Permit CITY OF TIGARD ELECTRICAL PERMIT
:4.11,(,,,,,,,,,,, '" a':'.. COMMUNITY DEVELOPMENT Permit #: ELC2010 -00176
" Date Issued: 04/16/2010
T t G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S102AC00500
Jurisdiction: Tigard
Site address: 12490 SW MAIN ST
Subdivision: Lot: 0
Project: Tigard Liquor Store
Project Description: (4) branch circuits for sign, fountain, soffit lights and deck lights
Owner: FEES
WOODARD, CHARLES L AND Quantity Description Date Amount
ARLIE C, PO BOX 23303
TIGARD, OR 97223 4 crt Branch Circuits 04/16/2010 $78.44
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 04/16/2010 $9.41
Electrical
Contractor:
THREE DOG ELECTRIC
5250 SW CAMERON RD.
PORTLAND, OR 97221
PHONE: 503 - 246 -4726
FAX: 503 - 246 -2113
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $87.85
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 99 or 1.8Q0.332.2 4.
Issued By: -
� Perm 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' `& Date:
LICENSE NO. C.........—*
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 Applic „ � , , r ,, " � `f —,�z � , A i x w , ED a } # , ` ' I OR OI I ICI iJS ON 1 . .241. ; 7,"
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City of Tigard DateB / / f' lc Permit No.:66C D _60 / 7()
1 14 13125 SW Hall Blvd., Tigard, OR 9 y 6 2010 Plan Review
. C Phone: 503.639.4171 Fax: 503.5 0 Dates : Other Perm iW7, — z . 9QO-2 J
I t ; R I )' Inspection Line: 503.639.4175 { Date Ready/By: Juris: ® See Page 2 for
- Internet: www.tigard - or.gov C �, ! b t t-' Notified/Method: Supplemental Information
TY NAM 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- 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 -2 ", "1 -3 ",
Job no.: Job site address: 1 2. 0 5(/J M 'A ito S1' 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP:1 i G wax, , Q --7 2.2- s ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: 1 Project name: "ri 640.0 / ... . 1 Qum Si. peg ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qrv• 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 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
• Limited energy, multi - family 67.84 2
FC>uR. AJwLtJ C 1 ra.currs s i V N - cou tv t C a., " residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
SOF LI(aIiTS At..)4 Doc4 L16 los 200 amps or less 100.70 2
❑ PROPERTY OWNER . ❑ TENANT 201 amps to 400 amps 133.56 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
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 1 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
. APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56.18 2
Contact name: branch circuit
Each add'I branch circuit 3 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
tY dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
CONTRACTOR . . Signal circuit(s) or limited - energy
Business name: r eL. p G E. Let L Q,I panel, alteration, or extension. Page 2 2
I
Each additional inspection over allowable in any of the above
Address: $ 2, S O S (A.) C 1, 1l r'L0 til I1Q.O *it, Additional
spe inspec li s t e d (%z ti on (1 hr min) 66.25/ hr
Investigation (I h min) 66.25/ hr
City/State /ZIP: � 0(Z \ L1aILJ4 ` O Q 4:172.24:172.24:172.2._ ( Industrial plant (1 hr min) 78.18/ hr
Phone: (8)3) 2L((,. ^ 471,6 Fax: f$o3 ) Zk(o- L 1i 1 3 Inspections for w no fee is
90.00/ hr
)
CB Lic.: i3 gSOS El e c rical Lic.: ( Q, / Suprv. Lic.: 4i, is mi n 'PERMIT FEES
Suprv. Electrician sign e , r r
• (.0 8 Subtotal: , 7 ,f- �/
, y
� w�. , Plan review (25% of permit fee):
Print name: F Q(L E.12- Date: 4-( 6 _ Zo I O .
State surcharge (12% of permit fee): 9 , y
TOTAL PERMIT FEE: 8" 7 _ �S
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
I:\Building\Permits\ELC- PermitApp.doc 10/01/09 440- 4615T( t 1/05 /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:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum 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
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
Fl 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
I: \Building\Permits\ELC- PermitApp.doc 10/01/09