Permit CITY OF TIGARD ELECTRICAL PERMIT
f ° COMMUNITY DEVELOPMENT Permit #: ELC2010 -00352
T1QARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/09/2010
Parcel: 2S 112AD00900
Jurisdiction: Tigard
Site address: 14800 SW SEQUOIA PKWY
Subdivision: Lot: 0
Project: The Home Depot
•
Project Description: (1) branch circuit for server room HVAC
Owner: FEES
THE HOME DEPOT Quantity Description Date Amount
2455 PACES FERRY RD.
ATLANTA, GA 30339 1 crt Branch Circuits 07/09/2010 $56.18
wo /Purchase Service or
PHONE: 770 -438 -8211 Feeder
1 ea 12% State Surcharge - 07/09/2010 $6.74
Electrical
Contractor:
CHRISTENSON ELECTRIC INC
111 SW COLUMBIA ST, STE 480
PORTLAND, OR 97201
PHONE: 503 -419 -3300
FAX: 503 - 419 -3695
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.
.t,
Issued By: . /If //!_ - Permittee Signature: /Al 11P/ /C4i/r
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 -09 -2010 FRI 02:26 PM CHRI=S ELECTRIC , FAX N0, 95034193695 P. 01/02
JUL 0 9 2010
l)K 111 I I(I Iltil l)\I 1,.'` ,•,
Electrical Permit A lies ion TI QQ��
OF ! f1fl� Received tJ /� /
1 m - i ,•�s�
City of Tigard CITY N �' G
' I • 13125 SW Hall Blvd., Tigard, OR 9722. 1 IILD'NC DI VIS , ,I N " R"vie Other Permit; `
: ®'' Phone: 503.639.4171 Fax; 503.598.1 Datc/B
Date Ready/BY; ® See Page 2 for
j I . . .
f Iii. Inspection Internet. tine: www.ti iird -o r .gov NoNotified/Method: FM Supplemental Information
. mct: tad- o.gov _
E OF WORK • PLAN' REVIEW
Please chock all that apply (submit 3 Seta anions w /atoms checked below):
[j New construction CI Addition /alteration/replacement Q service or feeder 400 amps Of more ❑ !3uilding over three stories,
❑ Demolition b Other where the available fault current ❑ Marinas and boatyards,
exceeds 10,000 amps at 150 volts or 1a Floating buildings.
CA7G e ' Y OF CONSTRUCTION - less to ground, or exceeds 14,000 I7 Commercial -use agricuituml
❑ 1 and 2 family dwelling !� Commercial/industrial ❑ Accessory building amps for all other inslullationa, buildings -
0 Fire �, ❑Installation of 75 KvA or
❑ Multi family ❑ Master builder ❑ Other: I or
derived system,
❑ Emergency system, tie separately
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of CI "A" "E "1 -2 ", "1 -3 ",
' y {� 10011P or more. occupancy
Job nd i ' . j Job site address: 1 LAW �V \y `7a .t�� `
P CI Six or more residential units, ❑ Recreational vehicle parks.
----k , ❑ Hennh -care tiacilities. 13 Supply voltage for more than
City/State/ZIP: 04)4 " `) L (✓i ' ,/,, ❑ Hazardous locations" 600 volts nominal.
_ l / ❑ Sun ice or reader 600 imps or mars.
Suite/bldg./apt. no.: Project name k� Y� _ - FEE SCHEDULE
'1 '� � Deetr lminn I Qty I pee. 1 Tatnl 1
Cross street/directions to job site: Q au c,- \ " i� -- - r- New reaidcntial.sinale- or muld.!amlly dwellIDg.unit. -
— -" --- Includes attached garage.
I,000 sq. ft. or less 168.54 4
Subdivision: Lot no.: Eu. add'/ 500 sq. ft. or portion 33.92 1
Tax map /parcel no Limited energy, residential - 75.00 - 2
DESCRIPTION OF WORK w ith about sg [t )
Limited energy, mufti-family 75.00 2
\ t `_ ; .. 1 , residential (with nbov_c sy. ft1
C ,1}�(l l i-,la� , �C�(/ if`( ..i' �C ) 1.�+ \ �l V' Services ur feeders Installation, alteration. and/or relocadon
200 amps or less
1 00.70
VJv 11 i D•02'� � ' ) 201 amps to 400 amps 133.56 2
CI PROPERTY OWNER • 0 T ENANT 200.34 2
401 amps m 600 amps
Name: -
601 ampa to 1,000 amps 301.04 2
Over 1,000 amps or volts 553.26 , 2
Address: Temporary services or feeders installation, alteration, and /o
City/State/ZIP: relocation —
2 amps ur loss 59.36 1
Phone: ( ) _ I Pax: ( ) - 201 amps to 400 amps 125.08 2_
Owner installation: fins installation i s being made on property that I own w hich i s n ot
401 amps to 599 amps 16854 , 3
intended for sale, (case, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, ur extension, per panel
Date: A. Fee far branch circuits with
Owner signature: � nlmve service or feeder fee, 7 42 2
• ❑ APPLICANT I ❑CONTACT PERSON each branch circuit
B. Fee for brunch circuits without �/
Business name: /1 A: -> t:.7 >l�i✓ ti •C' service or feeder fee, flay, C 56.18 610 tt,8 2
branch circuit _
�, (;� Ea dt add'/ branch circuit 7.42. 2
Contact name: - v'1 " �
Address: Miscellaneous (service or feeder not
Each manufactured or modular 67.84 2
City/State/ZiP: _ dwcllin: service and/or feeder
Reconnect only 67,84 2
Phone: ( ) I Fax: " ( ) Pump or irrigation circle 67,84 2
E- � — Sign or outline lighting
67.84 2
CON1ftACTOR Signet circuit(s) or limited energy
�� l panel, alteration. or extension. Pa- 2
C. 5 ------- ^4 i . usiness name: %l `� -}x ;1A. .9 . i % , .- `ti's - - Eaeb additional inspection over allowable in any of the strov
\ Additional inspection (1 hr min) 66.25 / hr
C Address: `\ 1 3>✓`} 0, ( 1.L � � { . �l _ -- L I Investigation (1 hr min) _ 66.25/ hr
City /State'•/ /.lP � ( ( 1 Gk" OV .t 1 c1;41._) I lndustriW plant (i hr min) 78.18 / hr
� r s (. � (.., ]nspcctians for which no tars is 90,00! hr
Phone: ( CI - E) j } � _{ : ,_ - I ( � i ' srcciIIcal� listed (%hr min)
CCB Lic.' — 1 ,, Electrical Lie.: - ' C) • • t 1(►&�tprv. Lie,: L - 1 2 - 1 ` �
E LECTRICAL PERMIT PEES
, . Subtotal EMU
/� t `, ^ " ^ Plan review (25%of permit fee):
Suprv- Electrician signature, acquired: � � � - �---x _ _ --
r 1 Stott surcharge (12% of permit fee): Print name: ��L •'Q ! _ Date: 4 I I % a TOTAL PERMIT FEE: r- ,(l a, AI
Authorized signature: _ This permit application expiren if a penult is not .. taint within loo
days after it bas been accepted as . mplctc,
Print name: Date. _ • Numbest of inspections allowed per permit. _
" 6,1 /u5it;omAVEn Jv` f
r\ IIuildlnB�enni1611 ?LC.pcnnitApp.doc o7 /OU10 1 1 I + `� - 1 _,