Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00646
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/16/2010
TIGARD Parcel: 2S 102AA01100
Jurisdiction: Tigard
Site address: 12047 SW PACIFIC HWY
Project: Tigard Auto Stop - Brake Team Subdivision: Lot: 0
Project Description: Electrical for TI.
Contractor: WHISKEY HILL ELECTRIC INC Owner: TIGARD AUTO STOP PARTNERS
PO BOX 206 2829 RUCKER AVE STE #100
HUBBARD, OR 97032 EVERETT, WA 98201
PHONE: 503 - 981 -4640
PHONE: 503 - 796 -2887
FAX: 503 - 981 -4643
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo /Purchase 11/16/2010 $93.28
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/16/2010 $11.19
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $104.47
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 spt forth in OAR
952 - 001 -0010 through OAR 95 - 01 -0090. Y y d• . - • • •f th • - • •irect questions to OUNC by calling 503.232.1987 or 1.800.332 344.
Issued By: i•!a Permittee Signature: _ • iJ_
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.
.Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard L3+ �CE�ED Received Date /By: 1 f r J r' to t Permit No.: ` 4 ,
° 10_ (C)1 a,
13125 SW 1 -Tall Blvd., Tigard, OR Plan Review frU •
. °_,' Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other.Permit: p, 10 oo - •
TIGARD Inspection Line: 503.639.4175 NO\1 1 5 2 O�O Date Ready /By: Juris: 0 See Page 2 for , 1Q
Internet: www.tigard-or.gov I i Notified/Method: 7 Supplemental Information
c fi ti t Q9T,IG / s Please check all that PLAN REV IEW
�^ . a O�, 3 � �,, � ,a ., ,. , i <, "i. ,��� 4 � `t"�C' : ,: , „ a „ ,.. ,,. M..� .,'; a �.� "••�,
�°�TYP QF F
if y��}� ease cec aa apply su
❑ New construction Addit /. 1 4tirfl4'ep acement PP y ( bmit 2 sets of plans w/ltems checked below :
p )
❑ Service or feeder 460 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
;a o �caNS rRUC�TioN f ' exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
C ORY
"'�� '� " ATE�G ^� "' "'' ' ' t ' �' "' 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: ire pump. Installation of 75 KVA or
❑F ❑
❑Emergency system. larger separately derived system.
i %4 fOSITE •INFO ❑ Addition of new motor load of ❑ `A' "E",
1. C I OOHP or more. occupancy,
Job no. n.....9 7 Job s ite address: /010,40 `W iaae �W
�� 9 / J ❑ Six or more residential units, ❑ Recreational vehicle parks.
❑ Health -care facilities. Supply voltage for more than
• /a
City /State /ZIP: / i l o r+ 1 3
` rf ! 9 a .2
❑ Hazardous locations. 600 volts nominal
Suite /bldg. /apt. no.: Project name % f rd 4 l.,to fT p it ❑ Service or feeder 600 amps or more.
4 EEE, SCHEDtJC f
Cross street /directions to job site: Description I Qty. I Fee. I Total 1 * ,
^_ _ _ _ __ _ - - ._ - - _ __ New residential single- 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 1
Tax map /parcel no.: Limited energy, residential
j� ,� k° �r s '12ESCRIPTION 10 � '' ' w ab s tt . 75.
Limited (ith energy , mult i - family 75,00 2
ELe i' .,rc, f ? _ residential (with above sq. ft.)
I [ Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑rPROPERTY fOW ERA' mo ' / „^ z TENA T _. 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
•
Cit /State /ZIP: Temporary services or feeders installation, alteration, and /or
Y relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
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
,_ r above service feeder fee,
7.42 2
❑' APPLICANT i GO'STuACT= PERSON
,.�,...x ,a„ i, ,,,, , ..,,. ��a.e�, each branch circuit or
Business name: B. Fee for branch circuits without '
service or feeder fee, first 56.18 5 /4 2
Contact name: branch circuit
Each add'I branch circuit S 7.42 37, 76 2
Address: IVliscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67 84 2
Y dwelling, service and/or feeder .
Phone: ( ) Fax: : ( )
Reconnect only 67.84 2
P ump or i rr i gat i on c 67,84 2
E - mail:
Sign or outline lighting
�f 67.84 2
E �r O NTRACT.O�R II I Signal circuit(s) or limited - energy
Business name: O/1
) - SP/ y1ll ieC►if i ' L' panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Po Box 4p le Additional inspection (1 hr min) 66.25/ hr
jbQ C/ c . f✓ a Investigation (1 hr min) 6625/ hr
City /State /ZIP: 9�3 Industrial plant (1 hr min) 78.18/ hr
Phone: ,�b3 9w - v&ve, Fax: (693) q j.- yO 3 Inspections for which no fee is 90.00 / hr
specifically listed (/ hr min)
CCB Lic. /6af fr8s Electrical Lic.: ( �loc /S Suprv. Lic.: , ;,,,sELECTRTCAI. P00IT1FE)H ,,
Suprv. Electrician signature, required: Subtotal: .93, u7
��// `� / , Plan review (25% of permit fee):
Print name:/ jA/ / (7/i; /aS Date: ///////e3 • State surcharge (12 %of permit tee): //, /9
( TOTAL PERMIT FEE: / y�
Authorized signature:
This permit application expires if a permit is not obtainetiwithin 180
days after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit.
I: \Building \Permits \ELC- PermitApp.doc 07/01/10 440 - 4615711 I /05 /COM /WEB