Permit CITY OF TIGARD ELECTRICAL PERMIT
i3 • COMMUNITY DEVELOPMENT Permit #: ELC2010 -00463
TIGA R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/31/2010
Parcel: 2S102AC00500
Jurisdiction: Tigard
Site address: 12492 SW MAIN ST
Subdivision: Lot: 0
Project: Dolan Glass
Project Description: Conversion - overhead to underground.
Owner: FEES
WOODARD, CHARLES L AND ARLIE C Quantity Description Date Amount
PO BOX 23303
TIGARD, OR 97223 1 ea Services or Feeders - 200 08/31/2010 $100.70
amps or less
PHONE: 1 ea 12% State Surcharge - 08/31/2010 $12.08
Electrical
Contractor:
NORTHSTAR ELECTRICAL CONTRACTORS
19450 SW CIPOLE RD, STE 107
TUALATIN, OR 97062
PHONE: 503 - 612 -0840
FAX: 503 - 612 -0891
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $112.78
Required Items and Reports (Conditions)
This permit i • _ • • • to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done ' accordance with = _ •roved •tans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. TTENTION: Oregon la quir s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - %01 -0010 through OAR 952-4% ' 0100. Yo a obtain a copy of the rules or direct questions to OUNC by ca ' 0 .246.6699 or 1.800.332.2344.
•
Is ued By: _ .41.4.-...‘ Permittee S . • ture: � .0 ,4
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' . . i 1 v pw 1 _ 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.
Au g. 31. 2010 12:56PM NORTHSTA,4
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1 -; cr'''' f 3/ id Permit Nos&C 60
. q 13125 SW Half Blvd.., Ti -
gard, OR 97223
III well .:
Plait Review --
2 • • Phone: 503.639.4171 Fax7 503 598,1960 A : ! --, .,. .: , - .- , mid Oilier Permit
TIGARD ay.
Inspection Linc: 503.639.4175 * ' '-- - ' Dam Readytny. turn. fa Sec Page 2 for
Internet www,tigard-or.go Nedikatmeniod: Su pplemental information
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T OF W.2Nithat,z2,1-r A t/./ym PLAN REV1Ew
i...r —
El New construction ddit ion/alteration/rep lacement l'I''''.,' tiL all I'm "nnl Oubmil 2 S'Is a 02. %%Inca* ebeeketli
0 Net% me or feedet um amps Or mord 0 Building mar dove stories
0 Demolition -„ Other:
miler': the ;wadable !eels current 0 mannas and boatyards.
• - 1 ' • CAT C 1 ' OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
• . .
_ _1.ei_tti grouncLore.xceeils-1 -13-Commereial.nsrogricuil tool — — --- - - E - 1 - - - ersd - 24amilrdwelling — W - C - 'ornmErcialtintInstrial - 0 - AlfeeSs77 riiMirTg —
amps tor au other installations. buildings.
0 Multi-family 1 Master builder 0 Other: 0 Fire uump. 0 Installation of 75 KVA or -
•
0 Emergency system. forger separately derived syslein
JOH SITE INFORMATION AND LOCATION • 0 Addition of new motor load of
A iMEIN A M
Job no.: -sr A Job site address: 2-6.t,1 I 00HP or more. occupancy.
0 six or more residenoni unju.
Ci ty/Stare/ZIP; ' 11 1
• • Hl
i • 0 eath- f t
care aciliies.
0 klairo.loos locations. 0 Recreational vehicle parks.
0 Supply voltage for more than
600 volts nominal.
SuiterbItigJapt. no.: Project mune: __ 0 serviee or ['ceder 600 ampx tir more.
FEE SCHEDULF. % • -- ‘—..- 4- 4r
Cross streetidireCriOns to job site: i / 11/
New residential single- or multi-family dwelling unit.
Includes attached garage.
-
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea add*/ 500 sq. ft. or portion 1--- 33.40 I
Tax Map/parcel no.:
Limited energy. residential
• . . DESCRIPTION OF WORK . iwnh ahoxe sq. R.) 75.00 2
•
r f /S/1/F74(0e1/ i ValliCrP - Limited cnerP,y, multi-family
_lesidentiallwith above sk ft) 75.00 2
i 1 7 ' i NO . Services or feeders installation., siren ion, and/or I ati . /
200 amps or less
':-.'
O pRoitity 61 - .: :: ' • . . ::::. - •.- 121• TENANT • - • ,.. — .- ... 20 t amps to 400 amps 7 106.85 . 2
- -•• "
_ . ... .... ' _•4i./1-ainps to 600 amps . - ... 160.60 . . 2
Name: • .
— — -- 001 amps to 1.000 amps . • . 240.60 •.. 2
_
Address:
• Over 1,000 amps or volts 454,65 2
— — ,
City/State/ZIP: Temporary services or feeders Installation. alteration, and/ or
. . . relocation
Phone: ( ) .1 Fax: ( ) 200 lungs or Icss 66.85 I
Owner installation: This installation is being made on property that 1 own whi 201 atnps to 400 amps 100.30 2 ch is not ,
intended for sale, lease. rent. or exchange, according to ORS 447, 449. 670. and 701 - .101 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension: ter •ancI
Owner sig - nature: Date; _
A re.c for branch circuits with
0 APPLICANT p CONTACT PERSON above service or feeder fee, 6.65
_ each branch circuit 2
Business name:
. - 13 Fee for branch circuits
C:Oniact nine; -. ':',,/so,,, ':',,/so,,, service or feeder fee.
2
fUsi brancn circuit
Address: . Each add] branch circuit 6.65 2
— Nlisrellaneous (service or feeder not included)
City/State/ZIP;
' Each manufactured or modular
feeder 90.90 ! .)
(twain- sem= and/or
Phone: ( I j Fax: : ( )
ReCOOdecl 0n1) b6.85 2
_
E-mail: - Pp or irrigation circle 53,40 ' ,
um ___
CONTRACTOR Sign or outline lighting .53.40 2
--
Business name: Signal circuit(s) or limited-
North.Star Electrical Contractors energy panel. alteration. or
Address: 19450 SW Cipole Rd, 0107 extension. Describe: Pose 2 2
Tualatin. OR 97062 .—
City/State/ZIP: (503) 612-0840 Fax (503)612-0891 Cach additional inspection over allowable in an of the above
• - -
Lie #34-359C MB 490454 Metro 41911 l'cr in __
spection . ....r 62.50
_,..,_______
Phone: ( • /
'0
I- •------- 0 • — • . - . . . ' . ' ' - 1.. ovestigalion per hour t i lir mini
62.)
— -- -. — d
...,,,,.: . ._
, Electrical Lie.: i pry. Lic.: s 1iostria. m
11( . 1 1
p' per hour 73.75 1
,.. ..•.__
L____ ELECTRIZAL PERMIT FEES . . .. 1/M TD
Suprv. Electrician signature, required: , Subtotal
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— - -- : —
Print name: Date
Plan review (25% of permit fee): 0 q
a G •
• . l• " Se surcha (12% of p /
ermit fee): e ilir o 4" ,all •
A
Authorized signature: l tat surc TOTAI, PERMIT FEE: VP ,--,-,
4 . : 0
— . .- ---- .
MI N permit al Mika 6011 expires if a permit is not obtain Ix hin 1 n
Print name' Dane:
days after il has been 2trepted as complete.
' .
^ No:nisei or in onowod per permit.
I '.DuildingloreretaLC-PermitApp.doe 05/23/06 .1.1n,i5iSTrtitoWOMAvER •
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