Permit CITY OF TIGARD ELECTRICAL PERMIT
B. COMMUNITY DEVELOPMENT Permit #: ELC2010 00607
T i G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/29/2010
Parcel: 2S102AD03450
Jurisdiction: Tigard
Site address: 8777 SW BURNHAM ST
Subdivision: Lot: 0
Project: City of Tigard
Project Description: (4) circuits to power pole.
Owner: FEES
TIGARD, CITY OF & Quantity Description Date Amount
TIGARD WATER DISTRICT ET AL, 13125 SW
HALL BLVD 4 crt Branch Circuits 10/29/2010 $78.44
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/29/2010 $9.41
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 $87.85
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 obt,'n A rnp of the rules or direct questions to OUNC by calling 5' 6.6699 or 1.800.332.2344.
i r
Issued B . / - i_ - Permittee Signature: — / i —
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.28. 2010 11:17PM No. 5388 P. 2
Electrical Permit Application I(12 OFFICE UST. ONLY
City of Tigard RECEIVE E , ' M t►e s1iM perm. No,; , , _ d14 7
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ether permit:
T
Phone: 503.718.2439 Fax: 503.598.1960 Dale/B
TI i ,\ I t l t Inspection Line: 503.639.4175 0 C I 2 8 2 011 Dale ReadyBy: ® See Page 2 for
Internet: www.tigard Notified/tvfcthod: Supplementallnformation
TYPE OF woR4'TY OF TIGAiw PLAN REVIEW
❑ New construction Addition /alterat t etItl�gpIVISION Please check all that apply (submit 2 sets of plans wfilms* checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards,
CATEGORY OF CONSTRUCTION exceeds 10.000 amps al 150 voles or ❑ Floating buildings.
less to ground, or exceeds 14.000 0 Commercial - use agrioullural
❑ 1- and 2- family dwelling ,Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: I] Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION
13 Emergency system. larger separately derived system.
['Addition of new motor load of 0 "A'. "E". "1 -2 ". "1 -3 ".
Job no.: Job sift address: T T
�O ' �^ n Ur n �� . 100HP or morn. o ecreah
(� /
Ut/ p 0 Six or more residential units. 0 Recreational vehicle parks.
City/State /ZIP: ` �/ 1` V` /, (j /� ^ ❑ Health -care facilities. ❑ Supply voltage for more than
� °� ['Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ['Service or 18eder 600 amps or more
� FEE SCHEDULE
V
Cross street/directions to job site:. 31,0 acid r ontelation 1 OW. I Fee. I Total 1
V r�Y 7 New residential single - or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. edd'I 500 sq. R. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft,) 75.00 2
Limited energy, multi - family 75.00 2
1(\k l-, . r n t t k Ap ( , `-"' , 3 Q y- T` n � . residential (with above sq. R.)
" {' Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: ( \ i Dc ` ar d 601 amps to 1,000 amps 301.04 2
Address: `3 \( W g \\1 • Over 1,000 amps or volts 552.26 2
M S Temporary services or feeders installation, alteration, and/or
City/State/ZIP: A V ar a 01_ 0C1 a 3 relocation
Phone: (5'O3)' tyi; V 11 Fax: ( • ) 200 amps or less 59.36 t
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
401 amps to 599 tunes 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
ct APPLICANT I ❑ CONTACT PERSON above service Or feeder fee,
each branch circuit 7.42 2
/� '
Business name: lea \1GnLD d gzl t La 1 W `- ` e 4, ,, ye . D �pt 13. Fee for branch circuits tvithenr
service or feeder fee. first i
Contact name:
� t branch circuit 56.18 2
LM OD � Each add'I branch Circuit 3 7.42 2
Address: `L.f JOO N� (9,01:1- Av L , 1'�OZ - 1" Miscellaneous (service or feeder not included)
V f Q Each manufactured or modular
City/State /Z1P: \u6ApJ f VON eat* dwelling, service and/or feeder 67.84 2
V (AY -P
Phone: ( 3) P 1 VJ ..-q S I Fax: : ( ) Reconnect only 67.84 2
, � 1 Pump or irrigation circle 67.84 2
E - mail: C r j e UG-f\v e te(_-F c_. - c O Sign or outlinelighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
►� �`''., 013. A My • panel, alteration, or extension. _ Page 2 2
Business name:
`Lt � ate cal, �- °"LnC rA.PC'h'►' Each additional Inspection over allowable In any of the above
Address: r (1 3 U t i ( ;)awk e DI ea_ - sl 3 Additional inspection (1 Isr min) 66.25/ hr
City/State /ZIP: V C \' e r ` � J A Industriapla(lhrrtwr) 78.18/ hr
[/v l Industrial plant (t hr min) 78.18/ hr
Phone: )) De t _ S.5 %! L
Fax: b r 'j, t J Inspections for which no fee is
" l specifically listed (t4 hr min) 90.00/ hr
Cal Lic.;' Electrical Lic.� Suprv. Lie.: `s ELECTRICAL PERMIT FEES
Subtotal:
Suprv. Electrician signature, required: Plan review (25% of permit fee): ��
• Print namo J; M 1 . /' I Date: 11,�'� - 9 State surcharge (12 %ofpermit fee): t � �
1 V l TOTAL PERMIT FEE:
Authorized signature: This penult application expires if a permit is not obtained wlrhla 180
days after it has been accepted as complete.
Print name: I Date: a Number of inspections allowed per permit.
isnuilding \PormiIS\ELC- Pami,App.doc 07/01/10 4.10.4615T(1I/OS/COMAVO
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