Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 00513
T [ GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/21 /2010
Parcel: 2S101AD00400
Jurisdiction: Tigard
Site address: 6655 SW HAMPTON ST 220
Subdivision: Lot: 0
Project: Data Motion Inc
Project Description: (1) branch circuit for TI
Owner: FEES
HAMPTON OAKS LLC Quantity Description Date Amount
6665 SW HAMPTON, 2ND FLOOR
TIGARD, OR 97223 1 crt Branch Circuits 09/21/2010 $56.18
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/21/2010 $6.74
Electrical
Contractor:
FUZION ELECTRIC LLC
21782 SW KRISTIN CT
ALOHA, OR 97006
PHONE: 503 - 528 -6033
FAX: 866 -284 -0482
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 OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature:
.(2S::f........._
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
R'S SIGNAT E Date:
� ( CONTRACTOR INSTALLATION ONLY
IGNATURE OF S 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.
Electrical Permit Applicati f E roll O1:l ICI: (isl.: (>N�►.V
"'•" R eceived �
Ci of Tigard �- Permit No.:
tY g Date/B : 9 �/ /O 4k j C LC c2o / 0 —0 .5
. C ° 13125 SW HaII Blvd., Tigard, OR 97225 E P 2 1 2010 Plan Review ether Perini u���� - Qt�o2��
Phone: 503.639.4171 Fax: 503.598.1960 Date/B :
1.1 C. n l: D 75 CITY OF TIGARD Notified/Method: ot R fur: _ � " S lii p � me n
Internet: www.tigard-or.gov Supplemental Information
BUILDING DIVISIO ��C7
TYPE OF W RK PLAN REVIEW
❑ New construction '_: Addition/alteration/replacement 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 ICommercial/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 ", "1 -2 ", "1 -3 ",
Job no.: Job site address: ( 5 SW AIM n � 5+ • Six or or more. uP�cY
i' n 0 ^ ❑ Six or more residential units. ❑ Recreational vehicle parks.
I
City/State /ZIP: t t� d - a, 2 4 ❑ Health -care facilities. 0 Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 2 Q Project Warne: /d ( p0 on 1 1 ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: J VA P O ( — 002.03 t> «rtption FEE SCHEDULE
Qty. 1 Fee. 1 Total 1 •
k New residential single- or multi- family dwelling unit.
-U /9-7%9 /47tl770 /Ne i Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft)
_ Limited energy, multi - family
T J--
is, d 2 t s 2_ A residential (with above sq. ft.) 75.00 2
/ Services or feeders installation, alteration, and/or relocation
I, Y) net, .) (A)C,, l k 200 amps or less 1 00.70 2
ik PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
P � ,tt (� 401 amps to 600 amps 200.34 2
I
Name: L L. G 601 amps to 1,000 amps 301.04 2
Address: (04 (D 5 5 ( j /-4r 6 t1 Q Z F f cruy - Over 1,000 amps or volts 552.26 2
/� Temporary services or feeders installation, alteration, and/or
City/State /ZIP: �{r d d� 9 �ZZJ relocation
Phone: ( ) J Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I 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, 1 er 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: 13. Fee for branch circuits without
service or feeder fee, first / 56.18 j(p , /2 2
Contact name: branch circuit L
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each 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
Business name: 2i,U(1 0 1PG L LL panel, alteration, or extension. Paget 2
Each additional inspection over allowable in any of the above
Address: Z1 Q Z 5t -) g f 5 r) h G4.- • Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: A- ( O h o , c , 7 a 0 /_ Investigation (1 hr min) 66.25/ hr
1� Industrial plant (1 hr min) 78.18 / hr
(�
Phone: (503) 52,g'• � '33 Fax: ( gb(p) 2_,314 - 0 -I ig 2_ Inspections for which no fee is 90.00 / fica hr
/] �/
specifically listed (h hr min)
CCB Lic.: 1 9 a p- Electrical Lic.: csq / 2/ uprv. Lic.: SS2-$ ELECTRICAL PERMIT FEES
ZV Subtotal: 54 ,. (`6
Suprv. Electnc required: "1- P- 0
Plan review (25% of permit fee):
Print name: 4-6(eff" jb .` Date: cii -id /0 State surcharge (12% of permit fee): `l-°t!0
TOTAL PERMIT FEE: (p 2 • - { r t•
Authorized signature: •. This permit application expires if a permit is not obtained within 180
? / days after it has been accepted as complete.
Print name: prey 1, • r , Date: ^Z Q rl • Number of inspections allowed per permit.
1: 1Building \Pamits\ELC- PormitApp.doc 07/01 /10 440- 4615T(11/05/COM/WEB