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Permit • CITY OF TIGARD pE ELECTRICAL PERMIT { ,. COMMUNITY DEVELOPMENT Permit #: ELC2010 -00292 • TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/16/2010 Parcel: 2S 102AA01100 Jurisdiction: Tigard Site address: 12035 SW PACIFIC HWY A Project: Tigard Auto Stop - Spec Space Subdivision: Lot: 0 Project Description: Move existing service to new location. 7/6/10 changed (4) temporary services to (4) services and charged additional fees B.T. 8/2/11, reinspection fees paid. Contractor: WHISKEY HILL ELECTRIC INC Owner: TIGARD AUTO STOP PARTNERS PO BOX 206 2829 RUCKER AVE STE #100 HUBBARD, OR 97032 EVERETT, WA 98201 P PHONE: 503 - 796 -2887 PHONE: 503 - 981 -4640 FAX: 503 - 981 -4643 FEES Quantity Description Date Amount 4 ea Temp Services or Feeders - 06/16/2010 $237.44 Specifics:, 200 amps or less 8 crt Branch Circuits w /Purchase 06/16/2010 $59.36 Type of Use: COM Service or Feeder Class of Work: ALT 1 ea 12% State Surcharge - 06/16/2010 $35.62 Electrical Type of Const: 165 Electrical Permit 07/06/2010 $165.36 Occupancy Grp: 20 12% State Surcharge - 07/06/2010 $19.85 Electrical 1 ea Reinspection Electrical 07/26/2011 $90.00 1 ea Reinspection 12% Surcharge 07/26/2011 $10.80 11 12% State Surcharge - 08/02/2011 $10.80 Electrical (manual) 1 ea Reinspection Electrical 08/02/2011 $90.00 Total $719.23 Required Items and Reports (Conditions) This permit is '. • - • • - ct 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 - ccordance with •proved 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 la . re• o to follow the rules adopted by the Oregon Utility Notifi - '•n Center. Those rules are set forth in OAR 952-001-0010 thr•ugh OAR 952 -00 -0.90. Y • obtain a co y f the rules or direct questions to OUNC • .••• • - 2,1987 or 1.8Q,0.332.2344. / i /� Issue • By: , Permittee Signa • /� " / i i 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 the next available inspection date. 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. -7/6/ k 041 cAort C(dd, "x i( j :: CITY OF ' TIGAR® ELECTRICAL PERMIT G a Permit #: ELC2010 -00292 COMM UNITY DEVELOPMENT 7 � ,� Date Issued: 06/16/2010 � icAlts 13125 °SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S102AA01100 Jurisdiction: Tigard Site address: 12035SW PACIFIC HWY A Subdivision: Lot: 0 Project: Tigard Auto Stop - Spec Space Project Description: Move existing service to new location. 7/6/10 changed (4) temporary services to (4) services and charged additional fees B.T. • Owner: FEES TIGARD AUTO STOP PARTNERS Quantity Description Date Amount 2829 RUCKER AVE STE #100 EVERETT, WA 98201 4 ea Temp Services or Feeders - 06/16/2010 $237.44 200 amps or less PHONE: 503 - 796 - 2887 8 crt Branch Circuits w /Purchase 06/16/2010 $59.36 Service or Feeder 1 ea 12% State Surcharge - 06/16/2010 $35.62 Contractor: Electrical WHISKEY HILL ELECTRIC INC 165 da Electrical Permit 07/06/2010 $165.36 PO BOX 206 20 da 12% State Surcharge - 07/06/2010 $19.85 HUBBARD, OR 97032 Electrical PHONE: 503- 981 -4640 FAX: 503- 981 -4643 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $517.63 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. Y a c.: • o the les or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. 