC��'
(' Sign or outline lighting 67.84 2
' ' - CONTRACTOR Signal circuit(s) or limited- energy
Business name: lU U �' (� 1- t panel, alteration, or extension. Page 2 2
W " `' * � l ( Each additional inspection over allowable in any of the above
Address: - 6 k.J - 3 ( s F �'` � Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: I ( i ) C J \ Investigation (I hr min) 66.25/ hr
• ` t1 ,./` C� 0 -'! Industrial plant (1 hr min) 78.18/ hr
Phone: (e ) g,a ��
- d R Fax: (SrJ3) v`�_ ( C f Inspections for which no fee is 90.00/ hr
4 _ (t specifically listed ('/ hr min)
ti CCB Lic.: 62cfC-� G7 Elect is l Lic.:` - • a `` rv. Lic.: L(C6 ELECTRICAL PERMIT FEES
0 7/ /11 , � �'�T /p,f // D Subtotal: 7 55 - L
Suprv. Electrician signature, required: • Cie o
/' a Plan review (25% of permit fee): / � (
Print name: 6.21 ,p / �1 Date: ✓ b t a State surcharge (12% of pennil fee): _ y(
1.. t TOTAL PERMIT FEE: (U 7 9 4.(C" Authorized signature: / This permit application expires if a permit is not obtained within 180
Z
days after it has been accepted as complete.
Print name: J1.. ( k Date: 3 • 4-( (..) • Number of inspections allowed per permit.
1:\ Building \ Permits \ELC- PcrmitApp.doc 10 44046151111/ 05rCONI/WEB
RECEIVED
Building MAR 9, 4 Tr)
0
Conduit seals O CITY OF TIC ARD
BUILDING DIVISION
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Replace dispenser with new reusing
all existing conduit seals and wiring
To comply with Art 500, 501, 502, and
514 of the NEC.
Class 1 Div1 group D below grade
Class 1 Div2 group D up to 18"
Philip Gauntlett
p . goto?
4884s
Northwest Pump & Equipment
503 - 519 -6056
CITY OF TIGARD
Approved
Conditionally Approved ( ):
For only the work as described in:
PERMIT NO...ataIDELM13.1 OFFICE COPY
See Letter to: Follow ( ):
Attach .. ....... . - -- ( ):
Job Address: RE • '� .
By: _ Date: 4'