Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 00682
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/10/2010
�1 ARI Parcel: 2S102AC00800
Jurisdiction: Tigard
Site address: 12555 SW MAIN ST
Project: MyConnect LLC Subdivision: Lot: 0
Project Description: (1) branch circuit for additional plugs.
Contractor: WILLAMETTE ELECTRIC INC Owner: HEUVELHORST, MICHAEL J
PO BOX 230547 C/0 KADEY, GEORGE S JR
TIGARD, OR 97281 12551 SW MAIN ST
TIGARD, OR 97223
PHONE: 503 - 624 -3631 PHONE:
FAX: 503 - 624 -2938
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 12/10/201D $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/10/2010 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports (Conditions)
This permit is 'ssued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. At work will
be done ' accordanc ith 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. TENTION: Orego la. -.uir-= you to follow the rules adopted by the Oregon Utility No' -, '• Center. Those rules are set forth in OAR
952 -001 0010th•\ ugh OAR 95 c ii � � • u may obtain a opy of the rules or direct questions to OU X 32.1987 or 1.800.33 344. /
• Issue By: I Perm ittee Signature: �` i � '' e r
/ 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:
CONTRACT INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' _ ' .,,S1l'O--f'l[Jc't-� Date:
LICENSE NO. ll( � /'
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.
12/09/2010 THU 13:33 FAX 5036242938 Willamette Electric C j 002 /002
Electrical Permit Application FOR OFFICE USE ONLV
City
of Tigard Permit No.
tJ g Datc/By: 6g- 9 /o t -f� eke,A6 /D'Od(o 9..Z ° 1 3125 SW Hall Blvd., Tigard, OR 97223 Platt Review MI
. ° : Phone: 503.639.4171 • � Other Permit: p o'0to- 251
' - Fax: 503.598.1960 g3 (..\-) Date/By: a
Ti GAR.D Inspection Line: 503.639.4175 n o Date Rcady/13y: Juris: f21 See Page 2 for
Internet: www.tigard or.gov O� \C1,14* O A Notified/Method: Supplemental Information
TYPE Or ViORIC — PLAN REV1EW
P lease chcck all that apply (submit 2 sets of pl w /items checked below):
❑ New construction @Addition /alterati�j. merit )
❑ Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other: $ where the available fault current 0 Marinas and boatyards.
CATEGORY OF',CONSTRUCCION 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 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.
.1ID 3 Sflt 'INFORMA AND LOCATION .; . ❑ Addition of new motor load of ❑ "A" "E" "1 -2" "1 -3
Job no.: (. 4 / 6 ( Job site address: /, oL-' s 1001IP or more. occupancy.
❑
( ❑Six or more residential units. Recreational vehicle parks.
City /State /ZIP: lC!! ^(/ G / 7122 3 ❑Health -taro facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: pi/ (i Nee f---. 0 Service or feeder 600 amps or marc.
. :: . FEE.SCIIEDULE ....- .
Cross street/directions to job site: D ,.
Description 1 Qty. 1 F. 1 Total ] "
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1 ft. or le 168.54 4 —
Ea. add'/ 500 sq. ft or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
• DESCRIPTION OF WORK (with above sq. R) 7S 00 2
Limited energy, multi - family 7500 2
A residential (with above sq. fl,)
a
r � C O Services or feeders installation, alteration, and /or relocation
O 200 amps or less 100.70
1_2_
❑ PROPERTY OWNER ❑ TENANT 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 -
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
I above service or feeder fee,
0
. APPLICANT .l ❑. CONTACT - PERSON 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first f 56.18 ( I 2
Contact name: branch circuit
Each add'I branch circuit 7.42 I 2
t Address: Miscellaneous (service or feeder not included)
City/State/ZIP: /State /l.,IP: Each manufactured or modular 67.84 2
tY dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
! 'CoI913AOTOR,, Signal circuit(s) or limited- energy
Business name: Wrilamette 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 (I hr min) 66.25/ hr
City /State /ZIP: Tigard, OR 97281 Investigation (1 hr min) 66.25 / hr
Industrial plant (i hr min) 78.181 hr
Phone: (503) 624 - 3631 Fax: (503) 624 - 2938 Inspections for which no fee is 90.00/ hr
specifically listed ('G hr min)
CCE Lic.: 75059 Electrical Lie.: 34 - 283C Suprv. Lic.: 4226 - S EI ECTRICAL:.EIERMI7f; :FEES
c'' Subtotal: 17 , /
Suprv. Electrician signature, requirettr
Plan review (25% of permit fee):
Print name: David Fife Date: /.. / State surcharge (12% of permit fee): `
J TOTAL PERMIT FEE: ,/,c;' " `•
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
l: V3uildi°gTermitsAELC- PcrmitApp doc 07/01/10 440 - 46157•(71 /05 /COMIWEr3