Permit ,t® $4 a ii W.
. CITY OF TIGARD ELECTRICAL PERMIT
a .
` , COMMUNITY DEVELOPMENT Permit #: ELC2009 -00424
Date Issued: 08/18/2009
T1G'ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1 S1 8/2009 800
Jurisdiction: Tigard
Site address: 11675 SW 66TH AVE
Subdivision: WEST PORTLAND HEIGHTS Lot: 7
Project: City County Insurance Services
Project Description: Add /alter (11) branch circuits. 8/20/09: ADD (1) 200 amp service.
unimun immumummoimma
Owner: FEES
HAINES BUILDING, LLC Quantity Description Date Amount
PO BOX 428
LAKE OSWEGO, OR 97034 11 crt Branch Circuits 08/18/2009 $113.35
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 08/18/2009 $13.60
Electrical
Contractor: 1 ea Services or Feeders - 200 08/20/2009 $80.30
KEC ELELCTRIC INC amps or less
1281 NE 25TH AVE # K 0 ea 12% State Surcharge - 08/20/2009 $9.64
HILLSBORO, OR 97124 Electrical
PHONE: 503 -439 -0904
FAX: 503 -640 -3838
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $216.89
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 • • - 952-001-010'. 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: /! / lrfeL 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.
'Aug 1 9 2009 9:24 KECELECTR I C 5 0 3 6 4 038 3 8 p . 1
• •
•
Electrical Permit Application Ad d F.: OFF It. F. 1 ISF t /N1.1'
City of Tigard "lr Received .
_......,... Permit No.: E(CA9e) .. to ,,,
,
7 DateiB :
1I 1N ---- . I I 13125 SW Hall Blvd., Tigard, 0 r ,., t, ,,,,„„-, ,, ,s Plan Review
: Phone: 503.639.4171 Fax: 50 - .'' ' ''+ V ';' Date/13 • Other Permit
- II
' i 1 ('; A lZ. )
InspectionLine: 503.639.4175 ,, . - 7. ' • , te ' w. /By: AL...46v ES See Page 2 br
f
Internet: www. tigaid-or.gov Notifiedilviethod: 4 fel" Supplemental information
D...29.P...........—
.1 ................ - it - -lg:::: Ptliiiii!FP:'
El New construction El Addition/alterattan/rdolli pI �hc�k all that apply (submit ast or plams w/itcmz checl�d below):
k i %.";• El Service or feeder 4.00 amps or more 0 Building over three stories.
1:1 Demolition 1:I Other: ''''' ay
n r:ii-v: - : , : , ,7 . i 1,I.,,,, ," where the availab/e fault current 0 Marinas and boatyards.
.;:.....:1: .. ........................................... .. ................... ........................ exceeds 10000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 0 Cammercial-use agricultural
0 1 - and 2-family dwelling CO Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation cif 75 KVA or
larger separately derived system.
:1kitfg1'Eeri 7:..... 0 Addition of new motor load of
Job no.: 09-1050 Job site address: 11675 66th Ave 10011P or more. occupancy.
El Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: Tigard, Or CI Health-care facilities. 0 Supply voltage for more than
['Hazardous location& 600 volts nominal.
Suite/bldg./apt no.: Project name: City County Insurance 0 Senice or feeder 600 amps or more.
ACM ;
Cross streetidirections to job site: pat riptiOR I iQty. I Fret. i Total 1 • 1
New residential single- or multi-family dwelling unit.
Includes attacked garage.
Subdivision: 1 Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft or portion 3340 1
Tax map/parcel no Limited energy, residential
75.00 2
i '''' '.. " -::i ' .?6 • F ' W ' il ' 7..1.." 'ii - ES - bilf#40140.6.ftfOt!ii:44 1 .:U.; " :;:i4L ' ZUMF;74111.1: (with above sq. ft.) .
Limited energy, multi-family -
Remodel TI residential (with above sq. ft) 75.00 2
Services or feeders installation,ulteratton. and/or relocation
' 200 amps or less 1 80 F ft., 2
1 201 amps to 400 amps 106 85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 1 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps 10 400 amps 10030 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
L t MCCA * - Ofiraillgiffeetillig ntOctr tag 0 above service or feeder fee,
6.65 2
each branch circuit
Business name: B. Fee for branch circuits 6
4 ...-
without service or feeder fee, i i 46.85
Contact name: i l bh ircuit
- Each
add'I branch circuit 1 6.65 Pi 2
frrst nuic c sf;90. 9 2
Address:
Miscellaneous (service or feed not included) ?V5
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E-mail: Pump or irrigation circle 53.40 2
Sign nor mililine lighting 5340 2
Signal circuit(s) or limited-
Business name: KEC Electric, Inc energy panel, alteration, or
Address: 761 SW Bailey Ave extension. Describe: Page 2 2
City/State/ZIP: Hillsboro, Or 97123 Each additional inspection over allowable in an of the above
Per inspection 62.50
Phone: (503) 439 1 Fax: (503) 640 Investigation per hour(1 hr min) 62.50
CCU Lie.: 99267 it Electrical Lic.: 4 1/ Suprv. Lic.: 4489S Industrial plant per hour 73.75
- 7:-:i•Z-;:::i:=Wi
Suprv. Electrician signature, required: „is." Subtotal: C11_135 -- I.'
1/
Print name: Kenneth E. Conway Date: 8/13109 Plan review (25% of permit fee):
State surcharge (12% of permit fee): 13.
