Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 00581
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/21/2010
Parcel: 2S101 BB01400
Jurisdiction: TIGARD
Site address: 12060 SW GARDEN PL, BLDG# 5
Subdivision: PARK 217 Lot: 0
Project: Expressions Printing
Project Description: (1) branch circuit.
Owner: FEES
GVA KIDDER MATHEWS Quantity Description Date Amount
ONE COLUMBIA STREET SUITE 950
PORTLAND, OR 97258 1 crt Branch Circuits 10/21/2010 $56.18
wo /Purchase Service or
PHONE: 503 - 221 -9900 Feeder
1 ea 12% State Surcharge - 10/21/2010 $6.74
Electrical
Contractor:
RELIANT ELECTRIC OF OREGON LLC
20200 SE OLDENBURG LN
SANDY, OR 97055
PHONE: 503 - 701 -4562
FAX: 503 - 668 -4190
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 o • or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: �/ v 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.
Oct 20 10 10:34a Reliant Electric Oregon 503 - 668 -4190 p.1
I S) Electrical Permit Applicatioin t.(�1z 01:1:1(.1.. t , ..1.. 0.1.N
- t•
City of Tigard \ . t+ 1�1[�S/Ltl Permit No.: ic: — .
13125 SW Hall Blvd., Tigard, OR 972 �
r ` 9410-
Phone: 503.639.4171 Fax: 303.598.1 0 •` � o �� .. -i:. °li Pertrtik iGt ,� d
- r 1 c; n „. a inspection Line: 503.639.4175 Q C, .\ C? �` ,'.. - : : Jam: to See Page 2 for
Internet: www.tigar' or.gov ^� \ ``,\• t ppkmrnfalLrfornatton
Ck • TYPE OF WORK 0 % V N GO V 1 PLAN' REVIEW
❑ New construction JE Addition/alteration/repkOnt I Please check all that apply (submit 2 sets of plans whiems cbecked below)
1 ❑ Service or feeder 400 an or more ❑ Building over throe stories.
❑ Demolition ❑ Other: ; whore the available fort current ❑ Marinas and boatyards
CATEGORY OF CONSTRUCTION l exceeds 10,000 amps at 150 volt or ❑ Floating buildings.
less to ground. or exceeds 14.000 ❑ Commereial-use agricultural
❑ 1- and 2- family dwelling ommercial/industrial 0 Accessory building amps for all other installations. buildings.
El Multi-family Master builder ❑ Other: l ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SF E INFORMATION . AND LOCATION
El Emergency of new new systan. larger separately derived system.
❑Additionotorloadof ❑ I:' "A ". " "l- 2 2". "1 -3 "•
Job no.: I Job site address: y 21 (a D 510 �&i P la CC or or more. Re coca ion
l vehicle parks.
0s,.")°- or m are resideetiel units. ❑ Reaoatiom
City/State/MP: Tt /� /jf ,r^ /� D rL C( 7 ❑ Health -care facilities. ❑ Supply voltage for more than
J "`r- y CI Hesardous locations. 60 volts numbed.
['Service or feeder 600 amps or more.
Suite/bldg./apt. no.: Project name: �,�r 35; Ut'v -s " NP
FEE SCHEDULE
Cross street/directions to job site: nemiNWn I our. 1 Rt. 1 Tod 1
New reddential stogie- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft or portion 33.92 l
Tax map/parcel no.: Limited residential
' 67.84 2
DESCRIPTION OF WORK (with above sq. R)
I B ^ I q�-7 .� /� �, �� ) /ranted energy, multi - family 67.84 2
'^ 1 new (/ 1��1 ip /Ilk' residential (with above sq. f.)
liAllf (/ t/t 1 (1, rieto Services or feeders installation, alteration, and/or relocation
200 amps or less 300.70 2
❑PERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders lnatallatioa, alteration, and/or
relocation
t
Phone: ( ) I 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
Owner signature: Date: Branch circuits d— new, alteration, or extension, per panel
J A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: iz a i c 14 or/ / , B . fiwrst Fee for branch circuits �
Contact name: v fender fee, f 56.18 i g' 2
T✓ iihotrr hran b servi or it 5
Address: ] 7 6 e - ty✓f t f e t u •. Each add'/ branch circuit 7.42 2 f
.`1 �^� SS Miscellarwow (service or feeder not included)
City/State/ZIP;/� lj "1 Each
y amodular 67.84 2
Phone: (r�3� $ q /� V
Fax : ) Reconnect only 67.84 2
E -mail: Y Y. (Q ill-S(,'(, ( tt0 I, CeYri Ptunp or irrigation circlo 67.84 2 1 ,
ONTRACPOR Sign or outline lighting 67.84 2
�,f Signal circuits) or limited -
Business name: G aid- Red- E' d- Y(L de Or 1.__L c.... energy panel, alteration. or
Address: extension. Dcsorlbe: Page 2 2
1 !J `
City/State/ZIP: Each additional inspection near allowable In strZot the above
( /j� J (� ���'���� Per inspection 66.25
Plume: ( ) F ax .D ,, �' T 1 L CI Investigation � hour ( hr min ) 1 66.25
I
CCB Lic.: )Wii-G121 Electrical Lie. - i . _ 6 _ S •t, ' - ' 3 3S Industrial plant per hour 78.18
/ ' f 18LECTRICAL PERMIT FEES
Suprv. Electrician signature, required . • /�/ � _ Subtotal: j j,1
II Print name: 1 i p
I �}— Z)—i D Plan review (25%of permit fee): ¢�j-
• '� I t / Date: (/ f{/ t State surcharge (12% of permit fee): 1 '
Authorized signature: - , f l TOTAL PERMIT FEE: 102..
y� o 'llth permi application expires if a permit is not obtained within 189
Print name: S'� 9 yet, pi p l Date: 1 V — 2D - 1 V days after it has ban accepted as complete.
6 .
J
• Number of inspectima allowed par panoit.
t1Buditir PrrmionEl.C•Potaitapp.da 10/01/09 4404615T(1 1105icoarnvEs
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