Permit I , . ; CITY OF TIGARD ELECTRICAL PERMIT
ii
. COMMUNITY DEVELOPMENT Permit #: ELC2010 00216
` Date Issued: 05/05/2010
TIGARD` 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S102AA04700
Jurisdiction: Tigard
Site address: 8900 SW COMMERCIAL ST
Subdivision: Lot: 0
Project: Ballroom
Project Description: (5) branch circuits
Owner: FEES
PAGE, SUNNIE Quantity Description Date Amount
8900 SW COMMERCIAL ST
TIGARD, OR 97223 5 crt Branch Circuits 05/05/2010 $85.86
wo /Purchase Service or
PHONE: 503 - 639 -4861 Feeder
1 ea 12% State Surcharge - 05/05/2010 $10.30
Electrical
Contractor:
ALL AMERICAN ELECTRICAL CONTRACTORS
PO BOX 1426
GRESHAM, OR 97030
PHONE: 503 - 657 -4351
FAX: 503 - 496 -3995
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $96.16
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 -r r 1 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 42/ 4 /` ,or
Permittee Signature: (ail/ 19 �z' 7 (
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.
CaII 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 E�pDIicatioin _ 4 10 � -. °.��"` ( ,. "�" 'lt t. _I a(,t� . 4 .
MAY 20 J .1
• a Received j' 5' /0 Permit No.. r �/) —
e s - City of Tigard Date /B +3
i ° 131 23 S E {all E31vd., T i r d, OR 9 OF TIGARI) Plan Roview
Tigard, Other 1'x[11111'.
S . m Phone: 503,639.4171 Fax: 503 ING DIVISION Date/By:
: .�; Ready/lay: Surf ; , fA See Page 2 for
rsi • t. Ir pia, inspection Line: 703,639,4 Notined Data Ready /Method; f Supplemental Information
xS,w Internet: www,tigard or.gov / _o—
r TYPE OF WORK O KR PLAN REVIEW
Addition /alteration /rC ;ration/replacement Please check all that apply (submit 7, at of plans w /hams checked below):
❑ New construction p ❑ Se' vice or feeder 400 amps nr more ❑ Building over three storios.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
• CATEGORY OF CONSTRUCTION exceeds 10,000 amp at 150 volts or 0 Floating buildings,
---• leaf to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling Commercial /industrial 0 Accessory building mops for all other installations. buildings.
❑ Multi-family ❑ Master builder
❑ Fire pump. ❑ installation x!'15 KVA nr
_ ❑oche(: larger ac rntel derived system
❑Emergency system, Y
JOB SITE INFORMA'T'ION. AND LOCATION 0 Addition of new motor lead of
IOOIIN or more. occupancy.
Job no.: Job site address: Moo .5ew. (dwMrtivlu•'I 1�
Six or more residential units, ❑
Recreational vehicle parks,
❑ Health-cant facilities, In Supply voltage fw more than
City/State/Zip: Q t' ) �. Q ? 2.23 ❑ Hazardous locations, 600 volts nominal.
❑ Service or feeder 600 amps or more
Suite /bldg,/apt. no.: Project name: FEE SCHEDULE:
Cross strcet/directions to job site: olecrIntion j oa. 1 1 1 - nod „[--
New residential single- or multi - family dwelling unit.
Includes attached garage. T _ _
� l,QOA ft. or less 168,54 4
Subdivision: Lot no.:
Ea. add'I 500 sq. It. or portion 63.94 ! �_•
Tax map /parcel no.: Limited enogy, residential 67 2
DESCRIPTION OF 'WORK (with above sq. 0. _ . -
Limited energy, multi- fhmily 67.84 2
1 _r^ t v- _ residential (with above sq. 0)
�( S T±+�I `fir S �'u - Services or feeders installation, alteration, and/or relocation
g,,e- V►D- 1 200 amps or less 10010 2
2 01 amps m 400 amps 1 33,56 2
PROPERTY OWNER Q TENANT _
401 amps to 600 amps 200.34 2
Name: ,5 �fA h i _ A 601 amps to 1,000 amps 2
t Over 1,000 amps or volts 552.26 2
Address: �q 00 5. W • ow �► �e♦P ( . Temporary services or feeders Installation, alteration, and /o
City /State /ZIP: ' -', a Q 72•2 3 relocation
200 carps or teas 59.36 I
Phone: (10)) (p 3 Q 6� / Fax: ( ) 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I 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 er ant l _ --
Owner signature: Date: - A. Fee for branch circuits with
0 ❑ CONTACT above service or feeder fee, 7,42 2
• APPLICANT each branch circuit
B. Pee for branch circuits without
Business name: _ service or seeder sec, fast I 56.18 5 8 2
Contact name: branch circuit
. le ach add'1 branch circuit 7.42 -. - 2
Address: -
Miscellaneous (service or feeder not included) -
Each manufactured or modu 67.84 2
City /State /ZIP: dwellins, service and/or feeder —
Reconnect only 67,84 2
Phone: ( ) (1'flx:: ( ) Pump or irrigation circle 67.84 2
E-mail: Sign or outline lighting 67.84 2
CONTRACTOR • Signal circuits) or limited- energy 2
� noel el alteration, or extension, Pa84
13usiness name: 4 1..... 1,04,,,,,t (y4/� -( � : . _ - = s 641�1/4Ver Each additional Inspection over allowable In an of the above
Address: Additional inspection (1 hr min) 66,25/ hr
• P 0 , D f �2 L Investigation (1 hr min) 66.25/ hr EIMII
City /State /Z1P; G Qjv D 0 Industrial plant (1 hr min) 78,18 / hr
Phone: (f (4 ) G57_, ( 4 3 s - ( Pax: ( 5 )) f._ 3 c ii, f, Inspections for which no fee is 90.00/ hr
• s cifrcall listed ('/r hr min
CCB Lic.: /cZ9$b Electrical l.ic. ;x c - (I ' .(q Suprv. Lie.: Cry 3 /.4 ✓ ELECTRICAL PERMIT FEES
_
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p ubt
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Suprv. Electrician signature, required: Plan review (25% of e mit ice): „��
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State surcharge (12% of permit fee); 1 ,7b_
Print name:
(Iv h t J . (f Date: �j/ TOTAL PERMIT FE F
Authorized signature: This permit application expires if a permit Is not obtained within 180
ii t t days after It has been accepted as complete.
Print name:
v ti'G lit. 0/7/0 / t Date: - • Number of inspections allowed per p nail.
1.taulldin9tPerrnIMILC•PermilAPp doe 101Ot/09 440.46151(11 /05/COMAVEa
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