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Permit a CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2010 -00462 T (G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/31/2010 Parcel: 2S102AC00500 Jurisdiction: Tigard Site address: 12490 SW MAIN ST Subdivision: Lot: 0 Project: Tigard Liquor Store Project Description: Service reconnect only. Owner: FEES WOODARD, CHARLES & ARLIE Quantity Description Date Amount PO BOX 23303 TIGARD, OR 97223 1 ea Reconnect Only 08/31/2010 $67.84 PHONE: 1 ea 12% State Surcharge - 08/31/2010 $8.14 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 $75.98 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 -00 rough OAR -001- 00. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issue 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. 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. Aug. 31. 2010 - 12: 57PM— NORTHSTAR , ,,` : alga : /o 8 � � • OFF1 No. O LY P. 3 uty of II Igard ' E � I ems ° 13125 SW Hall Blvd.. Tigard. OR 97223 —. ° E�CL ©0c , Phone: 503.639.4171 Fax: 503 54 Alan Rcvicw TIGARD Inspection Line: 503.(139.4175 ! F)alC/Fly: — Oilier Permit: .4. . bate Rendyrl)y: Internet: www,ligard- ctr.gov Notilied!Mnhud: N °' ® tiee PageSror ' Supplemental Information J 1N R 1 57 1 1 '' '' "tr PL, EVIEW - El New construction ~' j ®., . 1 tr =. Addiliolt /a heratic r1 rip`('aeeltic'nl Inlc ;: dn all thud aunlytsuhutit? sesafplans „ sehecked het,nvl~ E j Demolition I Other. ❑ hem tee or roetk .dun amps or mom nodding over t sloriCs odium the av ;nlal +Ic milli Current • CAT F C .00 and •. ex ceeds 10,000 amps at 150 volts or 0 Marinas pting.buildias —. • g - - l' - and 2- amilydwellirr Zamm . . • al Accessory building TO gdi ar exceeds 14,000 ❑ Commcrcial•usC agricultural Multi -family roans For alt other installations. building;. $J Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 7i KVA or ❑ Emergency system. larger separnely derived system. JOB SITE INFORMATION AND LOCATION ❑ Additionor new motorloadof Job no.: Job site address: _ D /9r M imp o „norc. 1 / 1219 /� ❑ Sts or more aai,tential uninails. ❑ Recreational vehicle parks. City /StntC/LIP; �7 0 Hea4hrare facilities. ❑ Supply voltage For more than $Ultc/bld /n t.I -: ❑Hazardous location% 600 volts nominal R• P Project name: - 0 Service or reeler 600 mops or morn. Cross strect/directions to job site: - 1------, FEE SCHEDULE — 't; IIMZIM Toml f • New residential single - or multi- family dwelling unit.. r — _ Includes attached garage. Subdivision: Lot nu.: 1.000 sq, ft. or less 145.15 Tax mall /parcel Ito, — Ea. add 'I 500 sq. R. or portion 33.40 . . DESCRIPTION OF WORK Limited energy. residential (wall above SCI. R.) 75.00 7 '� limited energy, multi - family 2 _re5lddntial (wide above s•. ft.) 75.00 /f Lf I'1 /A-.. = Services or feeders iltsralla(1on, alteration. and /or rclocarittn ❑ PROPERTY . r WNER . `. :. ` OG snips or lass 30.30 2 • . . 0 . -. 201 amps to 400 amps_ MI I(16.85 .. Name: 7i)I amps to 600 amps 160 ` • Address: 601 amps to 1.000 amps MI 240.60 2 Over 1.000 amps or volts r 454.65 2 City/State/ZIP: Temporary services or feeders installation. alteration, and/or Phone; ( ) relocation Fax: ( ) 200 amps or 66.85 I 201 am s to 400 am Oer wn installation: This installation is being m property p y ade on ra that I own which is not p Ps 100.30 2 intended for sale. lease, rent. or exchange, according to ORS 447, 449.670, and 701 401 amps to 599 amps 133.75 Z Owner signature: Date: Branch c ircuits — nee alteration. or extension, er .suet ❑APPLICANT — . A rCe f bra C ir c u it s n•i ❑ CONTACT PERSON nbove service or feeder Fee. Business name: _ each branch circuit 6 2 -' - 8 Fee for branch circuits `�ontec` A une; rrirhuur service or feeder fee, • __ asst branch circuit 46 R5 . 2 - Address: Each add'I branch circuit . b._6 2 _5_1_ 2 City/State/ZIP: �f� CCItnneous (ser'icc or Pcedernor included) Each manufactured or modular — Phone: ( ) Fax: : ( ► (Melling. service and /or feeder 90.90 2 tq Reconnect On!) M �/, I E-mail: -• 66.85 � /r 2 p( - _ P u mp nlp Cr irrigation circle 53.40 CONTRACTOR Sign ur outline lighting S: JO i Business name: Signal circuit(s) or limited. NorthStar Electrical Contraclors ener panel. alteration., or • Address: 19450 5W Cipolc Rd, #107 ' Tualatin, OR 97062 extension. Describe: pc l City /Slate/ %1P: (503) 612 -0840 got (503) 612 -0891 . - Each additional inspect over allowable m any of the above • L r ” , - Lic #34 -359C CCU 1190454 Metro # 1911 . I hone: ( ) ��` 1_•. inspection + 62.50 i • • investigation per hou (I h, mini ~L 62.51) • C'('B Lie.: I Electrical Lic.: pry. Lic.: (nduurinf plant per hour - -�. S I- - 73.75 -- �— ' uprv. Electrician signature, required: • L -___ ELECTRICAL PERhIIT FEES . g1( Print name: d�� Subtotal: M ?• 4 EL -�-4E� - Plan review (25% of permit feel: 'I (I El / A uthorized signature: I I---- State surcharge 112%ofpermit fee): ` �{ _ I __ TOTAL PERMIT PEP..: Ee� ;1 en Print name: This permit appI.ca[i0n expire, era permit is not obtained wi tin ' 0 �� 1 Date: - days after it has been accepted as complete. ! ` •BuiWm4;Nvmids °.5/23,06 " Number of inspections allowed per permit 44A.a615T(1 I!avcoxVwEa • •