1 Issued Byc `Z���� ./r�� Permittee Signature: ��� OWNER INSTALLATION ONLY The installation :is being- made•on property I own which is not intended for sale, lease or rent. OWNERS 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 day. This permit card shall be kept in a conspicuous place on the job site until completion:of the Approved plans are required on the job site at the time of each inspection. � ' '�,' CITY OF TIGARD ELECTRICAL PERMIT : . = COMMUNITY DEVELOPMENT Permit #: ELC2010 -00292 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/16/2010 Parcel: 2S 102AA01100 Jurisdiction: Tigard Site address: 12035 SW PACIFIC HWY A Subdivision: Lot: 0 Project: Tigard Auto Stop - Spec Space Project Description: Move existing service to new location. Owner: FEES TIGARD AUTO STOP PARTNERS Quantity Description Date Amount 2829 RUCKER AVE STE #100 EVERETT, WA 98201 4 ea Temp Services or Feeders - 06/16/2010 $237.44 200 amps or less PHONE: 503 796 - 2887 8 crt Branch Circuits w /Purchase 06/16/2010 $59.36 Service or Feeder 1 ea 12% State Surcharge - 06/16/2010 $35.62 Contractor: Electrical WHISKEY HILL ELECTRIC INC PO BOX 206 HUBBARD, OR 97032 PHONE: 503 -981 -4640 FAX: 503 - 981 -4643 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $332.42 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: e Permittee Signature: / ,G' 6 A/ 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. Electrical Permit Application ` ., �� #0 Y , 1 e FOR OFF : Ic , ON LI ,4{ \xi a n\` s'tM e,., ,,,.., % 11 I 2 2 8 Of TI B h'd , Tigard, OR 97 ` a `O Date/13 .' Permit No.:. 1 i ReceiVed g 23. - 6 i•• Plan Review II Phone: 503.639.4171' Fax: 503.598.160 0 „, iw!go DateB : Other Permit: l' I G A R D Inspection Line:. 503.639.4175 J r` IN' '' r, a ate Ready/By: I ® See Page 2 for Internet: www.tigard or : gov Q ' � `� \S` Notified/Method: K Supplemental Information ^; TYPE OF W. O RK< �,•= 4t) y • PLAN;,REYIEW ❑ New construction ❑ Addition/alteration /r `lacement Please'check all that apply (submit 2 sets of plans w /items checked'below).. ❑Service or feeder 400 amps or more ❑ Building over three stories. ❑ ❑ Other,: where the available fault current ❑ Marinas and boatyards. ' CATEGORY ,OF CONSTRUCTION, • • - - 't exceeds;10,000 amps at 150 volts or ❑ Floating buildings: - less to ground, or exceeds 14,000 ❑ Commercial -use agricultural 0 , 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ' 0 Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVF.•or ' . J `SITE. INFO * +I OCATIQN ❑' Emergency system. larger derived system. ' • . _ ,• - , ' : ❑ Addition of new motor load of ❑ "A” "E" "1 -2" "1 -3" 'Job no Job site address: 100IIP or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: Project name: 0 Service or feeder 600 ampsor more. _ _ . ' ' FEE SCHEDULE ' - Cross street/directions to job site: Descri - 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'! 