Permit ;F CITY OF TIGARD
ELECTRICAL PERMIT
t
a COMMUNITY DEVELOPMENT Permit #: ELC2010 -00282
Date Issued: 06/11/2010
j G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S102CC00500
Jurisdiction: Tigard
Site address: 13500 SW PACIFIC HWY 92
Subdivision: Lot: 0
Project: Spec space
Project Description: (6) branch circuits for spec space preparation.
Owner: FEES
13500 PACIFIC CORP Quantity Description Date Amount
BY CAPOZZOLI ADVISORY FOR, PENSIONS
INC, 21500 HAGGERTY ROAD, SUITE 100 6 crt Branch Circuits 06/11/2010 $93.28
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/11/2010 $11.19
Electrical
Contractor:
PERFORMANCE ELECTRIC
15727 SE HAPPY VALLEY TWN CTR 170
HAPPY VALLEY, OR 97086
PHONE: 503- 558 -0496
FAX: 503 - 558 -0693
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $104.47
Required Items and Reports (Conditions)
This per ' s 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 do in accordance with approved • . s. 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 • uires yo to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 $01 -0010 thr• gh OAR 952 -00 -0900. 4 ,•u ay obtain a copy of the rules or direct questions to OUNC by c 503.246.6699 or 1.800.332.2344.
Is ued By: Permittee Signa
OWNER INSTALLATION ONLY
The installation is being made on propert • n which is not intended for sale, lease or ent.
•
OWNER'S SIGNATURE 6. / /- / - • / — 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.
May 28 10 03:26p Performance Electric Nort 503 558 0693 p.2
Electric! Permit Application .. TMovi /1,!.,e0,1, `, ,� d ,,"° ° .,, p ,, p ya .
Ci o f Tigard Receive
t Date/Ry g 1 0 P ermit N ��.C�p /6 -hod
t '• _ v 13125 SW Hall Blvd., Tigard, OR 97223
Plan Review
1 . Phone: 503.639.4171 Fax; 503.598.1960
Date.By: Other Permit:
'' "' GAS Inspection Line: 503.639.4175 Date Ready/By: Allis:
® See Page 2 for
!At iraVoaqakt Internet: wN•w.tigard- or.gov Notified/Method: Supplemental information
TYPE OF WORK [ PLAN REVIEW
❑ New construction Addition /alteration/replacement I Please check all that apply (submit 2 sets of plans writems checked below):
11 Demolition ❑ Service or feeder 400 amps or more El Building over three stories.
❑ Other: where the available fault current atyardS
❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Flamng buildings.
❑ 1 - and 2-family dwelling ommercial /industrial less to ground, or exceeds 14 000 ❑ Commercial -use agricultural
Y g ❑ Accessory building amps for all other installations. buildings
❑ Multi- family ❑ Master builder
0 Other: ❑ Fire pump. ❑ Installation of 75 K VA or
,1013 TIE INFORMATION ION AND LOCATION ❑ Emergency system. larger separately derived s stew
❑ Addition of new motor load of ❑ "a" 'E 1 �„ .,.
Job no.: L' 6 4 Job site address'= "'' QU '� 1001IP or more occupancy.
a S -!Fn C. ❑ Six or more residential ruts. ❑ Recreational vehicle parks.
CI ty /State %Z.IP: / / , h •�/ n ❑ Health -care facilities. ❑ Supply volta.e for more than
rG `_ ❑Hre
ardoos locations, 600 volts nominal.
Suite /bldg.!apt no.: Pr Fr O' oject name: ❑ Service o r f eed er amps or 600 more.
FEE SCHEDULE
Cross street/directions to job site: = Description
j Qty. I Pee. 1 Total I •
blew residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. fl. a less 145, I S 4
Subdivision: Lot no.:
Ea. add'I 500 sq. ft. or portion _ 33.40 I
Tax map,'parcel no -: i Limited energy, residential
DESCRIPTION OF WORK (wish above sq. ft.) 75.00 1 2
9 ' — 7 Limited energ)�, muhi - family I 75.CU 2
d .....-41 _ i' .....-41 4 ../ .,.ti _ ..41116 ' G /L ! residential (with above sq. R) 1
1 Services or feeders installation, alteration, and /or relocation
200 amps or less 80 ! 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 j ?
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240 2
Address: Over 1,000 amps or volts 454.65
2
City /Stale /ZtP: Temporary services or feeders installation, alteration. and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or Icss 66.85
1
2
Owner installation: This installation is being made on property that J own which is not 201 amps to 400 amps 100.30
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, r panel
Owner signature: Date:
❑ APPLICANT A. Fee for branch circuits with
❑ CONTACT PERSON above service or feeder fee,
6.65 each branch circuit
Business name: B. Fcc for branch circuits coq ( 640.1g
without service or feeder fee, / Contact name: first branch circuit �; F UC -.Z
Address: Each add'I branch circuit ,5 A N IGS" -
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular
dwelling, service and'or feeder 90.90 'pa i 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 ■
E - mai I: Pump or irrigation circle _ 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
I3usincss name: % /'' e1 / ( Signal cireuit(s) or timited-
_, 0/ ! A-_, - J i i . C / energ, panel, alteration, or
/ , ;
Address: , /` / �io e . Describe: Page 2 2
City /Stale /ZIP: A If/MOW D A/ t ' ach additional inspection over allowable in any of the above
/ — .Per inspection 62.50
Phone: (5 ) 5 0._ f �/ /Y , Fax ( U —66?_? Investigation per hour (I hr min) 62.50
CCB Lic.: �j , Electrical Lic,: ; a c Supty. Lic.: � S Industrial plant per hour 73.75
4 �' ELECTRICAL PERMIT FEES � 3. t itt
Slimy. Electrician signature, require
,-' • / r •
Plan review 5% of permit fe
( ) Subtotal:
.� �`j fi ' ' Date: 5 ien 2
Print name�• / cA, �''��,. -1
T' ` ., • y 0 State surcharge (12% of permit tee): 1 ,:_.g,,,
Authorized signature:
TOTAL PERMIT FEE:
Print naive: per
This permit application expires if a permit is not obtained within
days after it has been accepted as complete.
• Number of inspections allowed per permit. f i�/�
I ��P. uilding +Pc.-mits\a_c_permitApp.dx 0attiy/p6 440- 46I5T { /05 /t'.oM/WEB r C)6