Permit AFB .f trti CITY OF TIGARD
ELECTRICAL PERMIT
io
F.. COMMUNITY DEVELOPMENT Permit #: ELC2010 -00161
I-i l G A K a 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/09/2010
Parcel: 2S114AA00200
Jurisdiction: Tigard
Site address: 16285 SW 85TH AVE 408
Subdivision: DURHAM HALL BUSINESS PARK Lot: 0
Project: Azore
Project Description: (1) branch circuit for new milling machine. Panel "A" circuit.
Owner: FEES
SHIPMAN, W H LIMITED Quantity Description Date Amount
BY NORRIS & STEVENS INC, 621 SW
MORRISON STE #800 1 crt Branch Circuits 04/09/2010 $56.18
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 04/09/2010 $6.74
Electrical
Contractor:
PATTERSON ELECTRIC LLC
1834 NE ESTATE DR
HILLSBORO, OR 97124
PHONE: 503 - 640 -4088
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $62.92
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 a ote 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. ATT TION: Oregon fa Vv. requi .0 to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0 10 thr ugh OAR 952 -001 -0 • obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1800.332.2344 �
Issued 1
Permittee Signature: k��%�t C' x XJV.:V�c:�J\ _
/ 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' 44,— r , _ Date: g //
LICENSE NO. 1 1 6 S
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 A plication . , � 4
;
`? Received
} 1 City of Tigard Date/By:
/p Permit No.: pevo- W /(/
e! ° 1312 SW Hall Blvd., Tigard, OR 97223 Plan Review
r` i , 1 2 .- Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit:
Il
Inspection Line: 503.639.4175 Date Ready /By: 1u ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: / Jc 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- family dwelling NT Commercial /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 ",
2 C v A ! 5 } O +� I00HP or more. occupancy.
Job no.: Job site addres I J `
❑Six or more residential units. ❑ Recreational vehicle parks.
City /State / "LIP: OR Ct7 22 44 ❑ Health -care facilities. ❑ Supply voltage for more than
r ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.'# 4/0..c.A O S Project name: ❑ Service or feeder 600 amps or more.
l t FEE SCHEDULE
2 . Cross sire to job site: ` ,/ ���� fC A , Description 1 Qty. 1 Fee. 1 Total 1 •
. r+t New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
fax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 67.84 2
. DESCRIPTION OF WORK (with above sq. ft.)
t ^\ y 11 1 Limited energy, multi - family
t r c ■ ' 1'- 6� r 1�1 t 1 ��t excA. � IgC, residential (with above sq. ft.) 67.84 2
r Services or feeders installation, alteration, and/or relocation
U�'�� ��� � ) 1 � 200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I 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 f o r b r a t clicircuitsi ... -__. --
. ❑ APPLICANT I ' , CONTACT PERSON r , above service or feeder fee,
7.42 2
each branch circuit
Business name: B. Fee for branch circuits ``
Contact name: 6 \ without service or feeder fee, ' 56.185 K? 1t) 2
O 6 Y4�►` 'e r S 6 ". first branch circuit •
Address: Ch -ad_d'1 branch circuit 7.42 2,..
Miscellaneous (service•or_feeder not included) _
City /State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ($. °°7c3 - 1..41 I Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR . Sign or outline lighting 67.84 2
Business name: II i- ` �� Signal circuits) or limited -
�h°�4-e r. 5U t& EL C ! t I.o energy panel, alteration, or
Address: f1 3 N, E. , 54 o 4 De t extension. Describe: Page 2 2
City /State /ZIP: .; us O ( Cn g 1 t 1 ( 2 q Each additional inspection over allowable in any of the above
( 3) � � n - C/ 6 ( ) Per inspection 66.25
Phone: ` t/ Fax: Investigation per hour (1 hr min) 66.25
CCB Lic.: l q gdcri Electrical Lic.:' ( -2 CI Suprv. Lic.3 \ 11(S Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: i Subtotal: s°(
Print name: V \ OL e i a, a k 00 Date: z/— j — /v Plan review (25% of permit fee): --1:1.)-- UUUU ` State surcharge (12% of permit fee):
69' 1i1
Authorized signature: TOTAL PERMIT FEE: to .5) 2
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building 'Permits\ELC- PermitApp.doc 10/01/09 440 .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 $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
•COMMERCIAL WORK ONLY: •
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
n 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 10/01/09