500 sq. ft. or portion 33.92 ' 1 Tax map /parcel no.: . Limited energy, residential 67:84 2 `DESCRIPTION 'OF' WORK, - _4 above ve sq. ft.) Li mited energy, multi - family 67 :84 ' 2 OAJ ee it )V i/i ia'S /L,' residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 0 S' /(/ rai v s 200 amps or less 100:70 11,0 ,3g 2 )❑ PROPERTY .OWNER 1 ❑ TENANT . 201 amps to 400 amps 133`56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 55226 2 City/State/ZIP: /State /ZIP: Temporary services or feeders installation, alteration, and /or Y relocation Phone: ( ) Fax: ( ) 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. Feefor•branch circuits with • ❑ APPLICANT 0V CON .PERSON feeder f 7.42 2 . above service'or feed fee, • • • __- - -- - *- - each branch circuit Business name: WVI / 64.7 L/ /./ B. Fee for branch circuits without / j (J7 service or, feeder fee, first Contact nam e: branch circuit 56.18 2 Each'add'I branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) C i /State /ZIP: Each manufactured or modular tY dwelling, service and/or:feeder 67.84 , 2 Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 • Pump or irrigation circle 67.84 2 E-mail: Sign or outline lighting 67.84 2 ' 'CONTRACTOR ' _ - „ =' , . t Signal circuit(s) or limited- energy Business name: / s panel, alteration, or, extension. Page 2 2 P.t/�i #( Each additional inspection over allowable in any of the above Address: Additional inspection (1 hr min) 66.25/ hr City /State /ZIP: Investigation. (1' hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr specifically listed (%3 hr min) CCB.Lic.: Electrical Lic.: Suprv. Lic.: •,.- `• ELECTRICAL ",PERMIT =FEES- y Suprv. Electrician signature, required: o Subtotal: (p j „ Plan review (25% of permit fee): Prints name: Date: State surcharge (12% of permit fee): 1 C(,, TOTAL PERMIT FEE: If S .4_ AuthOfized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: • Number of inspections allowed per permit. tABuilding1Permits $ELC- PermitApp.doc 10101/09 440- 4615T(11/05/COM /WEB 06/14/2010 12:16 5039814643 WHISKEY HILL ELECTRI PAGE 02/02 Electrical Permit Application .. _f 'TOR OFFICE (15F. ONi Y 1111 . City of Tigard JUN 1 5 2010 Received y Permit No E_ 0. 0/ 13125 SW HMI Blvd„ Tigard, OR 97223 Plan Review li' • Phone; 503,639.4171 Fax; 5O3,598,196 Datc/By, OtherPennh: T 1 G A RD inspection I.,inc: 503,639.4175 • • • : Date Randy/By: Jurr 0 gee 1'aLK. 2 for Internet www tignrd- or,gov Notified/Method: mental ( , �C Supple Informntlan � :i A t v;� yy}} t ^� ll , 8 .1,.a, 4IY � l ' ° �,.�il �Y 1 �p�y ryy7jyM�yi�1( y��y('{�, w . .1 r J y M y ., ry 1 , ,�l t,.W tiY r t i k, k 4 , 4 IG4a, 4 I!, y , t LW I ., ,t , ti, f , i , :411 4aI 1 y i t e . 13,, P 1 7 tly vf,{?mi ,..: 7�y, I y , y 1 1{ ;1 r 7 rt '� Y 1 r re71JR ^ W ' #' r � .•,. ux. ;. , .• „ xl;d; "��( l�.u..�.r„s::. ..,' 4 1 ,, .�.,f__. ,'�, �.'