Permit ni ,q CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00389
TtGRD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 07/28/2010
A
Parcel: 2S102BD00600
Jurisdiction:
Site address: 12725 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Shokohian
Project Description: (9) branch circuits.
Owner: FEES
ADRANGI, FARID Quantity Description Date Amount
4289 ORCHARD WAY
LAKE OSWEGO, OR 97035 9 crt Branch Circuits 07/28/2010 $115.54
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 07/28/2010 $13.86
Electrical
Contractor:
MR ELECTRIC OF CLARK COUNTY
14300 NE 20TH AVE. D102 -313
VANCOUVER, WA 98686
PHONE: 360 - 574 -7200
FAX: 360- 546 -2158
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $129.40
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 O • 952- 001 -0100. You may obtain a • - • • .•. • • • act questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ! � � Permittee Signature: /
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. 24. 2010 4:15AM ).51b ^(3p; No 4387 P. 1
Electrical Permit Application � ANOD xt� rol ti lil i Ilti ()NI I,.
City of Tigard 00lit13� D `a " PemutNo.: e ,& D —CCU
I N
w 13125 SW Hall Blvd„ Tigard, OR 97223 � 1 11 Plan Review
. Phone: 503,639.4171 Fax; 503.598.1960 Q ��1�, Date/13 ; Other Permit:
, I t r k t ' Inspection Line: 503.639.4175 la :us Rcadyll3y; See Page 2 for
Internet: www.tigard•or.gov Ara3 i l.citiifced/Method: / Supplemental Info don
• E OF Informs
PLAN REVIEW
❑ Now construction Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w/ tems checked below);
❑ Service or feeder 400 amps or more ❑ Building Over three stories.
❑ Demolition ❑ Other:
where the available fault current ❑ Marinas and boatyards,
CATE¢ORY OF CONSTRUCTION exceeds 10,000 amps at 150 vo11s or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ commercial-use agricultural
❑ 1- and 2- family dwelling gi 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 1a Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", •'l -2 ", "1 -3•',
Job no.: Job site address: p/l� I001-1P or more. occupancy.
2 1 trtxr {-1 l C. �� �( ❑ Six or more rosidontial units, ❑ Recreational vehicle parks.
City /State/ZIP: "II"
f, � a `r--� _9 l " ❑ Health -care facilities. ❑ Supply voltage for more than
'� ❑ Hazardous locationS, 600vollsnominal.
Suite/b1dg. /apt. no.: Project name: ' ' i S t -)D1Ca ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: i t t , F� Deccrtpnan 1 OM Fee. 1 total I •
�� vvv / l ], V ,/� � New residential single- or multi- family dwelling unit,
Ill ludes attached garage.
Subdivision: Lot no,: 4 W D sq. ft. or less 168.54 4
L` Ea, ndd'I 500 sq, ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
' 6 Limited energy, multi- family
1 2-0 V o 14 O C r • 'f . I a Hbv o �,, r lp u residential (with a sq. ft.) 75.00 2
_-, btu) L ) P Services or feeders installation, alteration, A ndlor relocation
t I 5 L �Vh f3 C i r te ( .I— , 200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 • 2
401 amps to 600 amps 200.34 2
Name: "f f1,n' 5 � t _o aon 601 amps to 1,000 amps 301.04 2
Address: c2.: - + 75 f of ` 6, pruo v Over 1,000 amps or volts 552.26 2
�
f7 � � I Temporary services or feeders Installation, alteration, and/or
City /State /ZIP: 1-1 0( relocation
Phone: (b3) 1 6` , (s-lo l l� I Fax: ( ) 200 amps or loss 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
❑ APPLICANT bove service or feeder rec.
I I ❑ CONTACT PERSON each branch circuit 7.42 2
Business name: My , 4 1,66 B. Fee for branch circuits without
service or feeder fee, first ( 56,18 , lff 2
Contact name: ktS\k� branch circuit
Each add'l branch circuit . g" 7.42 cri,3 2
Address: N kte � ∎D� -3 l Miscellaneous (service or feeder not Included)
City/State/ZIP: cJL� e l 8'( /1
Each manufactured or modular
Cit V
y r O O tV V LO dwelling service and/or feeder 67.84 2
Phone; (563) Q`p 75-S5 I Fax:: Cb 0), -d 1cg Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: 06A S ∎_k c Gt mie to c, i LA • Le7V1A- Sign or outline lighting 67.84 2
CONTRACTOR Si gnal circuit(s) or limited- energy
Business name: r W • f'� r` � �� panel. alteration, or extension. Page 2 2
'�!` Each additional inspection over allowable in any of the above
Address: i LAS 03 cD `e t 1 ) 3 Additional inspection (1 hr min) ' 66.25/hr
City /State /ZIP: -I p Investigation(1 hr min) 66.25/hr
V ��t 6) 1 A U �/' 1 ( h g L S � Industrial plant (1 hr min) 78.18/ hr
Phone: Q5) Diq tc c-s o V) -- Fax: G1 cu -G Inspections for which no fee is 90,00 / hr
specifically listed (t6 hr min)
CCB Lic.: Uocn , C.- Electrical Lic.: ( L Suprv. Lic.: S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required � `- Subtotal: (5 51
JJJ Plan review (25% of permit fee):
Print name: r Y._ - e e Date: J ( b State surcharge (12% of permit fee): . 1 3, Est
( _ TOTAL PERMIT FEE Y °', 14 .6 — (-
Authorized signatur • - . --�
Thtg permit application expires if a permit Is not o it
wlthln 180
jif
Print name: �� �py /
Date: '���3 (� days after It has boon accepted as complete.
s
�� t "J' ' �1L 17 (! Number of inspections allowed per permit.
l:l'Building''ermiI \6J C- perm1lApp.dec 07/01/10 4 4615T(11/05/C0M/WE2
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