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CIT OF TIGARD ELEC RICA PER IT
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COMMUNITY DEVELOPMENT Permit #: ELC2010 -00090
T I GAR 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/24/2010
Parcel: 25 101 CA00200
Jurisdiction: Tigard
Site address: 7904 SW HUNZIKER RD
Subdivision: Lot: 0
Project: Nelson Vial
Project Description: (3) branch circuits for light, plug and relocate conduit by transformer. 3/2/10, adding (6) additional
branch circuits.
Owner: FEES
NELSON VIAL LLC Quantity Description Date Amount
7000 SW VARNS 3 crt Branch Circuits 02/24/2010 $71.02
PORTLAND, OR 97223
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 02/24/2010 $8.52
Electrical
Contractor: 6 crt Branch Circuits w /Purchase 03/03/2010 $44.52
DICKINSONS ELECTRIC Service or Feeder
8449 SW BARBUR BLVD 0 ea 12% State Surcharge - 03/03/2010 $5.34
PORTLAND, OR 97217 Electrical
PHONE: 503 - 246 -3550
FAX: 503 - 213 -6049
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $129.40
Required Items and Reports (Conditions)
This permit i . - • . b'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don - ' accordance wit - •proved 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 la re• you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 *01 -0010 through OAR 952 -00 110* Y•u may obtain a copy of the rules or direct questions to OUNC by calling 50 6.6699 or 1.800.332.2344.
Is- edgy: ` . - Pe rm i ttee S ignatu Th - C Iry
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 503.639.4175 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.
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���� OF ,- ���® ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELC2010 -00090
T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 02/24/2010
Parcel: 2S101CA00200
Jurisdiction: Tigard
Site address: 7904 SW HUNZIKER RD
Subdivision: Lot: 0
Project: Nelson Vial
Project Description: (3) branch circuits for light, plug and relocate conduit by transformer.
Owner: FEES
NELSON VIAL LLC Quantity Description Date Amount
7000 SW VARNS
PORTLAND, OR 97223 3 crt Branch Circuits 02/24/2010 $71.02
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 02/24/2010 $8.52
Electrical
Contractor: •
DICKINSONS ELECTRIC
8449 SW BARBUR BLVD
PORTLAND, OR 97217
PHONE: 503 - 246 -3550
FAX: 503- 213 -6049
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $79.54
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 wit
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. AT " TION: Oregon law requir- you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 -0010 through OAR 952 -001 -0 %•. You . y obtain a copy of the rules or direct questions to OUNC by calling 503.248-e699 or 1.800.332.2344.
Iss ed By: ✓ go,„ _ —' -, Permittee Sig
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.
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CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00090
T [ G AL� R 13125 SW HaII Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/24/2010
Parcel: 2S 101 DA01900
Jurisdiction: Tigard
Site address: 7000 SW VARNS ST
Subdivision: Lot: 0
Project: Nelson Vial
Project Description: (3) branch circuits for light, plug and relocate conduit by transformer.
Owner: FEES
NELSON VIAL LLC Quantity Description Date Amount
7000 SW VARNS
PORTLAND, OR 97223 3 crt Branch Circuits 02/24/2010 $71.02
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 02/24/2010 $8.52
Electrical
Contractor:
DICKINSONS ELECTRIC
8449 SW BARBUR BLVD
PORTLAND, OR 97217
PHONE: 503 - 246 -3550
FAX: 503 - 213 -6049
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $79.54
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 actor• -• -= • • approved pl -ns. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTE• ON: Oregon la • r - • •ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0• 0 through OAR 952 -00 100. You • obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2 4•
,
Issues By: i �� — =— -' L Permittee Signature: r
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:
C � , - RACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' - � �� Date: 40
LICENSE NO. IoaS
Cali 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 Application , RR `I :2" ' fi't xt Ao
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City of Tigard Date /B : 0 O( �c B PermitNo.: 62/ 0 ?0
U PI V 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
''' Phone: 503.639.4171 Fax: 503.598.1960 DateB Other Permit:
I 1 e i ARI) Inspection Line: 503.639.4175 Date Ready/By: luris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
• TYPE OF WORK PLAN REVIEW -
❑ New construction ddition/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 ", "I -3 ",
•
Job no.: Job site address: , i / S
100HP or more. occupancy.
t ✓
r ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP:
( ??04 xtk�L Health -care facilities. ❑ Supply voltage for more than
`� /> / � 1 f " ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: ( Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description r Qty. 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
1 / r �_ ,/ Limi[ed energy, multi - family 67.84 2
l � �d -7 tj 1 ud 7 I Ly C-(�'�4 :4' re (with above sq. ft.)
7 /� Services or feeders installation, alteration, and/or relocation
- `�'''' -" 2 00 amps or less 100.70 2
0 PROPERTY OWNER . 0 TENANT 201 amps to 400 amps 133.56 2
Name: N q_ t-- Ot>J Ur ti I✓ (_1 (� - 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
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 I own which is not
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 ex tension, er panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT . ' 1 ' ❑ 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 / 56.18 2
Contact name: branch circuit
Each add'I branch circuit f / 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
/ /' panel, alteration, or extension. Page 2 2
Business name:
�ir/G� ✓ c� G
y
L Each additional inspection over allowable in any of the above
Address: G ` 1 e � ; ) h bL, / „ter ?/' 4 - Additional inspection (1 hr min) 66.25/ hr
ee >� �` 66 Investigation (1 hr min) 66.25/ hr
City/St i I 71 G/ °” ` —' � Indus plant (1 hr min) 78.18/ hr
( / ) = G % ' G ' � f .� ' l,l
Phone: Inspections no for which fee is
J) 1 "' ,f= � Fax: (,�G 90.00/ hr
specifically listed (Y2 hr min)
CCB Lic.: 61 _ j i i
c ✓ Electrical Lic.:) , /Lied.`, Suprv. Lic.: :� j ELECTRICAL PERMIT FEES
__/ al: 7� • b 2
Suprv. Electrician signature, regttired� .l .� ` _ Plan review (25% of permit
Subtot fee): _e
Print name:4‘. y t4 /) it?Oi _ 2 Date: L( !C' - State surcharge (12% of permit fee): $ . 57,
TOTAL PERMIT FEE: 7 9 . 5
Authorized SignatUr 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. 10/01/09 440- 4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
i •RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n 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
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ 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