Permit
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2010-00014
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/12/2010
Parcel: 1 S136CD01000
Jurisdiction: Tigard
Site address: 11745 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Aarons Furniture
Project Description: Add/alter (15) branch circuits for more lights and additional outlets.
Owner: FEES
MONAGHAN FARMS, INC Quantity Description Date Amount
14120 EAST EVANS AVE
AURORA, CO 80014 15 crt Branch Circuits 01/1212010 $160.06
wo/Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 01/12/2010 $19.21
Electrical
Contractor:
FARWELL PERRY ELECTRIC
2536 NE 10TH AVE
PORTLAND, OR 97212
PHONE: 503-890-2352
FAX: 503-760-8498
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $179.27
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 AR 952-041-0100. 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:
r
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWN SI NATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGN RE OF SUPR. E Date:
LICE SE NO. 4-0
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.
�+ llectracal Permit Applicatio® RECEI\/E1 . FOR Ol O. RA 1' SI O
• Received ��
City of Tigard JAN. Date /By. �:�! Permit] �(..�' l ye_ �) f!� �d/
111 13125`SW.HaII Blvd., Tigard, OR. 97223 HIV 200. Plan Review
Other Permit:
503.639.4171 Fax: 503.598.1960 Date/By; _ _ - __ _ _ -__ -_ P2ot Q.. QQ0 p
f..' _ Phone: - Co
T 1 GA IZ D
Internet: www tigard U1 DING 1 Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: ad la See Page 2 for
or gov B t ill DING DIVISION N Notified/Method: : _ Supplemental Information
—
�1.g ItFt ' 9 1'i�r� 'TSnm XY o ems'. r , ` '" ' +`y'- rd ' ' 't,. w , . 7 5 " ` r ! + R "*
�te 1 7,.. ∎ �, ? e ° TYPE�,OF WORK . v l r 41,t b., . x t t w 4 , .P,LAN RE VIEW," - 4 .. • i
ii A : � a� x�ti � ' :;,*, ., °a ',... . `��7 77 � + ,., ,,p�:s,. � :_ o-, ,�., x � . aJ f a ° .w' +�la yx�v7� , 1 Z ,.,'a . ,c�' �. �..,€ iK .✓. _,.,u,. ., a ., r. i�,.�r,.. ,
❑ New construction ,. Addition/alteration /replacement Please check all that apply (submit2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
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� n I A /, CATEGORY OF. CONSTRUCTION 4''' " � �r :;' 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 '
Ct3 l sir 5 ' r � , , s . ia} 4 t __ h , - ❑ Emergency system. larger separately derived system.
13 � r �., ki w JO B 4 SI TE INFO + LQ,CATIONS 5 r 1 ❑ Addition of new motor load of ❑ "A ", "E , "1 - ", "1 - ",
`" . 1.' S ; w Pa 'Tic w v IOOo or more residential R occupancy.
Job no.: Job site address: i I n
`�- � f ❑ Six or more residential units. ❑Recreational vehicle parks.
City/State /ZIP: r 6 yOreD Oa ❑ Health -care facilities. ❑ Supply voltage for more than
i ❑ Hazardous locations 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
+vi {P" r ,.. eag , . Q E 0$ . 01EDULE x i' e, t-,;� ., :.; ; .A'
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 it or less 168.54 4
Ea. add'I 500 sq. ft. or portion 3 1
Tax map /parcel no.: Limited energy, residential
y' v' i a ice' e t N {r 4.', CRIP„TIONt,OF,rWORK'r, `` r" �' t t ., �`w�a '. 'a with above ft. 67.84 2
Limited energy, multi - family
T t sh k o s A, s +4 fi, sF,a l i ( s9 _)
,pq 67.84 2
i� r tdve_ k+. / A 0 y�" Lttk.5 residential (with abovesq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
q , ;g) r 31 PROPER'Iii 1OW1VERtY Vv s ' ". ,r0 ,; TENANT'pr 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
" s j r N' El 7r '''''''474'4''''''''' a � i f y " auk
0,,,, ,y .1 `{ 4 r P APPLICAN T, i , ! ,r y l il ? m :g l I,� PERSON 7 , s ,g d , ,1 above service or feeder fee,
each branch circuit 7.42 2
Business name: 13. Fee for branch circuits
Contact name: without service or feeder fee, I .
56.18 2
first branch circuit
,
Address: Each add'I branch circuit 14 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
Jl,a ,ki.t ' +1'i xi< ` N,.z e ' . CONT RACTOwra ' aY, " i , ;x ` u, v r' x.`44 Sign or outline lighting 67.84 2
Signal circuit(s) or limited -
Business -name: - 1- 412 ,,, ELL PE EL energy panel, alteration, or
Address: ZS 36 fJ 6 . I Ow Ave_ extension. Describe: Page 2 2
City /State /ZIP: Pp1ze-kA ,,, / ae 9 7j 1 a- Each additional inspection over allowable in any'of the above
Per inspection 66.25
• Phone: (503) sq 0 - 35Z Fax: ( ) 2S — 1 433 - -
Investigation per hour (I hr min) 66.25
CCB Lic.: 9 1 Electrical Lic . _ g Suprv. Lic.: 4067 S Industrial plant per hour 78.18
_ :.K.A1 r(` k ,, 4ELECTRI_CAL iPERMIT5,FEES, Is., "a +, ,
Suprv. Electrician signature, required: Subtotal:
Print name: O �;� �1��� Date: Plan review (25% of permit fee):
` l 3 F. d
Authorizedisi nature: J
State surcharge (12% of permit fee):
--
j
g TOTAL PERMIT FEE: ' "l q , a '7
' This permit application expiresif a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
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