� : .. .t: ^�' { "It 7� „: i "or7°'i � . »i • a,t*. ❑ NeW ConStructinn IS] Addit ion /alteration /replacement incase check all Mai apply (submit g acts of plans Whims checked below): ❑ Scrvicc or feeder 400 amps or MOM El T nildini over :Firm stories, 0 Demolition ❑ Other whore the available fault current �Marinns b•t"• r, z <r • - lt 7utdbnnlyards. !ON: , t a h . . ✓ r " % ' ° , 7 ' 7 , l , . ( -... I , exceeds 10.000 am nt I 50 volts or ❑ Floating buildings, �' � �-d� � a a � �`' ' c�), � ��ts`1E�'�r9�' u r ;�, ± r >t � n ` less to ground, or exceeds 14,000 ❑ emitmereinl• use ngricuinunt ❑ I— Find 2- family dwelling El Commercial/industrial ❑ Accessory building amps rar all other installations, buitdimp. ❑ MuIti- family ❑ Master builder El Other: ❑ fire pump. ❑ installation of 75 KVA or 10' ^ l 1 °t4" ; ' 9 ,1;1 , r ; I � ,; 0 Emergency system. hr r ec amtcl derived s at, 4W ; r 141 1' yl � %i l ,L 1 , =,11 '1L1e, b ?. `44 1, , '. , ���__YYi r,r n° r r gre y .:s .,r:,,::r}.... ,_ ., ..., , r, Iw ..,..M,.. �c,et. r , i. +1,(.. TMt~r, r. "•' ❑ Addition of now motor lard of ❑ .. „ « _ Job no.; Job site address: 12035 SW Pacific Hwy IN or more. occupancy. — — -- _ . O Six 0r or more residentinl units. Ci Rccreationnl vehicle narks, C4/State /7VP: Tigard Or 97 ❑ Hc,•dtli - c;7re facilities. ❑ supply voltage for mare than / f — /� ❑ T rclattic Iocationa 600 veil, ncmmnl Suite/bldg, /apt, no.; ii Projec m Tigard AutoJ.di ' t ♦ -...- ❑ Service or feeder 600 a mps or more z ,, r'1L r LLk`.1J+ 014 St woo a; 9� c Cross street /directions Lo ,job site: Greenberg Rd ._ 1� 4/L - r� " - ' � /ti ---- .� sacri a'mt QtY. I Fee. Tntnl . New residential single- or multi - family dwelling unit. C _ 40 et L-e__—. includes attached garage. Subdivision: _ot no.: 1,000 sq. ft. or less 168,54 4 "'" — Ea, acicl'I 500 sq, f, or p011100 33.92 1 Tax map /parcel no.: Limited energy residential ",�G Ertl a� i ' 1 it'°? 1 °, r 67.84 1 , IF ON, r" . , 1' ',Y ? 1jatil,l' IV � 6KNOM.Ri + k' ?'11 It i t 'P �i ' ..4 (with above ft, 2 Limited energy, multi- family Move cxisHn service to n location 67,84 2 g residential (with above sq, R) Services nr feeders installation, alteration, and /or rclocntlon k 200 amps or less 100,70 2 '! (n l �1 t 1 46^r'i /.rM�ll 1'v '°,+1 �, , M ' + �'�'II. ,.<5 Tr)y�P Ira, Wkda 1 Ptf :i i i. , Xrk 201 imps to 400 amps 133.56 2 � y 1 � °.. ' t.W, T' d, �I. Name: 401 amps 10 600 amps 200,34 2 ...r. 601 amps to 1,000 amps 301,01 2 Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders Installation, alteration, and /or City/State /ZiP: _ relocation Phone: ( ) F ( ) 200 amps or loss 4 59,36 237.44 1 Owner installation: This instnllat:ion is being made on property that I own which is not 201 amps to •1.00 amps 125 2 intended for salt, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 899 amps I66.S4 2 Branch circuits- new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with a g r {;t' t�}11 r a(: a q� i ry , hF (st +l t 7 , r 11 I. 9 y a serv or feeder fee, R 5936 2 r ' ." l : r POlti rls� +,,E ta,^ t?Wi I rt l /1 , C i titgb "l 7.42 i ,., , t , r , „,. „r' ., : �I. 1 H each branch circuit Business name: B Fee for branch circuits N'ythot,l — service or feeder lee, first COnteet name: branch circuit 56.18 2 •"-• - . pact, add branch circuit 7.42 2 Address : — Miscellaneous (service or feeder not included) Each manufactured or modular t City /Statc/7,IP: dwelling, service and /or fccdcr 67.84 2 Phone: ( ) Fax: : ( ) Reconnect only 67,84 