Permit 4 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00092
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 02/24/2010
Parcel: 2S102AD02900
Jurisdiction: Tigard
Site address: 12770 SW ASH AVE
Subdivision: BURNHAM TRACTS Lot: 5
Project: City of Tigard
Project Description: Add /alter (1) branch circuit for gate and controller relocation.
Owner: FEES
CITY OF TIGARD Quantity Description Date Amount
13125 SW HALL BLVD
TIGARD, OR 97223 1 crt Branch Circuits 02/24/2010 $56.18
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 02/24/2010 $6.74
Electrical
Contractor:
NORTHSTAR ELECTRICAL CONTRACTORS
19450 SW CIPOLE RD, STE 107
TUALATIN, OR 97062
PHONE: 503 -612 -0840
FAX: 503- 612 -0891
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 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 throu h OAR 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.
Issued By: ' X 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' l Date:
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.
FEB 24 WED 04:10 PM 001
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Electrical Permit Applicat n a '1.,,A � t? � r' � `... i' ? ,. ,FO +OF FIEFA.sE ; ONLY o
x City nr 4 2010 Received
r o ill d (, Ire,lnit NO.SC \���p \w
`f f Tigard DatNUy l.-
il
'" '''" (3125 SW Hall Blvd., Tigard. OR 9722 EB , t
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Ul
6 1 un Reties
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t 5 it r TIG Dalc /ll hcr I'crnuC
t Phone: St)3.G3).4171 Fax: _03.. )8. j. 11 �•� } YY - --
',, , i' 4 , 4 Inspection Line: 503.639 4175 Lj I Y i,ii' 1 I Dale Readrr
��D �v - I r
TIGARD,; Sec Viler 2 far
.644,: :e�c,.,iw' I nternet: www,tigttrd or. gov BUILDING DIV ISION Nnlitic m• � �,�_ C Supplemental tnrormulinn
TYPE or WORK w_w— �.
PLAN REVIEW
t C ot constru El Addition /nitcration /replacement
I`k ' check all thin umly (submit 2 set, u1•plam tviiteuts checked belows ❑ pct t Ire nt Feeder .IIIU amps o1 nmr0 ❑ nuiltiing o'er three stories
Il1UI Ittoii Other — v Isere the available lush current ❑ Marinas and boatyards •
, ' ..CAT G ' OF CONSTRUCTION exceeds 10,000 amps at 150 volts ul ❑ Floating buikI44 :,
Ins to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling . Commercial /industrial ❑ Accessory building nngt :; for all other iiisinllations. building;.
❑ Multi - tinnily Muster builder ❑ Other: ❑ File pum0. ❑ Installation 0E72 KVA or
❑ Gmergency system, larger separately delived system.
'JOB SITE INFORMATION AND LOCATION ❑ Addition anew motor loud of I•_ ", °I -3",
—
Job no.: Job site address: i (/� `. AASZ]T 1001 or store. occupancy.
i / ❑ Six Vi more residential units. ❑ Recreational parks.
CI[ylState /ZIP: _ ❑Ha z ard care facilities. ❑ Supply voltaee for more than
yy A ' __ in Hazardous locations. . 600 volts nominal.
Suite /bldg. /npt_ no.: P roject nante:/ / 7.-- ❑ Service or feeder 600 amps or more.
' — � �T FLF SCHEDULE
Cross street/directions to job site: / /2/ F-P2 �7 \ D c__ •
ri anus !I . Fcc, l'°ad
// New residential single- or multi - family dwelling unit.
• Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less 145.15 411
— - -- Rd add 500 sq. ft. or portion 33.40 _ 1
Tax map /parcel no.: - Limited ener residential
energy. 75.00 2
DESCRIPTION OF WORK (with above *4. ft.)
1 A. ' r i ' C A • &/v 6 ( Limited energy. multi- family 75 0 —
� testdc ntiol (with Above sq. n J _ _
r� Services or feeders Installation, alteration, and/or relocation •
(i(j �+ v 200 amps or less ' 80.30 .. .2 — • "' •❑ PROPERTY OWNER : " ..:. ❑ TENANT - - .. 201 amps to 400 amps 1 06.85 2 • di1 -amps to 600 amps .. • - - 160,60 . 2
N ame: ... - - -= — —
-- r,0I -nmps to 1.0)00 nrnps • • - 240.60 2
Address: Over 1.000 amps or volts 454.65 2
City/State/ZIP:
— Temporary services or feeders installation, alteration, and /or
_ relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1 I
Owner installation: This installation is being made on property that I own which is not 201 n,nps to 400 amps I 100.30 2
intended for sale, lease. rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps { 133.75 2
tlr:uicit circuits - new, alteration, or extension, per panel
Owner signature; Date:
A. I'ce for branch circuits with CI APPLICANT CI CONTACT PERSON 7 above service or feeder fee. I
_,^ each branch circuit 6.6 / f 2
Business name: 3. Fee for branch circuits L„ lC Il ) t —
,ri„,urrr service or feeder fee. 4.16 t XS� 1 1 2 l
Contact name: alts[ branch t ireui;
Address: Each add'I branch circuit I 6 2
_ Miscellaneous (service or feeder not Included) _
City /5tate!Z11': Iiuelt manufactured or rnodul or
90.90
dwelling. service and/or feeder - 2 — Phone; ( 1 I Fax:: ( 1 w Reconnect on1■ 46.85 2
E- mail: Reconnect
or irrigation circle 1 53.40
CONTRACTOR Si en or outline lighting 53.40 2
Business Wattle: Sianak circuit(3) or limited -
NorthStar Electrical Contractors energy pone], alteration, or
Address; 19450 SW Cipole Rd, #107 CXtelston- Describe: Paae 2 2 • Tualatin, OR 97062
City/State /ZIP: (503) 612 -0840 Fax (503) 612 -0891 . - ,. - _Each additional inspection over allowable in any or the above
W
--" - - Lic #34 -359C CCB #90454 Metro # 1 _— Per inspection - E 63.50 i -
Phone: ( 1 ltvaslr er h I lir per mirO __62.50 _ _
CCD I.ic,: I Electrical Lic.: I prv. Lic f l /S. Industrial plant per hour 73.75 I
� � • L.._L..._...:• ELECTRICAL PERMIT FEES .
Suprv. Electrician signature, regoit'ed: ,r• Subtotal:
' ' r f - ---. - Penn review (25 %of permit fee):
Print nam � o * 1 Date: �w ��0 -- -
/ state surcharge (12% of permit Fee):
Authorized signature; —_ TOTAL PERMIT FEE; )'''..1
Thin permit npplirnfirm evpire5 if P permit is net nbat wit In ISM
Print nettle: , Oahe, days niter it has been accepted ns complete.
"_" - i''ri m11eI or inspecti allowed per pefmil
1 'Duilding\Penvitste C•Permlcnpp,dac n5 / ?3/00 •14
( \,2,--h C M-u,r ph. .