Permit CITY OF TIGARD ELECTRICAL PERMIT
11 • COMMUNITY DEVELOPMENT Permit #: ELC2010 -00492
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/14/2010
Parcel: 2S102AA -ROW
Jurisdiction: Tigard
Site address: 12245 SW MAIN ST
Subdivision: Lot:
Project: Liberty Park
Project Description: Relocating panel. NE end of Main St. at Liberty Park.
Owner: FEES
CITY OF TIGARD Quantity Description Date Amount
13125 SW HALL BLVD
TIGARD, OR 97223 1 ea Services or Feeders - 200 09/14/2010 $100.70
amps or less
PHONE: 503- 639 -4171 1 ea 12% State Surcharge - 09/14/2010 $12.08
Electrical
Contractor:
MR ELECTRIC OF CLARK COUNTY
14300 NE 20TH AVE. D102 -313
VANCOUVER, WA 98686
PHONE: 360 - 574 -7200
FAX: 360- 546 -2158
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $112.78
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 throu. , •AR 952 -001 You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. .
Issued = Ad0■0 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.
Sep. 11. 2010 1:37AM No, 4945 P. 2
Electrical Permit ApplicationpECE� Fo1 0171i1(1', usl: ONLY
City of T Received 4 ,
51 M 13 125 S W Hall Blvd„ Tigard, OR 97223 r planRevie�v
Phone: 503.639.4171 Fax: 503.598.196 C 1 1 0 2010
Date/B ; Other Permit:
1 t (: A I t t) Inspection Line: 503.639.4175 Date Ready/By: lielan El See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE o ' :" ' g ' ION PLAN REVIEW
❑ New construction g Addition /alteration/replacement Please check all that apply (submit 2 seta of plane w /items checked below):
❑ Service or feeder 400 amps or more Q Building over Three stories.
❑ Demolition ❑ Other: where the available Club current ❑ Marinas and boatyards.
CATECORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
• leas to ground, or exceeds 14,000 ❑ Commercial - use agricultural
❑ 1- and 2- family dwelling g Commercial/industrial ❑ Accessory building amps for all otter inatallationa. buildings,
❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION LOCATION ❑ new system. larger E",'1 2 -r system.
' 1 ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3",
Job no.: a..¢. I Job site address: s '7 5 i . 1 M , ( k lime e a rest
occupancy.
1 1 (/� 5 W 1 11J1� s 1 � 1
1 , ❑ Six or more residential units. ❑ Recreational vehicle parks.
Cit y /State /ZIP: �/+ ,^ I O Health-care facilities. 0 Supply voltage for more than
��1 t V 3 ['Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 1 be r - pP;vni( 0 Service or feeder 600 amps or more.
t FEE SCHEDULE
Cross street/directions to job site: SW al 3 }. Dandelion Qlr. I F«. T°ieI Fr' F New residential single- or multi- family dwelling unit.
i, F a La _ In) . Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168,54 4
a add•I 500 sq. ft. or portion 33,92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OP WORK (with above sq. ft)
Limited energy, multi- family
_ P�,boC � an residential (with above sq. ft.) 75,00 2
Services or feeders instaltation alteration, and/or relocation
200 amps or less I 1 100.70 2
11KROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: * v OP' . 0 a • A 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: V ... SW kkik, , c3N, / . Over 1,000 amps or volts , 552.26 2
City/State/ZIP: ; -o / O a - f D. Temporary services or feeders installation, alteration, and/or
ty /State/ZIP: `� c y cy relocation
Phone: ($b3 , t ..ao 0 5 Pax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation iS being made on property that 1 own which is not 401 amps to 599 amps 168,54 2
intended for sale, lease, rent, or exchange, according 10 ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel -
Owner signature: Date: A. Fee for branch circuits with ar. APPLICANT r Q CONTACT PERSON above service or feeder fee. 7 42 2
each branch circuit
Business name: 1' 1 r- v-` e ck r (L QQ G1f�, i \ I � B. Fee for branch circuits without
"t ` service or feeder fcc, first
Contact name: A 4\ / • `J branch circuit 56.18 2
Each edd•I branch circuit 7.42 1 1 2
Address: ‘42 b 0 Ng 90 „ cov _ Miscellaneous (service or feeder not included) _
/Statc/ZIP: Each manufactured or modular 67.84 2
Ci
ry V on( C AN) 'r , W 1•! (7 dwelling, service and/or feeder 67.84 2
Phone: (900) 5 I Fax: ( (�) ■ �] i.d< Recomect
`,, c� Y (sir ✓'I ^ / Pump or irrigation circle 67.84 2
E -mail: OtkI L e e c._ -(` t!..t1Nvn Sign or outline lighting 67.84 2 -
CONTRACTOR Signal circuit(s) or limited- energy
Business name: Y • u . c.,. 4`► ` „- - 0 r r Clay t ( 1.44 4 panel, alteration, or extension. Page 2 2
Each additional inspection over allmvable in any of the above
Address: l� :00 t.....E• 2 A , k -31 Additional inspection (1 hr min) 66.25/ hr
'^ n ,p,� �,(� Investigation (1 hr min) 6625/ hr
City/State/ZIP:
J (^,11 . V ' % ” f lO Industrial plant (1 hr min) 78.18/hr
Phone: g150) a•Q3 Fax: ( 0 rJ " ■ (os Pl 51 Inspections for which no fee is 90.00/ hr
specifically listed ('/n hr min) ,
CCB Lie.: \ Electrical Lie,: ( c t 36 sum, Lic.: 'Sg 0 U $ ELECTRICAL PERMIT FEES
Suprv. El signature, required: Subtotal; UPD ,' Q
_ Plan review (25% of pcmrit fee):
Print name: J ' 1 M lei se ( Date: Ot 110 ' O State surcharge (12% of pcmtit fee): 1 z oryg
TOTAL PERMIT FEE: \ .2. 1.4
Authorized signature: This permit application expires it a permit is not obtained within 180
f �" """ days after It has been accepted as Complete.
Print name: I Date: • Number of inspections allowed per permit.
1:\ u l4inglPermilc\ELC.PermiIApp,doo 07 /01 /10 440- 4615T01 /05/cOWWea
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