Permit CITY OF TIGARD ELECTRICAL PERMIT
11 • COMMUNITY DEVELOPMENT Permit #: ELC2010 -00640
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/10/2010
Parcel: 2S101 DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY
Project: Triangle Pointe Subdivision: FARMERS INSURANCE Lot: 0
Project Description: (2) branch circuits for pumps in boiler room.
Contractor: GLOBAL ELECTRIC, INC. Owner: TRIANGLE POINTE LLC
PO BOX 162 901 NE GLISAN ST #100
NORTH PLAINS, OR 97133 PORTLAND, OR 97232
PHONE: 503 - 647 -5650 PHONE:
FAX: 503 - 647 -5649
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 11/10/2010 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/10/2010 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules- are set forth in OAR
952- 001 -0010 through • 52- 001 -0090. You may obtain a co. • . 11178r43• direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344
Issued By.-' � /� �- — _ Permittee Signature: / /�. •� =cf
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept In a conspicuous place on the Job site until completion of the project
Approved plans are required on the job site at the time of each inspection.
From: 11/09/2010 17:19 #692 P.002/002
Electrical Permit Applicat ;C �t �' ', - V. K a i + 1 3
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13125 SW Hall Blvd., Tigard, OR 9722 v ., Q` ] J /$ � Permit No
t ✓ ] . a g , ,C Date /By: �l / 4 / ( Q f y l�Cw ICJ 00 (Ji ya
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ky Plan Review 503.639.4171 Fax: 503 598. I , ri ° � c, � Date /By. Other Permit
lal'� It+t)' Inspection Line: 503.639.4175 f3' N1 Date Ready/By: furis 63 See Page 2 for
Internet: www.tigard C �` (3� Notified /Method: �G/ Supplemental Information
a TYPE OF W10\-' \� PLAN REVIEW
❑ New construction Er Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
13 Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑Other:
where the available fault current ❑ Marinas and boatyards.
CATS RY 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 rot 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. largo separately derived system
T ❑ Addition of new motor load of 3 St ❑ "A" "F " I I a"
Job no.: Job site address: /333 St,/ 6 g RA,/ 100HP or more. occupancy
❑ Sis or more residential units. ❑ Recreational vehicle parks.
--- •
City /Statc'Z1P: ! �7 fl.
❑ Heahh -care facilities. ❑ Supply voltage for more than
.."- ❑ Hazardous locations. 600 volts nominal
Suite/bldg. /apt. no.: '' Project name: �„,,.„`�,, to�,y t C ❑ Service or feeder 600 amps or more
i _ FEE SCHEDULE
Cross street /directions to job site: tkurlption 1 Qtv. 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 145.15 4
Ea. add'i 500 sq. fl. or pnnion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTIO OF WORK (with above sq. fl.) 75.00 2
( Limited energy, multi- family
h 6 / Cie 13 /"[3S PA t 1.1,! ttborvN residential (with above sq. fl ) 75.00 2
Services or feeders installation alteration and/or relocation
t ile ✓ 200 amps or less 80.30 2
0
❑ PROPERTY WNEIt 1 ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1.000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or ex tension, per panel
1 - — A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6 2
Business name: B. Fee for branch circuits
without service or feeder fee.
Contact name: first branch circuit 46 ..- lie K 250
Address: Each add'l branch circuit 1 6.65 .... „,11. 4 e - 2 7 1-tr
Miscellaneous (service or feeder not included)
,•.I City/State/ZIP: Each manufactured or modular 90 2
Phone:
dwelling, service and/or feeder
! ( ) Fax: : ( ) Reconnect only 66.85 2
n•. E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.4(1 2
Business name: 4L // 3A L FL E / !t (C . 1 - NC . Signal circuit(s) r limited-
energy panel, alteeration, or
Address: PO Al tiX �d extension. Describe: I Page 2 I 2
f c ,,Z
City /State/ZIP: ^/T'ji /'LA/ OA e7 7/ 33 Each additional inspection over allowable inan \ of the above
V Phone: (503 ) E'f7- 5'L3'O Fax: (5i ) L'9 - 7 ',5't `11 Per inspection 62.50
Investigation per hour (I hr min) 62.50
CCB Lic.: /.j g 92. F Electrical Lic.: 31-e 5,5C Suprv. Lic.: nj CS Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 4 G O
Subtotal: JJ
r �„ Date: Plan review (25 %ofpennit fee):
Print name: J4,5'7 s lei2. �) � State surcharge (12% of permit fee): f - 7(p 3
Authorized signature: TOTAL PERMIT FEE: 51 - -?
•
Print name: t / This permit application expires if a permit is not o ed within 180
]/l,'i i a/ S!P / !vy D ate: !/
days after it has been accepted as complete.