Permit CITY OF TIGARD ELECTRICAL PERMIT
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a • COMMUNITY DEVELOPMENT Permit #: ELC2010 -00483
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/08/2010
Parcel: 2S101 BD00105
Jurisdiction: Tigard
Site address: 12805 SW 77TH PL
Subdivision: Lot: 0
Project: Terex
Project Description: (8) branch circuits to replace existing HID fixtures with new T5 2x4 fixtures.
Owner: FEES
B R & G CO LLC Quantity Description Date Amount
2240 SUMMIT CT
LAKE OSWEGO, OR 97034 8 crt Branch Circuits 09/08/2010 $108.12
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/08/2010 $12.97
Electrical
Contractor:
SYLVANIA LIGHTING SERVICES INC
12535 NE MARX ST
PORTLAND, OR 97230
PHONE: 503 - 262 -8177
FAX: 503- 262 -8401
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $121.09
Required Items and Reports (Conditions)
This permit is issue• • •• • •e regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in a • • •ante with approve. plans. This permit will expire if work is not started within 180 days of issuance, or if w is suspended for more the 180
days. ATT• TION: Oregon law requ =- • • • follow the rules adopted by the Oregon Utility Notification Cente ose r are set forth in OAR
952-001-1010 thro h OAR 952 -001 -0 . • Yo /. ay .btain a copy of the rules or direct questions to OUNC by calling 503.246.6 1.800.3 . 4.
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Issue By: / �.��../ Permittee Si 9 nature: /�
— IMP/
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 IN TALLATION ONLY
i
SIGNATURE OF SUPR. ELE • Date: 9 8 e
LICENSE NO.
Ca11 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.
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-� �, ELECTRICAL PERMIT APPLICATI n1
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j - 1 T • ' • rtland, Oregon - Bureau of NEAR:A_ ervices
e , . alligas 1900 SW 4th Avenue, Portland, Oregon 97201. 503-823-7363 • FAX 503-8 1 c I 503423 -6868 • www.portlandonline.comlbds
Type of work Plan Review
U New construction Addition /alteration /replacementBUIt-U , lease check all that apply
U Demolition U Other. (.1 Fire pump V Building over three stories
Category of construction over
U Emergency system U Service or feeder 600 amps
❑ Addition of new motor load of
❑ 1 & 2 family dwelling €ommercial /industrial ❑ Accessory building 100 HP or more U Commercial use agricultural
Li Multifamily ❑Master builder CI Other:
U Patient area health care facility buildings
❑ Installation of 150 KVA or larger
Job site information and location ❑ Hazardous locations separately derived system
Job no.: Job address: is 80s S IL/ 77 a Noce- U Recreational vehide parks U A, E. 1- 2,'1 -3' occupancies
City/State/ZIP: Po RTj,0- 6✓ ,j 0 ie- 7�d
93 ❑ Marinas and boatyards ❑ Service or feeder 400 amps
or more where the available
❑ Floating buildings
Suite/bldg. /apt. no.: 'Project name: I- - X _ fault current exceeds 10.000
� �� U Si or more residential units amps at 150 volts or less
Cross street/directions to job site: U Supply over 600 volts nominal to ground, or exceeds
14,000 amps for all other
Subdivision: Lot no. Tax map /parcel no. U voluntary plan review installations
Submit 2 sets of plans with any of the above.
Description of work (example: 3 circuits for basement receptacles) The above are not applicable to temporary construction service.
/• . • (QJ- 0 / F rr,ge" , Z Tft // Fee' Schedule ,
co a. J tR- Xy •� T , -4 Descri • ion Qty. Fee Total ••
Residential single or multifamily dwelling unit.
U Reference RS / Combination Permit no. Includes attached garage.
1,000 sq. ft. or less $217 4
`. Pr ^pa ty owner , .. • • Tenant • Each added 500 sq. ft. or portion $ 47
Name: ■9"m9 A R-hOper • Limited energy, residential $ 47 2
• Limited energy, multifamily $ 47 2
Address: Services or feeders installation, alteration, and/or relocation
City /State /ZIP: 200 amps $111 2
201 to 400 amps 6159 2
Phone: I FAX: 401 to 600 amps $208 2
Owner installation: This installation is being made on property that I own, which is not intended for sale, lease, rent, 601 amps to 1,000 amps $315 2
or exchange. Over 1,000 am•s or volts $578 2
• er si• nature: Date: Temporary services or feeders installation, alteration, and /or .
i: Contractor • Subcontractor relocation
200 amps or less $ 99 2
Business name: 5/ / AIL/ p. L /6 k K.) 4 6E1E60_6 /4. 201 amps to 400 amps $150 ■ 2
Address: a S 3 r N� / a �r _ 401a m•sto600am•s $190 2
i\. Branch'circuits — new, alteration, or extension, per panel
City /State /ZIP: p 7Z, 0 I . 9 ?01-30 \ AFee for branch circuits with
service or feeder fee, each $10 2
\ branch circuit
Phone: ,c03 FAX: �3 - e l— A \
�� FAX t 2 —e B.Fee for branch circuits without
Elec. lic. no. C Sy 1 1 I ( CCB tic. no. r Pa. ° service or bran fee, first 2
D Each additional branch circuit :I 4-
Metro or City lic no. _ / ate:
Supervising electricia "V Miscellaneous (service or feeder not included)
Signature, required: . — Each manufactured or modular
6128 2
91.5 dwelling, service nd/or feeder
Print name: 727r)dTA V fa-AA 0� ���
License no. Reconnect only $101 1
C /O 0 0 Pump or irrigation circle $ 61 2
Authorized signature: Sign or outline lighting $ 81 2
Print name: cJ+E' C-tJA ' ' / Date: 9 Signal d t(s) or limited- energy $ 81 2
panel, alters , or extension.
■ Applicant !• Contact Person • Describe:
Business name: Sy tf'N4 if f6 !/-T_/_►t� Hourly rate: $116
L Each additional inspection over'allowable in any of the above
Contact name: W E After?... Per inspection $ 79
Address: /AS ,(JE /� Investigation fee
j'� " "� Other
City /State /ZIP: 1/� ca ) D�. ' 2 Electrical permit fees' y
Phone: 693 —02A2--49 - �, I FAX: 1723 Z-�y� Subtotal kg/ C
E mail: .�R.� r /'4 . 6/14fip,A- @ / , j }�j * _ Cp P lan review (25% of permit fee) — ®�' ��, • 17
Y State surcharge (12% of permit fee)
Credit Card ❑ Trust ❑ RS Permit/No Fees Due ❑ TOTAL PERMIT FEE �� ,
;-
This permit application expires If a permit Is not obtained within 180 days after it has Fee methodology set by Tri County Building Industry Service Board
been accepted as complete ^ Number of inspections allowed per permit.
insp pemrtapp_electricat 06122109
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