Authorized signature:
TOTAL PERMIT FEE: 126.9 171,
This permit appticaton expires if a permit is not ohm within 180
Print name: Date:
days after it has been accepted as complete.
• Number of inspections allowed per permit.
1A.BuilaingtPerantshEl.C-PesmitApp floc 0/21/06 440-4615TO I/OS/COM/WEB
itx/ili /A/...b,,/i4Z een/77M _
t_t..../ ie.&
_
4,19•17-A. r .....i..ri 0 °
.6- -cis
, Afrvii,,v e.e-ge-r
CITY OF TIGARD ELECTRICAL PERMIT
t ;_ Permit #: ELC2009-00424
COMMUNITY DEVELOPMENT Date Issued: 08/18/2009
LVARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S136DD03800
Jurisdiction: Tigard
Site address: 11675 SW 66TH AVE
Subdivision: WEST PORTLAND HEIGHTS Lot: 7
Project: City County Insurance Services
Project Description: Add /alter (11) branch circuits.
Owner: FEES
HAINES BUILDING, LLC Quantity Description Date Amount
PO BOX 428
LAKE OSWEGO, OR 97034 11 crt Branch Circuits 08/18/2009 $113.35
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 08/18/2009 $13.60
Electrical
Contractor:
KEC ELELCTRIC INC
1281 NE 25TH AVE # K
HILLSBORO, OR 97124
PHONE: 503 - 439 -0904
FAX: 503 - 640 -3838
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $126.95
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: G ( l i r lX (-1 tOt CLL1 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.
?4ug 14 2Qi�9 8:01 KECELECTRIC 5036403838 p.1
J
Electrical) Permit APnhicat L CEIVED h(1R (11'1.1(1: 1.x1: (
�:: Received �
City of Tigard Date/By A Permit No.: c. K2CCpc r a U
w 13125 5W Hall Blvd., Tigard, OR 97223 r , 1 4 2009 Plan Review �t L' /�
�. . Phone: 503.639.4171 Fax: 503.598 @60 C Date/By: Other Permit: 2 , .�J L lJ
T 1 C A 1 ) Inspection Line: 503.639.4175 Date Ready/By: lath ® See Page 2 for
Internet wt»v.tigard or.gov crr OF TIGr RD Notified/Method: ¶I Supplemental Information
4. . . , .:L;. 1,3F
12 New construction ® Addition/alteration/replacement Please cluck all that apply (submit g nets of pla wtitoms checked below)
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition 0 Other: where the available fault current ❑ Marinas and boatyards.
:r_... t •. , ■, 7 . exceeds 10,000 amps at 350 volts or 0 Floating buildings.
..., . _ ...... .. -. _ .._. __.... . ... ,. lea 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: 0 fire pump. ❑ Installation of 75 KVA or
,.... 1Ti F .1. I.1 4'1A i Emergency system.
separately derived system.
larger pa y d ed stem
_ .' - ?. .., .• ...... : i.. ❑ Addition of new motor load of ❑ A" ' E "L2" "1.3^
loaxP or more. occupancy.
Job no.: 09 - 1050 I Job site address: 11675 66th Ave
CI Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, Or 0 Health -care facilities. 0 Supply voltage for more than
❑ Hazardous locations, 600 trop nominal.
Suite /bidgJapt. no.: I Project name: City County Insurance 0 Service or feeder 600 amps or more:
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Tam 1
New residential single - or multi-family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map/parcel no.: Ea. add') 500 sq. ft. or portion 33.40 _ 1
Limited energy, residential
t : .... ., ��,}, 75.00 2
_- �3E$CH11C'I'I�A1 Q� '�ll ... . _ 3 ""3 1 . (with above sq. ft)
Limited energy, multi - family 75.00 2
Remodel 11 residential (with above sq. ft.)
Services or feeders installation relocation
200 amps or Tess 80.30 2
f ]F P RT OW1!l ..i . :. - . t. , 4 f ..'.. 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /StateJZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or Tess 66.85 t
Owner installation: This installation is being made on property that I own which is i t 201 amps to 400 amps 100 _ 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch Owner signature: Date: A. Fee for bran h circuits n ,,alteration, t or extension, panel
r K l _.'1 ' ° } p, above service or feeder fee,
, T 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 1 46 85 46.85 2
first branch circuit
Address: Each add'I branch circuit 10 6.65 66.50 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax:: ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
Signal circuit(s) or limited -
Business name: KEC Electric, Inc energy panel, alteration or
Address: 761 SW Bailey Ave extension. Describe: Page 2 2
City/State/ZIP: Hillsboro, Or 97123 Each additional inspection over allowable in any of the above
Per Phone: (503) 439-0904 I Fax: (503) 64 Investigation s ti ga i 62.50
nvgatti per hour (1 hr min) 62.50
CCB Lic.: 99267 Electrical Lic.: "4 - 426C Suprv. i 4489S industrial plant per hour 73.75
Suprv. Electrician signature, required: ../!' Subtotal. 113.35
Print name: Kenneth E. Conway Date: 8/13/09
Plan review (25 % of permit fee):
State surcharge (12%ofpermit fee): 13.60
Authorized signature: TOTAL PERMIT FEE: 126.95
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
" Number of inspections allowed per permit.
[: Suildinaermitsl £LC- PermitApp.doc 0527!06 440- 461ST(1IlO5ICOM/SNEB
K" i it^ t l a eof,Loa,