Permit CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT Permit #: ELC2010 -00678
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/08/2010
Parcel: 2S112AA00600
Jurisdiction: Tigard
Site address: 6713 SW BONITA RD 206
Project: Thermal Supply Subdivision: NELSON BUSINESS CENTER Lot: 0
Project Description: TI
Contractor: WILLAMETTE ELECTRIC INC Owner: WALTON CWOR NELSON 13 LLC
PO BOX 230547 BY TTA/EPROPERTYTAX DEPT 735
TIGARD, OR 97281 PO BOX 4900
SCOTTSDALE, AZ 85261
PHONE: 503 - 624 -3631 PHONE:
FAX: 503 - 624 -2938
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 12/08/2010 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/08/2010 $9.41
Type of Use: COM Electrical
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 • • R 952 - 001 -0090. ou may obtain a copy of . _ . - •r • irect questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B �'' 1 Perm ittee 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 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.
12/07/2010 TUE 15:05 FAX 5036242938 Willamette Electric RI 002 /002
Electrical Permit Applica > TOR orrice USE o "ivy v
d 8c N . R eceived • City of Tigard
Permit No.: Datc/B : ON ^ - AI }Y 11 " 13125 SW Hall Blvd., Tigard, OR 9��3(` 7 2010 Plan Review V
Phone: 503.639.4171 Fax: 503.59g:7960 D
Other Permit;
TIGARD Inspection Line: 503.639.4175 Date Ready/13y: Juris: l3 See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information �rtP r �..
'TYPE F� iZ .a. Uiv15i0ra . : `PLAN.. REVIEW
❑ New construction C] 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,
El Demolition El Other: where the. available fault current
Marina and boatyards.
yards. t
. CATEGORI OF 'CONSTRUCTION , exceeds a mps at 150 volts or ❑ Floating buildings.
s to ground , 14,000 {�
less or exceeds 14 0 Commercial-use agricultural
❑ 1- and 2- family dwelling J Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or • ❑ Emergency system. larger separately derived system.
4013 SITE IN •AND LOCA'T'ION ❑ Addition of new motor loa
Job no.: y �� Job site address: 6-7 , j ,� tv 6,. „/� [] Six 1 or more. c eation.
Six orP or more residential units- ❑ R ecreational vehicle parks.
City /State /ZIP: / v (] Health -care facilities. 0 Supply voltage for more than
❑Hazardous locations- 600 volts nominal.
°Suite /bldg -lapt. no ``1 (e, Project name: i � c ❑ Service or feeder 600 amps or more. L. FEE SCHEDULE
Cross street /directions to job s
J Description 1 Qty- I Fee. 1 Total . l :
New residential single- or mulii- family dweiling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel na.: - Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential
DESCRIPTION_ OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
/� residential (with above sq. ft.) _
/ / '✓1 �i�� / r / � ��
1 ~�1 v/�tf- J Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTX 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
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: 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 401 amps to 599 amps 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
❑ APPLICANT .. ❑ `CONT 'PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: B. Fee for branch circuits withou
service or feeder fee, first f 56.18 2
Contact name: • branch circuit
Each add'i branch circuit 3 7.42 .e , ;
2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: JStatelZIP: Each manufactured or modular 67,Sa 2
ty dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67 2
Pump or irrigation circle 67.84 2
E - mail: '
67.84 2
CONTRACTOR
Sign or outline lighting
Si gna l circuit(s) or limited-energy
Business name; Willamette Electric Inc, panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the abov
Address: P.O. Box 230547 Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: Tigard, OR 97281 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
•
Phone: (503) 624 - 3631 Fax: (503) 624 - 2938 Inspections for which no fee is 90.00 / hr
specifically listed (14 hr min)
CCB Lie.: 75059 Electrical Lie -: 34 -283C Suprv. Lic -: 4226 -S ELECTRiCAL. PERMIT FEES L, C _ ` S ubtotal: - Yy
Suprv. Electrician signature, require" �`
d:-
Plan review (25% of permit fee):
Print name: David Fife Date: State surcharge (12 %ofpermit fee): 1 , Z _
TOTAL PERMIT PEE: 65 '7 2..._
•
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: • days after it has been accepted as complete.
Number of inspections allowed per permit,
I:'0 3uilding \Permits'ELC- PnmitApp.doc 07/01/10 440- 4015TO 1 /0S /COMAVEB