Permit .1
I CITY OF TIGARD . ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit. #: ELC2010 -00024
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued; 01/15/2010
Parcel: 1S134BC00101
Jurisdiction: Tigard
Site address: 12144 SW SCHOLLS FERRY RD
Subdivision: Lot: 0
Project: Carl's Jr
Project Description: Add (1) branch circuit for microwave.
Owner: FEES
GREENWAY CENTER LLC & Quantity Description Date Amount
ANA KALAKAUA CENTER, 2155 KALAKAUA
AVE #602 1 crt Branch Circuits 01/15/2010 $56.18
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 01/15/2010 $6.74
Electrical
Contractor:
BECK ELECTRIC INC
15600 SE FOR MOR CT #B
CLACKAMAS, OR 97015
PHONE: 503 - 656 -7396
FAX: 503 - 656 -4397
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 OAR 952- 001 -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: \ gh I MOM( �Q I�� Permittee Signature:
��JJ 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' Q 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.
Electrical Permit Application C P z
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p.._.
0 . FOR OFFICE U FONLY ,, W „ T ..
111 A ,L, 4w City of Tigard I !! iew Pem,itNn: O(O , ° OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 D a1e /B Other Permit
• :TIGA Inspection Line: 503.639.41.75 Date Ready /By: ® See Pagel for
-w r Internet: www.tigard or.gov Notified/Method: Supplemental Information
TYPE OE 1VORK . . PLAN IREVIEW
.
❑ New construction `(, Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
D Service or feeder 400 amps or more 0 Building over three stones.
❑ Demolition ❑'Other: where the available fault current
0 Marinas and boatyards.
CATEGORI` `OT CONSTRUCT ION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 0 Commercial -use agricultural
❑ 1- and 2- family dwelling ' Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
El Multi-family Master builder ❑ Other: Fire pump. 0 Installation of75KVAor
.. _ ❑ Emergency system. larger separately derived system.
• JOB SITE INFORMATION::'AND LOCATION ❑ Addition of new motor load of D' A", °E "I -2 ", "I -3•'
4 100HP or more. occupancy.
.Ioh no.:15 •. l lob site address. ' � 64.0 ac:/, i /.5 E -CJyc, p J
/ / t "? ❑ Six or more residential units. 0
Recreational vehicle parks.
City /State /ZIP: ❑Health care facilities. D Supply voltage for more than
" e - .C . 0��
❑ Hazardous: locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ( q. -/ S j 4? D Service or feeder 600 amps or more.
FE ..
Cross street/directions to job site: . Description 1 Qty. I Fee. 1 Twat I •
New residential single - or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
1 Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: 15 3.4 fx. 00010 Limited id mited energy re ential
`DESCRIPTION OF WORK : (with above sq. ft.) 75.00 2
Limited energy, multi - family
4-44.0 C,-14-r -Fay /')') % L.C./ 6t,,'C4„ art f , residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
'PROPERTY: OWNER .
. -. [] :TENANT': '. 201 amps to•400 amps 106.85 2
Name; 401 amps to 600 amps 160.60 2
— ' 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 "amps to 400 amps 100.30 2
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, er panel
Owner signature: Date: A. Fee,for branch circuits with
❑ APPLICANT ❑ ";CONTACT. PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits (:,/ _ 1
without service 4b64
ice or feeder fee, ) ✓.r 2
Contact name: first branch circuit 1
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax:: ( )
Reconnect only 66.85 2
E -mail: - Pump or irrigation circle 53.40 2
• .:CONTRACTOR : _Sign or outline lighting 53.40
Business name: y� / '? Signal circuit(s) or limited -
G �- / C�i 1 ' / -- L - energy panel, alteration, or
Address: / 5 t `Z 5 , , fin L X. (..3 extension. Describe: Page 2 2
City /State/ZIP: C-,' a ce 6/47‘.2._ 6)C e % 7C) J5 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (57i) 05.A0-' '1 �j ` -%fe Fax: (.`J2P,) leS - ' - /
7 Investigation per hour (1 hnnin) 62.50
CCB Lic.: �
.�Cry'� .. Electrical Lic.: • -. c_ Suprv. Lic.: SC ' _5 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES •
Suprv. Electrician signature, required: 1 I E. 18
'�� l(A, ' - Subtotal:
� Date: 1 Plan review (25% of permit fee):
Print name:
— C�1�:✓ N v t s t `, State surcharge (12% of permit fee): ••--( —=
Authorized signature: t 7 I ( TOTAL PERMIT PEE* - ,___. 7. R.. 7 4'...91..-
Print name: � This permit application expires if a permit is not obtained within 180
�.k6� 4 es 136. to t7 t 5 -L Date: 1 1 i s p C, days after it has been accepted as complete. / 2 • Ct a
Number of inspections allowed per permit.
ilRuildin ¢1PennitslEl.f. PermitAnn doe 0511)(06 440.4615Tf1 I /OS /f.OM/WFR
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