2 f mail Pump or irrigation circle 67.84 2 "1 '{ '' i1WPmI v'1t,7¢'tf <' 4�: , tft0. UiA Ir r a( <�, I J, f :a. G" }'f "! Mt PP q Sign or outline lighting 67,84 2 ,r r r 7 + ' `f"R I '1,11,1 , ,;t �' '� r ' I to t SS l' *'� •�._ ,�',., a9 a � ' � „„�.,.d', � ^ �n ,i,l , ,;+, „7,�, 1'II' Signal Clf011ll(S) or limited n»n� L A , It 01 v� '.,.. P,i, ^, r; n panel alteration, or extension. I Page 2 2 Business name: Whiskey 1TiIl Electric Inc 1 I _ g -- knell additional inspection over allowable in any of the abov Address: PO Box 206 Additional inspection (1 hr min) _ 66.25/ hr investigation (1 hr min) 66,25/ hr City /State /ZiP; Hubbard Oregon 97032 Industrial plant (1 hr mitt) 78.18 / hr Phone: (503) 9814640 l=ax: (503) 981 -4643 Inspections for which no fee Is 90,00/ hr s ecifcall hated (' /: hr min) CCB Lic,: 162985 i. Electrical Lic,: C36 10”. l Suprv, Lic.: 4621S cV ,A,,1V,t ;k1ii, Xti ITgl. yjCc�,Gr�l ?kll ,EL''SX1,111 A1Ma' Subtotal; 2.96,80 Suprv. Electrician signature, required: Plan review (25% of permit Pee) Print name: Curl Cribbins Date: fi /i4 /10 State surcharge (12% permit fee); 35.62 TOTAL PI RMIT PEP: 332,42 Authorized signature: This permit nppticatlon expires Ira permit is nor obtained within IAa days niter it has been accepted as complete. Print name: Date: ° Number of Inspections nllowcd per permit. 1; 1n f■lllrc \rtrmitsNELC_PcrmIIApp, <Inr 7 /OI/Q9 44n 41111T(1 /05/CUM /WE 07/26/2011 12:49 5039814643 WHISKEY HILL ELECTRI PAGE 02/02 Electrical 'ermlI'l,�i�� ��ft P Yir roll orrl - :E l"isl': (.)N IN City of ' 'i e. R.cccivcd IN 1111 r�rldr;y P lan Review - - Permit Nn.: . 13125 SW Hall Bi i i eOltt ( {,cam - /C-4)72g.), of 4 / Phone: 503.639,4171 Fax; 501M4,260 ' Dote /By: Other Permit: T T G A R D inspe ctipn lint rO> f rill Dote Ready /By: Jun 0 gee Page 22 for Intcmct: WVVW. . - ro .40/0 -.� �Notilicd/Mcthod: Supplemental Information 1 1 • ' . Th'Pt i3r. ;WORic .. • ' • : , PLAN itvirtV± . : • • [i New construction Addition /alteration /replacement. Please check all that apply (submit 2 sets nfplans w /items checked below): 0 Service or ree 400 amps nr mere ❑ Building ov three Stories, Demolition thee: whore the nvailmhlo Ifiult current ❑ Mnrinna and boatyards. . • • • .CAT OR'V O" 'CONS R 1 'TiC71}i' , ' amps a exceeds 10,000 am 150 volts or ❑ Floating buildings. less to wound, or exceeds 14,000 ❑ Cum inercinl -use agrim,hnril ❑ 1- maid 2- family dwelling ; Commercial /industrial ❑ Accessory building amps for nli other inshdintiens. buildings. ❑ Multi- fanlily ❑ Master builder ❑ Other; ©Fircpump. C:l Installation of 75 KVA or . 1'0 6 S 11! IN.Pdk A tION " 'LOCAtiON ' ❑ rmcrgcncy system. larger separately derived system, ❑ Addition of new motor lead a ❑ "A", "R. "1•2• "1 -3" Jo a.; Job site address: 63:5 tL �y�S '` I I00HP OT Mort. occupancy, o /_ ^J "` � 8a",,, /Ti L' El Six or more residential units. ❑ Recreational vehicle parks, :z./lP. 7iP; / , ❑ I lcnith -cure facilities. ❑ Su pp Y I volts c for mere than g � �.�y t "Inaardmts lentins. 