Permit CITY OF TIGARD ELECTRICAL PERMIT
a COMMUNITY DEVELOPMENT Permit #: ELC2010 -00510
T t G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/17/2010
I ;
Parcel: 1 S135BD00300
Jurisdiction: Tigard
Site address: 9735 SW SHADY LN 200
Subdivision: TIGARD MEDICAL MALL Lot: 0
Project: Tigard Medical Mall
Project Description: Reconnecting split system.
Owner: FEES
MCFADDEN, ARTHUR L Quantity Description Date Amount
BY ERIC SKLARZ, 621 SW MORRISON ST STE
#800 1 crt Branch Circuits 09/17/2010 $56.18
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/17/2010 $6.74
Electrical
Contractor:
WILLAMETTE HVAC
3075 SW 234TH AVE. #206
HILLSBORO, OR 97123
PHONE: 503 - 628 -6841
FAX: 503 -848 -2597
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. 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 through 2- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1 . 0 0 . 3 3 2 . 4 / //
Issued By C/ 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.
Electrical Permit Application FOR OFFICE USE ONLY
111 q City of Tigard \10,T3 Date /B Received 1 , Permit No.: Lo-- taf� ' tv
13125 SW Hall Blvd., Tigard, OR 972 G Plan Review
Phone: 503.639.4171 Fax: 503.598.1 6 �0 Date /By: Other Permit: �G /. f U — `( - T 1 GAR D Inspection Line: 503.639 G` �� V Date Ready /By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov S P ap Notified /Method: TX..-(p 1 Supplemental Information
INI , TYPE OF WORK 0, • O` , o k 1 S�Ot1 PLAN REVIEW
G V , �
❑ New construction [Addition /alteration. a nt Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps 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 buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E - ', "I - 14 ,
Job no.: Job site address: IOOFIP or more. occupancy.
C� • / J J L> (' I ❑ Recreational vehicle a
0 Six or more residential units. parks.
P�
G' ❑ Health -care facilities. ❑ Supply voltage for more than
City/State/ZIP: /J ❑ Hazardous locations. 600 volts nominal.
&I/bldg./apt. no.: 50i� Project name: 'r���_ -p 7''„ l ❑ Service or feeder 600 amps or more.
�` FEE SCHEDULE
Cross street /directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 "
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1 , 000 sq ft or less 168 4 -
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
&Li above Limited energy, multi-famil 75.00 2
residential (with sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT • 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1.000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 125.08 2
intended for sale. lease, rent, or exchange, according to ORS 447, 449, 670. and 701. 401 amps to 599 amps 168.54 2
Branch circuits— new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: 4 - / :_,e.<'4 B. Fee for branch circuits without
I service or feeder fee, first r�
Contact name:
branch circuit 56.18 % • 1y/ 2
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: manufactured or modular 67.84 2
dwelling, service and/or feeder
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
panel, alteration, or extension. Page 2 2
Business name: �. Ili (� - f f ; • J��w� r L L r; • Each additional inspection over allowable in any of the above
2
Address: 0 7 c s (, ' f. /
- . ' s, / 06 Additional inspection (1 hr min) 66.25/ hr
City/Statc/ZIP: . . '3 Investigation (1 hr min) 66.25/ hr
l,/��,,yzIJ fJ 1 () 7 Industrial plant (1 hr min) 78.18/ hr •
Phone: (V ) ( 3 - - ,) .F Fax: f X r/R ' - 2 7 I nspections for wh ich no fee is 90.00 / hr
specifically listed (/2 hr min)
CCB Lic.: S % 7 i � Electrical Lic.: J ' r ' 4 J r r Su pry Lic.: tic') S ELECTRICAL PERMIT FEES
� /,'
Suprv. Electrician signature. required: � o i l�
• P lan review (25% of per
mit Subtotal: 6
fee):
Print name: Date: _1 / ./O State surcharge (12% of permit fee): G - 7'1
TOTAL PERMIT FEE: (.
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: * Number of inspect allowed per permit.
1: \Buildinu \Permits \ Eli-Permit App.doc 07/01/10 440 -461 ST( II /05 /COf11/WEB