Permit •
tt'• CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC201000001
TIGARD 13125 SW'Hall Blvd., Tigard OR 97223 503.639.4171 Date;lssuedt 01/12/2010
. . Parcel: 1S135DD01800
Jurisdiction: Tigard .
Site address:. 11565 SW HALL BLVD
Subdivision: Lot: 0 '
Project: Columbia Dental Arts
Project Description: (1) branch circuit to reconnect RTU.
Owner: FEES
PANG, KEIKO TR Quantity Description - Date Amount
46 -442 HOLOLIO ST
KANEOHE, HI 96744 1 crt Branch Circuits 01/12/2010 $56.18
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 01/12/2010 $6.74
Electrical
Contractor:
WILLAMETTE HVAC
3075 SW 234TH AVE. #206
HILLSBORO, OR 97123
PHONE: 503- 628 -6841
FAX: 503- 848 -2597
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 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 0A You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6 99 or 1.800.332. 4. —
Issued By: *2 �IIQ } Permittee Signature: /�/ 7 \
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.
..
rcli �ti,nty ni I U� ? " 1
Electrical Permit Application 4t, i� U � ,� , '�,.
p , ,�; i FOWOFFICE,USE ONLY
,. 11∎ § v :i ::4444 u ',t,,1 .� 'lr , ,inn,,,. ,,,P" 'm,. i m 1� : i ]. t:.';':: h...';...
i 1 , , • Received ,F
II P City of Tlgal (� Date/By S AO Permit No.: Lt's C ric — �D/
13125 SW Hall Blvd., Tigard, OR 972.I'� Plan Review
,t Phone: 503.639.4171 Fax: 503598.1 sr c Date /By: Other Permit:
T I G A RD" Inspection Line: 503.639.4175 : -,tt ,!" Date Ready/By: luris. ® See Page 2 for
r Internet: www.tigard - or.gov Notified/Method:1 ( , �,, SupplementaI1nformation
.. „ JAN 20,10 ( ``
'� r 1WPE W
tOF O K R - ' P ei _
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❑ New construction ® Addition/alteratiffP1510K46AFID Please check all that apply`(subinit 2. sets of plans w/items checked below):
❑ Demolition ❑Other: BUILDING
n' n ❑ Service or feeder 400 amps or more ❑ Building over three stories.
DIVISII /lit p� 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
' ITE IN (FORMAD LOCA s
❑Emergency system. larger separately derived system.
1 r.,„,'„';,., -
.. � iJOB, S
.w ., -- T ION `;A. N . � TIO:N - .. _ "s 0 Addition of new motor load of ❑ "A” "E" "I -2" "1 -3"
Job no.: Job site address: 11565 SW Hall Blvd 100HP 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: Columbia Dental Arts 0 Service or feeder 600 amps or more.
FEE S CHEDULE
job site: Description __.
, n � Qty. Fee . � �� I m Total 1 @
Cross street/directions to b i
*
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'l 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited ener gy, � res entlal
P DESCRIPTIONI OF WORK= ; . (with above sq. ft.) 67.84 2
Reconnect RTU Limited energy, multi - family
residential (with above sq. ft .) 67.84 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
_.. L ® TE NANT .� ¢ .
'�® PROPERTYa � n � _ _� _ ;,, r - 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 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 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
' r • . - E] , , APPLICANT,r s - • ® (CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: Same as below B. Fee for branch circuits
Contact name: without service or feeder fee, 1 56.18 54. 2
first branch circuit
Address: Each add'l branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
-w
t "' CONTRACTOR; , " •. ;- "' Sign or outline lighting 67.84 2
Business name: Willamette HVAC Signal circuit(s) or limited -
energy panel, alteration, or
Address: 3075 SW 234 Ave Suite 206 extension. Describe: Page 2 2
City /State /ZIP: Hillsboro OR 97123 Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: (503) 628.6841 Fax: (503) 848.2597
Investigation per hour (I hr min) 66.25
CCB Lic.: 56951 Electrical Lic.: 36346CRE Suprv. Lic.: 4025LEB Industrial plant per hour 78.18
', „ELECTRICAL PERMIT' FEES a,: . .,..'
Suprv. Electrician signature, required: Subtotal: `, 4P , a
Print name: Mike Sicard Date: 12/30/09
Plan review (25% of pemtit fee):"
State surcharge (12% of permit fee): �` f , ?�
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
1: \Building\Permlts\ELC- PermitApp.doc 10/01/09 440- 4615T( l 1/05 /COM /WEB