4110 volts nominal, no.: 'reject nn.rne7ts0. -_•. `I_CC(d�LV ❑ Service or feeder 600 mints or more. Cross strcct/directi0ns to jab site: neacription FEE SCREIQ1 u • iL T;,mi New residential! single- or multi- family dwelling unit, Includes attached garage. Subdivision; Let no.; 1,000 sq, it, or icss :68.54 4 On. add i 500 sq. ft. or portion 33,92 1 Limited energy, residential 'ax map /parcel no.: -•' AJESCIt tPrItiN •pr WOIRf ..... 75.00 2 " (with above Limited energy, multi-tinnily / 91 residential (with above sq. Et.) 75.00 2 / 1 r4 x.11 . Y , .. . i .D , / Services or feeders installation, alteration, and /or relocation 200 amps or less 100,70 2 I ti+'- —. •:, .. El T NAN1 201 amps to 400 amps 133.56 2 Ni1tnC; 401 amps to 600 amps 20(1.34 2 601 amps to 1 ,000 amps 301.04 2 Address: Over 1,000 amps or volts 552,20 2 City/State/71P: Temporary services or feeders installation, alteration, and /or �� relocation Phone; ( ) Fax: ( ) 200 amps or less 59,36 I 201 • Owner installation: This installation is being made on property that i own which is not 4 0 p s to 5g9 amps to 400 amps 125.08 6 8 54 2 intended for sale, lease. rent, or exchange, according 1:o ORS 447, 449. 670, and 701. Branch am amps I f,,R.54 2 Branch circuits - new alteration, or ex tension, per panel Owner signature: ,,,,• Date: A. Fec for branch circ with above service or feeder Ice, 7.42 2 �]; '/11�X t:1Z"A1V'1 : 1:1 CCSI�.TAC I' .l'I;ItS1)li' each brunch circuit Business Warne; B. Fee for branch circuits without -- .. - service or feeder fee, first Contact name: branch circuit 56,18 2 ' Rich add'I brunch circuit 7,42 2 Address; T Miscellaneous (service or feeder not included Fitch manufactured or modular 2 C ity /Sta1.e /71P, dwctlip, service and/or Feeder' Phone; ( ) Fax:: ( ) Reconnect only 07,84 2 E -mail: "� Pump or irrigation circle 67.84 2 • signor outline lighting 67,84 2 ' • • _ • CONTRACTOR ' Signal circuit(s) or limited - energy f;1,tCinCSS name: /� �, t /? �� r panel, alteration, or extension. Pa c 2 2 / Each additional inspection over allowable in any of the above Address: W 49 i ,l 1 �� Additional inspection (I hr min City /State /7_1P: r 0,7-4?/ t I hr min) 78,18/ hr r (�� Industrial plant (I lir min) 78,18 / hr Phone: -3) if /— /1�2 ax: (3) inspections for which n fee is �(!� F — °jy i 9 0,00/ hr ° (a: -LY '' specifically lined (h hr min) CCB Lic,/ta98 Electrical Lic ": C' Suprv. Lie,: ' / 5 , • • . :.ELEC`I'.IGIL..PERM.... k9. ' • . . Suprv. Electrician signature, required: Suhtnlal; ��� � Plan review (25% of permit Tee): Print nom / / - D a . t e : S t a t e surchar a 12% of Pee - WM / TOTAL PERMIT FEE; 40 0 Authorized signature: ,nature: This permit application expiera if a permit Is not obtained within 180 Print name.`; 17a1:e: y days after it has been accepted an complain. .. Number of Inspecn allowed per permit. 1:1Ateilding ernita,F.1.C- PermimAmr.dnc P7/el /1e 4 -0 6 I17( /COM /wF.H Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORKONL'I's V 1 Fee for all residential systems combined $67.84 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK :ONLY:: Fee for each commercial $67.84 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I: \ Building \Permits\ELC- PermitApp.doc 10/01/09