Permit 1,M r CITY OF TIGARD
ELECTRICAL PERMIT
w a .: COMMUNITY DEVELOPMENT Permit #: ELC201000270
Date Issued: 06/03/2010
:, GARD; 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S 102 DA00200
Jurisdiction: Tigard
Site address: 8720 SW BURNHAM ST
Subdivision: Lot: 0
Project: City of Tigard
Project Description: Niche - Installation of (1) branch circuit for split system.
Owner: FEES
TIGARD, CITY OF Quantity Description Date Amount
13125 SW HALL BLVD
TIGARD, OR 97223 1 crt Branch Circuits 06/03/2010 $56.18
wo /Purchase Service or
PHONE: 503 - 639 -4175 Feeder
1 ea 12% State Surcharge - 06/03/2010 $6.74
Electrical
Contractor:
GLOBAL ELECTRIC, INC.
PO BOX 162
NORTH PLAINS, OR 97133
PHONE: 503- 647 -5650
FAX: 503 - 647 -5649
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 . . • - ith 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 • TENTION: Oregon :w requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
• - 001 -0010 through OAR 952- s - 100. You may obtain a copy of the rules or direct questions to OUNC by call', ; 1 .246.6699 or 1.800.332.2344.
C Issued By: ,LI,/MA 4 Permittee Signature: Li _ 4' �,i.7lf/,I
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.
From: 06/03/2010 08:11 #517 P.002/002
i Er c u tic r r%
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Electrical Permit A li ' - -
AA '- - w Kok U t _ 1 /�9�. ,4 y • a City of Tigard JUN 0 3 2 010 `` < Received : 0 .eD Permit No &Ma DV-1 < D
I III
a 13125 SW Hall Blvd., Tigard. � OR 3 .
972 Plan Review
Ill ,,,::, Phone: 503.639.4171 Fax: -psi. tS+7° - flGAPD
Other Permit.
Date /8
, I c A R D Inspection Line: 503.639.4 yy I r I ! c , Date Ready /By: Ju ��. ® See Page 2 for
Internet: www.tigard -or.go «��IV V�� i l ' Notified/Method: ?� Supplemental Information
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❑ 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 .
mo u ` \ .. ` (tlr,alvll tid f ib 1�a rSSV �+ r,> u, q; \ g g_
') ��� \W „�i��.1 {�� , �,., i st 1q''ti \lt; ,? \'\ n �., ,,�"'„ „�,� -,���V d�,' 1���i . i1w V��n��1ay�������Y'�U��„�`��Us.+ exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
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less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ i- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
�'S, , �� � :n` \ t ? i t , t �� S, N y❑ larger separately derived system.
1\ H 1) 1 ,sT•Y�'� � �'�A+A i ' � UlPllt,�, a N t , 1 � �x m 7� , o V �;� � >> �. t \ i Emergency system. 6 P Y Y
;C,�s,�,n�.,in. r',��`i',;S��g ,i,,.Mn-.,su anm„vw,.,r,�wwi,o � i s A ��a� ��1'1h5itSC1�� ±mt ❑ Addition of new motor loadof
Job no.: Job site address: 8720 SW Burnham ]OOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite /bldg. /apt. no.: Project name: City of Tigard (16 6 ❑ Service or feeder 600 amps or more.
- WRS nnel,' jp '( p y,s\y xt t 1�111`# ' ,ti.g ,�` � ;
Cross street/directions to job site: Description I Qty. 1 v . 1 F Fee. � s,' Total � `' • 1
New residential single -or multi - family dwelling unit.
Includes attached garage.
1,000 ft. or less 168.54 4
Subdivision: Lot no.: sq.
Ea. add'I 500 sq ll. or ponion 33.92 1
Tax map /parcel no
Limited enero residential
i q,, S i ,a,l V 1, 0 tilt +1 is �,,�,, yy� t ��r 1 t� 67.84 2
� a,�V(" v� ��1,'�P� t1�te�t� aUv�', a; �1�',p, �., rf , 4�" 0#k*W 1 �.'>� s\?�1� MI 1 }F'� �tit�T\ y,; (with above sq. ft.)
ciruit for S Limited energy, multi - family
p residential (with above sq. ft.) 67.84 2
ht unit
Services or feeders installation, alteration, and/or relocation
y KM-1i: 200 amps or less 100.70 2
r,�w± 11,' Fi3( e i a , if 'ti ) ktSti ` 1a i�w , 8158 � 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 Y 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) i 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 extension, per panel
Owner signature: Date: A. Fee for branch circuits with
` �t yy �� , �q � ,,
w Yp +',Y ;*\, i>rS a t1 ' a ,, d
�iS� ,Y��t �?. , ,Y � ��p� � �4' \ r t,t, a5 r� @i?�?- �a'', above service . or ceder fee, 7.42 2 • ,• , 51 /Mk u 4 74 • V k • l� 4e EA • a n each branch c
Business name: B. Fee for branch circuits withour
service or feeder fee, first 1 56.18 56.18 2
Contact name: branch circuit
Each add'/ branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular 67 84 2
dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E Sign y � or outline lighting
`\, 1r'11�� , xPYe,' \ \G 2������1 +fit �i,�1 �.4 1 R "M , tin. e S 1k ��1` `"1,� 1 �`s1Y Signal circuit(s) or limited- energy 67.84 2 •
Business name: Global Electric Inc _panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the abov
Address: PO Box 162 Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: North Plains, OR 97133 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 647 - 5650 Fax: (503) 647 - 5649 Inspections for which no fee is 90.00 / hr
specifically listed (h hr min)
CCB Lic.: 156838 Electrical Lic.: 34 -655C Suprv. Lie.: 5210S �� ��i% +t 1 :f 1 :. ', � \v
15 /A8lt/ 74 /f /o/ /re Subtotal: 56.18
Suprv. Electrician signature, required: . 4 -A ..-
t/ l Plan review (25% of permit fee):
Print name: Justin Spiering f Date: 6/1/10 State surcharge (12% of permit fee): 6.74
Authorized signature: y}
�1 {f ���JJJ TOTAL PERMIT FEE: 62.92
!�
✓ T his permit application expires if a permit is not obtained within 180
Print name: justin Spiering Date: 6/1/10 " days after it has been accepted as complete.
Number of inspections allowed per permit.
t:, Building '\Permits PennitApp.doc 10;01 440.4615T(11,05 /COM!WER