Permit Electrical Permit Application - i I:012 OFFICE USE ONLY
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City an
of Tigard ` ` ` ReCeiVCd ate '�I03 /
g \ Per mit No..
1,01
EL �'�
° 1 31 25 SW Hall Blvd., Tigard, OR 9 Date./By: l��� -f /�jJ /
C 1 J: Plan Review
Phone: 503.639.4171 Fax: 503. A p p r Q\ Date/By: Other Permit. _
T 1 G A it D Inspection Line: 503.639.4175 ` 1 � I 1 . Date Ready /By: iuris/► / . la See Page 2 for
Internet: www.tigard-or.gov U 4 'i Notified/Method: � � Supplemental
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5 s.5 r , ,!' "> ti fi n ' "_ � �.�. ' k4: : .r l' :F: r.''C 5 ...f { rtfi .. ._ .rl a ��u
❑ New construction Addition /alterati plans _ d
® )
��tr ��1t nt Please check all that apply (submit 2 sets of wlitems checked below
❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ Demolition ❑Other: where the available fault current ❑ Marinas and boatyards.
.., ' r ,c ' I,ti; - 07 ( c ,x11 llfA4(; ` r ^ p ;; exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
Tess to , ^round, or exceeds 14,000
>, 0 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 of75KVAor
} �\ 16. ! i � a i . ❑ Emergency system larger separately derived syste
� .. �. �+....<_ ❑Add of new motor load of ❑ "A" "E" "1 -2" '1 -3"
Job no.: 67628 Job site address: 10855 SW CASCADE BLVD. or more. occupancy.
❑ Six x o or r more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: TIGRD , OR 97223 2 ❑ Health -care facilities. ❑ Supply voltage for more than
t� ^7E T ❑Hazardous locations. 600 volts nominal
Suite /bldg. /api. no.: 1 P ro j ect name: PAULSON TICARg STORE ❑ Service or feeder 600 amps or more
Cross street /directions to job site: " n °` '
Description 1 Qtr. 1 Fee. ° I '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
Tax map /parcel no . add'l 500 sq ft. n 33.92 1
Ea or portion
z. } }j£ - i e - s Limited energy, residentia
67.84 -
."+...r 3� .,V �* ! - ,. . _ . `f. , .. ,,a ; :- , .. : (with above sq. ft.)
Limited energy, multi - family
67.84
REPLACE LIGHTING IN SALES AREA AND WAREHOUSE residential (with above sq. fi.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
44' 171 iiilitt*IM � I •. '1••; ° y` -- ' LL B �. 201 amps to 400 amps 133.56
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
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
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 �` ii ..h„
x k =: rc i .r , -. ❑' O t" J'EI3S0 - above service or feeder fee,
,...... 7.42 2
each branch circuit
Business name: B. Fee for branch circuits 1 ti 56.18
Contact nam without service_or feeder fee,_ _—
IR,L [11411,.1 fL111.L 11 . I
Address: Each add'l branch circlast 1 9 7 -42 , 66 7R 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 67.84 2
Phone:( ) Fax::( ) e
E -mail: Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
m cl
, , ..' ,,r . o.. , ; o. iv lic17OR •.,-,; 4z ` A Sign or outline lighting 67.84 2
Business name: FRAHLER ELECTRIC COMPANY Signal circuit(s) or limited -
Address: extension. Describetion, or Pa
11860 SW GREENBURG ROAD e2 2 g
City/State /ZIP: TIGARD, OR 97223 Each additional-inspection over allowable in any of the above
Phone: ( Per inspection 66.25
503 > 639-4627 Fax: ( 39 -4673 Investigation per hour (1 hr min) 66.25
0 CCB Lic.: 37410 Electrical Lic.: 34 -13 Suprv. Lic.: 1816S I ndustrial plant per hour 78.18
Suprv. Electrician signature, r ed:
LEO rTl en2 ;1E-111421V
Subtotal: 1 2 7 qA
Print name Date: Plan review (25% of permit fee):
R. W. � 06/72,1 n State surcharge (12% of permit fee):
Authorized signature: 14.76
TOTAL PERMIT FEE: 1 .R 7 72
Print name: Date: This perntit.applicatian expires if a permit is not obtained within 180
days after it has been accepted as complete.
Number of inspections allowed per pennit.
I:\ Building \Permits\ELC- PermilApp.doc 10/01/09 440. 46151111/05 /COM/WEB
ELECTRICAL PERMIT
CITY OF TIGARD
PFt COMMUNITY DEVELOPMENT Permit #: ELC2010 -00314
TlGtIAD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 06/25/2010
Parcel: 1 S 135BC00900
Jurisdiction: Tigard
Site address: 10855 SW CASCADE AVE
Subdivision: Lot: 0
Project: Paulson Carpet
Project Description: (10) branch circuits to replace lighting in sales area and warehouse.
Owner: FEES
• PAULSON LIMITED LIABILITY CO Quantity Description Date Amount
BY RICHARD G PAULSON SR, 10855. SW
CASCADE BLVD 10 crt • Branch Circuits 06/25/2010 $122.96
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/25/2010 $14.76
Electrical
Contractor:
FRAHLER ELECTRIC CO
11860 SW GREENBURG RD
TIGARD, OR 97223
PHONE: 503 - 639 -4627
FAX: 503 - 639 -4673
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy`Grp:
Total $137.72
Require Items and Reports (Conditions)
This permit is rasped 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 through OA 952 -00 -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: Permittee Signature: d //-/ V
� Z f % /O /
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.
Cal1.503.639.4175 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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