Permit '° q CITY OF TIGARD ELECTRICAL PERMIT
ip
` COMMUNITY DEVELOPMENT Permit #: ELC2010 00264
„, .z� Date Issued: 06/02/2010
T jcA.Rta 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
atw fi„ _ . Parcel: 2S112AA00600
Jurisdiction: Tigard
Site address: 6777 SW BONITA RD 120
Subdivision: NELSON BUSINESS CENTER Lot: 0
Project: Stone & Wood Outlet
Project Description: Cj ry2,9,)Clt di 2C4,TS , 4 T
Owner: FEES
WALTON CWOR NELSON 13 LLC Quantity Description Date Amount
BY TTA/EPROPERTYTAX DEPT 735, PO BOX
4900 9 crt Branch Circuits 06/02/2010 $115.54
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/02/2010 $13.86
Electrical
Contractor:
ERIC OLSON ELECTRIC COMPANY
10013 NE HAZEL DELL AVE PMB 432
VANCOUVER, WA 98685
PHONE: 360- 609 -4901
FAX: 360- 693 -2980
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $129.40
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 ante with 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 NTION: Oregon law requires ou 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 -0100. ou , ay •... in a copy of the rules or direct questions to OUNC by c- ' •6699 or 1.800.332.234
Iss ed By: 1 / �� •/ �L>`.i Permittee Sig ;Wm: ' i1 � /�.
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 INSA LLATION ONLY
SIGNATURE OF SUPR. ELEC' , s ' • / i % ` r
. 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.
trPA r Po�� i't � P +i'� ' ;'R r'"�' 1i o, s ." 1 ` " Y 1a" .tl ? iJ a ^ i 7p
Ica' Permit Application �` ' ; a' G °r ''l � "' OIttOI I( I4t�ltil ON1 1���� 1,W.' :(w� r� +'i,V � � '�"qd�' I'f
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yr " ., • Re ceived
,p ��i, ,� , , ,,t C1 of Tigard Permit No.: �
•J g Date /B : � , � Ot( /l0 ����
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
.4: '�? r . ' Phone: 503.639.4171 Fax: 503.598.1960 Date /B : Other Permit: ��o / P
" P ei! Ins Line: 503.639.4175 Date Ready/Hy: Juris: ® See Page 2 for
I �� 121 N otified/Method: Supplemental Information
..t/...1' : . Internet: www.tigard or.gov PP
TYPE OF WORK PLAN REVIEW -
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit a 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 ® 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" "1 -2" "1 -3"
Job no.: 00208 Job site address: 6777 SW Bonita Bldg D 100HP or more. uancy.
re
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Ste 120 Project name: Stone & Wood Outlet ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 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 I
Tax map /parcel no.: Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 67.84 2
Installed 2- 30AMP/240V circuits; 2 -120V circuits; Moved two lighting switches; residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
wired rail lighting (3 circuits) 200 amps or less 100.70 2
❑ PROPERTY OWNER ® TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: Stone & Wood Outlet 601 amps to 1,000 amps 301.04 2
Address: 6777 SW Bonita BLD D Suite 120 Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: Tigard, OR 97224 relocation
Phone: (503)222 -9663 Fax: (503)222 -9669 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
., ` ® APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: Eric Olson Electric B. Fee for branch circuits without
service or feeder fee, first 1 56.18 56.18 2
Contact name: Eric branch circuit
Each add'I branch circuit 8 7.42 59.36 2
Address: 10013 NE Hazel Dell Ave PMB 432 Miscellaneous (service or feeder not included)
City/State /ZIP: Vancouver, WA 98685
Each mgnu or modular 67.84 2
dwelling, service and/or feeder
Phone: (360) 609 - 4901 Fax: : (360 - ) 693 - 2980 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: ericolsonelectric @gmail.com Sign or outline lighting 67.84 2
. CONTRACTOR . Signal circuit(s) or limited- energy
Business name: Eric Olson Electric panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 10013 NE HAzel Dell Ave PMB 432 Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Vancouver, WA 98685 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18 / hr
Phone: (360) 609 - 4901 Fax: (360) 693 - 2980 Inspections for which no fee is 90.00 / hr
specifically listed (Vs hr min)
CCB Lic.: 179408 Electrical Lic.: 37 -1053C Suprv. Lic.: 4910 ELECTRICAL PERMIT FEES
( /J Subtotal: 115.54
Suprv. Electrician signature, required: .,,,067. _"i_ Plan review (25% of permit fee):
Print name: Eric Olson Date: 6/2/10 State surcharge (12% of permit fee): 13.86
TOTAL PERMIT FEE: 129.40
Authorized Signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Eric Olson Date: 6/2/10 • Number of inspections allowed per permit.
I\ BuildingTermits \ELC- PennitApp.doc 10101109 440- 4615T(11 /05 /COM/WEB