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Permit - =i ;r , C , . CITY OF TIGARD ELECTRICAL PERMIT t N Permit #: ELC2010 00233 COMMUNITY DEVELOPMENT Date Issued: 05/12/2010 ,T1GARD, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S102DA00401 Jurisdiction: Tigard Site address: 13125 SW HALL BLVD PD Subdivision: Lot 0 Project: City of Tigard - Police Project Description: (2) branch circuits for server room Owner: FEES TIGARD, CITY OF Quantity Description Date Amount 13125 SW HALL BLVD 2 crt Branch Circuits 05/12/2010 $63.60 TIGARD, OR 97223 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 05/12/2010 $7.63 Electrical Contractor: 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 $71.23 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 O' - 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. � �1 0%I/ 4 c- /<!� & ,/ Issued By: Ad_ �ii�Ui --if 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' Date: LICENSE NO. Call 503.639.4176 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. 12. 2010 12:33AM No. 3649 P. 1 Electrical Permit Applic l ,f► , t EWE" `o ?b'' 0, , C 1 , I(•I 1,1 I. 1 G s h , 1 1 > ■ y City of Tig i R eceived Date/By; /0Z. / ii•, Permit No 1 a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ;'� / /� J © � 4 -. 1, i Q 1 Phone: 503.639.4171 Fax: 503.601 1 20 0 A : Other Permit; ii inspection Line: 503,639.4175 Date Ready/By; t;a See Page 2 for rw Internet: wnvvv.ligard or,gov CITY OF T1GARD Notified/Method: Supplemental Information TYP Afl. i DI _ PLAN REVIEW . ❑ New construction 53.. .dditionlalteration/replacement Please check all That apply (submit 2 sets of plans wftems checked below); ❑ Service or teder 400 amps or more ❑ Building over three glories. ❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commereial -use agricultural ❑ 1 - and 2- family dwelling commercial /industrial ❑ Accessory building amps' for all other installations. building3. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of l2. ❑ "A ", "1 "1 -2 "1 -3 Job no.: Job site address: \ t� e IVs 100HP or more. occupancy. 3 ❑ Six or more residential units. 0 Recreational vehicle parks. City /State /ZIP: 1 1 c i ckra li zZ3 ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous looations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: I'O�t CA,. ❑ Service or feeder 600 amps or more, • • FEE SCHEDULE Cross street/directions to job site: 5W R, rn 1 v„C\ 3, neacr,pIron 1 Qty. 1 Pee, 1 Total I New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: LOt no.: 1.000 sq. ft. or less 168.54 4 - — Ia. add'l 500 sq. ft. or portion 33.92 1 Tax map/parcel n0,: Limited energy, residential 67,84 2 DESCRIPTION OF WORK (with above sq. ft.) IQ Ci f ° "`C Limited energy, multi- family 67.84 2 , (� C c ✓ ( t 1 t CIVIC '^�R,/ -1� ( residential (with above sq. ft.) • S ` Services or feeders installation, alteration, and /or relocation QC1)- 200 amps or less 100.70 2 14 PROPERTY 01,VNER 0 TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: C� I-lot C� 601 amps to 1.000 amps 301.04 2 Address: \3 t � 5 ,,A / l j Over 1,000 amps or volts 552.26 2 City /$tale /ZIP: - � (>e_ '� Temporary services or feeders installation, alteration, and/or relocation Phone: ( 563 ) '7 18 —Z6 Pax: ( ) 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 125.00 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 with • PLICANT 1.e, l ❑CONTAC PERSON above service or feeder each branch circuit 7.42 2 Business name: (r I P C I C ` _ Clef( I . 1. B. Fee for branch circuits without Jt l 11 Ol Vv 4.1 -A service or feeder fee, first 1 56.18 51e . 1 ti 2 Contact name: , branch circuit Each add'l branch circuit l 7.42 1. L1'L 2 Address: 1 tAg k.. 6 2 0 , , A , 1t,--L _313 Miscellaneous (service or feeder not included) City /State /ZIP: �'� V\`w vu- Li J Y 9.a0 K, — dwelling, manufactured service a d/ modular 67.84 2 dwcfling, service and/or feeder Phone: ( c) ) S7 (4 --T2,00 Fax: : : cLI (0 I Sid _ Reconnect only 67.84 2 a Pump or irrigation circle 67.84 2 E -mail: Cr l, nyA. Qta`12-1 0 Mc 1)_ ` Q (lc i L c L , (-C/h,• ' Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited - energy . • Business name: 1�r, r panel, alteration, or extension. - Page 2 2 t 1 1 r 1 p c -, C.. (...),c; C c .ek 1 t7U AA Each additional inspection over allowable In any of the above Address: N3 Additional inspection (1 hr min) 66,25/ hr 1J� 7d vQ_ its ? - 51 1,a Investigation (1 hr min) 66,25/ hr City /State /ZIP: c U��`Ar kA W} St Industrial plant (1 hr min) 78.18 / hr Phone: (3(zb) ,5`p la - 1 7 t Oo Fax: gip()) 3 C ' 7,15-&' Inspections for which no fee is Ay specifically specifically listed (Y hr min) 90.00 / hr CCI3 Lie.: kw, g z , N Electrical Lie.. °1S-7 (!, Suprv. Lic.: (.1S S ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal; (0 3 . (Q 0 Plan review (251/4 of permit fee): 1, (p 3 Print name s ti.,..\ CAS u Date: .7 l ( / IL , State surcharge (12 of permit fee): / TOTAL PERMIT FEE! - If. 7.- j / Authorized signature: v This permit application expires If a permit Is not obtained within 180 days after It has been accepted as complete. Print name: ate: _ s/! I / IZr �� L4.4,1 "i � + • Number of inspections allowed per permit. 1: 18Uitdine6PermisU :CC.Permi,App.doc 10/01/09 440.4615T(I I /o5 /COM/Wf/ 1