Permit �', .. CITY OF TIGARD ELECTRICAL PERMIT
* . , COMMUNITY DEVELOPMENT Permit #: ELC2
o10 00426
:TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/19/2010
Parcel: 2S112DD01601
Jurisdiction: Tigard
Site address: 15755 SW SEQUOIA PKWY 100
Subdivision: Lot: 0
Project: Bridgeport MRI
Project Description: (1) branch circuit for xray HVAC system.
Owner:
FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 1 crt Branch Circuits 08/19/2010 $56.18
PHONE: 503 - 624 - 6300 wo /Purchase Service or
Feeder
1 ea 12% State Surcharge - 08/19/2010 $6.74
Contractor: Electrical
OREGON ELECTRIC GROUP
1709 SE 3RD AVE
PORTLAND, OR 97124
PHONE: 503 - 234 -9900
FAX: 503 - 535 -2763
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. NI 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 -00 -6 100. 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: ■
/_„,„-
j, Ot /4L! �
Permittee Signature: /�/V i / / -ti
/° L-/ (iq -- %JO/V
OWNER INSTALLATION ONLY
The installation is being made on property l own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
CaII 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.
Electrical Permit Aipplieatio .1', - i O12 01 1 ICI l OyJ.a ,
ReiLw / �t/ fJ
City O� Tigard 0//0 Q a � � � ' Penns No (�2. D V D
Da
v 13125 SW Llalt Blvd., Tigard. OR 97 AUG 17 2 1 - -
: -' ' r 9 '' Phone: 503.639.4171 Fax: 503.598.1960 Dale/Hy. Other Penni!:
;:r.', v , 1. D: Inspection Line: 503.639.4175 - ,, ' Date Ready /By: 3 wt ri1 See Page 2 for
_ Internet: www.tigard -or.gov ;, Notified/Method: / Supplemental Information
PE- - • T"1' OF PLAN 2EYIEW ,. !
[] New construction . 12 Addition /alteration /replacement Please check all that apply (submit 2 sets of Mans w/items checked below):
❑ Service or feeder 400 mops or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildin( .
less to gro und, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I - and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Mulh family ❑ Master builder ❑ Other ❑ Fire pump. ❑ Installation of 75 KVA or
larger irate.( wive. r .
JOB SI'J L INFORMAf ON AND LOCATION f system. motor load of ❑ "A °F" `1 -2' d "1-3".
d system.
t
Emergency ;t•
_ ❑Addition o
) "� "7 C Job site address: /5-76-5-5z1,10. 100FIP or snore. occupancy.
Job no.:
/ t 1 r buy Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: jj flcahh -care facilities, ❑ Supply voltage for more than
. l c ¢} s � :i y" ::. / - t 1 7 Z 2. Ilacardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: ' U Project name :' j . '" 7 - . w ❑ Service or feeder 600 amps or more,
( u ! S Cc'•- �c,t`t bv�l F _ iE ErSG HE DUC;'.'
Cross street/directions to job site -!_ 821 - Po IZT. _rig ' `� Description 1 Qty, I Fee. 1 Taal l k
r New residential single- or multi - family dwelling unit.
I Includes attached garage.
t 1,000 sq. R. or less 168.54 4
Subdivision: Lai f .: _._.
- - -- _ - _.._ - -- • • - Ea. add'l 500 sq. (1. or portion 33.92 1
Tax map/parcel no.: l� & e limited energy, residential --__ --
t 75
DES Of WARK I • (with above s 1. f1. ) - --
______. _�_ _- -_ (� _ � Limited energy, multi - family -- - -^ 75.00 �
X.. . Y2 N j 1 .., ,r '\(. - "V t. W ,, \ _ • residential (with above sq. II.)
'
- 7: - � ` .e t4� 1 t>n . ervices or feeders installation, alteration, and/or relocation
. . , 11" F� L so r less
100.70 2
i
(]' PROI!I RTY OWNER 'I'! NAN ; .' ) 1' amps o amps __ 133.56 2
t 400
401 amps t` 600 amps 200,34 2
Name: - 1 ! _t i.1 - 601 amps(, 1,000 amps 30L04 2
Address: Over 1,0 amps or volts 552.26 2
/ _ . 6 '" 0 Tem, rary services or feeders installation, alteration, and/or
City /State/ZIP: r• � anon
Phase: ( ) J Fax: ( - • i 200 amps or less 5 9.36 1
201 amps to 400 amps r 125.08 2
Owner installation: This instaliati is being made on prope y t t own which ' of - 1
intended for sale, lease, rent, or exc . nge, according to ORS 447, 449 670, 01. 401 amps to 599 amps 168.54 2
Branch circuits - new alteration, or ex tension, per panel
Owner signature: - __. - 1: - - __ ___ A. Fce for branch circuits with
;7� abo se or feed f ee,
C: ` APP[ APPLICANT 4 CONTACT.'!?it5G1N 7.42 2
. - �w_ - each branch circuit
Business name: B. Fcc for branch circuits without
.- -- service or feeder fee, first j 56.18 �° 2
branch ` X9 °t
Contact name: _
-- - Each add'( branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
manufactured - Each
City /State/ZIP: - -�- dwelling, service and/or fecdcr
67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
--- Pump or irrigation circle 67.84 2
E-mail: Sign or outline lighting 67.84 2
- . - ' _ -CONTRACTOR.- .
_ Signal circuit(s) or limited-energy
Business name: /^� �� 1 r panel, alteration, or extension. Page 2 2
t-�ie 0 i ,`. (.1 �
Each additional inspection over allowable in any of the above
Address: !' c1 c- --3 ,_ i- �.l�d�. Additional inspection (1 hr min) 66.25/ hr
________
City /State/ZIF:: , t '��f�-. i ` C) g--)c9 I' `{ Investigation(1hrmin) 66.25/ hr
�' _ Industrial plant (1 hr olio) 78.18/ lir
Phone: (so ) e .93 V 7 400 Fax: (cam ) 3 I' I d Inspections for which no fee is 90.00/ hr
F specifically fisted (' /t hr min) • CCB Lic.: 670-3 9t. ,1/ p ctrical Lic.: _ 9 6 -• J ej : uprv, Lic.: t(• ` •e; _ .. `- : FI - ,ECTRICAIL:". PERMIT FEES
[ Subtotal: >~
Suprv. Electrician sigttatu, t, : , ' - �Cn le., � it _/ f f - 1 r : r Plan review (25`%gofperrnrt fee):
Print name: iY ickr , L 1 q i�.1 R 0....._ ? i s :, + ` ,; State surcharge (12 % of permit fee): c" " 74(
r a permit Is not obtained within I s expires TOTAL. PERMIT FEE: �i t.....--"' Author ized signature: � ;
� , . �� T hls permit application H' ttO
P t��
Date: �l `' ) L J days after it has been accepted as complete.
Print name:
�'tl� Y (Ai €„ l �� �� it)� c - * Number of inspections allowed per permit.
l::Building`t'eni iis`•tiLC -Per nitApp.duc O7:0 1fit) 4404615T(111051COM%WCB