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Permit `', CIT OF ��+��.® ELECTRICAL PERMIT • `•" , -` COMMUNITY DEVELOPMENT Permit #: ELG2010 00336 c • Date Issued: 07/06/2010 ,T1GARlQ) 13125 SW Hall BM., Tigard OR 97223 503.639.4171 Parcel: 2S102BD00701 Jurisdiction: Tigard Site. address: 12785 SW PACIFIC HWY Subdivision: Lot: 0 Project: Spec Space . Project Description: (1)200 amp temporary service Owner: FEES • THE HOLLAND INC Quantity Description Date Amount 109 WEST 17TH STREET VANCOUVER, WA 98660 1 ea 12% State Surcharge - 07/06/2010 $7.12 Electrical PHONE: 1 ea Temp Services or Feeders - 07/06/2010 $59.36 200 amps or less Contractor: ACCURATE ELECTRIC, INC. P.O. BOX 871866 VANCOUVER, WA 98687 PHONE: 360- 567 -3330 FAX: 360 - 567 -3320 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $66.48 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: - Permittee Signature: v>if f`/ c!'9 ' G(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. JUL -01 -2010 16:11 Accurate Electric, In_c. 3 P.003 Electrical Ferl !t Application , ,., ' •!FOR)O [TICE 'USF.ONL;Y' - r rc ;t r '' " Receiv W, 7 4 City of Tigard Permit N Date/13 : osavoi© .-Qog 34 13125 SW Hall Blvd., Tigard, 0 7223 Plan Review a : Phone: 503.639:4171 Fax: 501 $1:960 . 1" Othe ''• _ .., Internet: ww�w.ti 5 a 0 rd or9 ov 5 1 O'O Notified/M eBod: 13 S Ieme t r`o / Date/B : �( 02 T pPae2for. g g JUL pp mentallnformation TYPE OF:'WOI ;PLAN REVIEW � , 1 1. , r trx n CI New construction t1 \ ,r t t nt 'or Please check all that apply (submit 2 sets of plans w /items checked below): ® Addition /a eE�tion /replacement' l BU fl J( DIVISION ❑ Service or feeder amps or more ❑ Butldingover :three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinasand boatyards: - amps ' CATEGORX QF CONS TRUCTION ' . exceeds 10,000 amp at 150 volts or Floating - buildings. zc Its o ❑ °bull 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 ... .:JOB SITE 'INFORMATION AND`LOCATION ':'- Emergency system. Larger separately derived system. ❑Addition of new motor load of ❑ A " , °E" 1 - " , " 1.3 " , Job no.: 10 -1070 Job site address: 12785 SW Pacific Hwy 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 0 Hazardous locations. 600 volts nominal. Suite/bidg. /apt..no.: Project name: Burgerville Shell Reconst ❑ Service or feeder 600 amps or more. FEE :SCHEDULE <." Cross street/directions to job site: Description 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'l 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy;. residential 67.84 • . • " DESCRIPTION. OF. WORK ': (with above sq, ft.), I ' Limited energy, multi - family 67.84 ( 2 Reconstruct shell to original condition residential'(with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 • PROPERTY OWNER l . ❑ TENANT 201 amps to 400 amps 13356 2 401 amps 10 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/or City /State /ZIP: relocation Phone: ( ) Fax: ( ) 200 amps or Tess I 59.36 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 [0; 599 amps 168.54 2 Branch circuits —.new, alteration, or extension, per panel Owner signature:, Date: A. Fee for branch circuits with above service or feeder fee; 'la AP U CONTACT PE' RSON 7.42 2 each branch circuit Business name: B. Fee for branch circuits. without _ service or feeder fee, first 56.18 2 Contact name: branch circuit ■ Each add'I branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) - City/State/ZIP: Each manufactured or modular 67.84 2 ty dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect onl 67.84 , 2 Pump or irrigation circle 67.84 2 E -mail: CONTRACTOR 64 Sign or outline lighting 67. 2 - - - Signal circuit(s) or limited Business name: Accurate Electric, Inc. panel, alteration, or extension. Palle 2 2 Each additional inspection over allowable in any of the above Address: P.O. Box 871866 Additional inspection (1 hr min) 66.25/ hr City/State /ZIP: Vancouver, WA 98687 Investigation (I hr min) 66.25/ hr Industrial. plant (1. hr min) 78.18/ hr Phone: (360) 567 - 3330 Fax: 567 - 3320 Inspections for which no fee is 90.00/ hr _specifically listed,('V hr min) CCB Lic.: 158875 Electrical L'c.: 37 -10 9C Suprv. Lic.: 5094S : - .ELECTRICAL - :PERMIT FEES . . Suprv. Electrician signature, required: .1 1 A Subtotal: 59.36 .4 i Jf 1 ! Planreview (25% of permit fee): Print name: Ken Sweo Date: 7 - - State surcharge (12 %of permit fee): 7.12 a a ^, TOTAL PERMIT FEE: 66':48 a/ Authorized signature: / 1 1 . : This permit application expires if a permit is not obtained within 180 P days afterit has been accepted as complete. Print name: Debi Watts Date: 7 -01 -10 * Number of inspections allowed per permit. 1: Building'Permits ELC- PernritApp.doc 10 440- 4615T(11•05 COM WEB