Permit .:":
n CITY OF TIGARD ELECTRICAL PERMIT
III ®, COMMUNITY DEVELOPMENT Permit #: ELC2009 -00506
•
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/30/2009
Parcel: 2S114AA00200
Jurisdiction: Tigard
Site address: 16285 SW 85TH AVE 101
Subdivision: DURHAM HALL BUSINESS PARK Lot: 0
Project: Brittle Kittle
Project Description: (2) branch circuits for wiring of mixer and oven.
Owner: FEES
SHIPMAN, W H LIMITED Quantity Description Date Amount
BY NORRIS & STEVENS INC, 621 SW
MORRISON STE #800 2 crt Branch Circuits 09/30/2009 $53.50
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/30/2009 $6.42
Electrical
Contractor:
WEST SIDE ELECTRIC CO INC
1834 SE 8TH AVE
PORTLAND, OR 97214
PHONE: 503 - 231 -1548
FAX: 503 - 736 -0677
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.92
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. ATT . • • =••n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 110 through OAR 9 ' 00 : 00. You may obtain a copy of the rules or direct questions to OUNC by calling,583246.6699 or 1.800.332.2344. - -
Issue By: 0 / ‘ Permittee Signa ' i - A W - [ i Cd."--1.."---.
' 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
l
SIGNATURE OF SUPR. ELEC' t, �� Date:
LICENSE NO. 4" 6 Q.7
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.
i„...„.411 2009 4:11PM West Side Electric 503-736-0656 p.2
Electrical Permit Application RECEIVED FOR OFFICE USE ONLY
City of Tigard Received 9 A 6 1 , y Penult No.: eLe cd -,
13125 SW Hall Blvd., Tigard, OR 97223 SEP 2 5 2009 Date/By.
II Plan Review
' 2 . Phone: 503.639.4171 Fax: 503.598.1960 Date/By. Other Permit
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: .Ittric
TIGARD 611 See Page 2 for
Internet: www.tigard-or.gov
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Boi DING pivisio otiii.cdrMethod: •"7/ Supplemental Information
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- I t ili. OF ‘jioxit .-- -'.. r . . i - . ' .,.. :.* ,'' • . -: ..::i-i '''"':7:i. "i)1 -: ..
o New construction ,Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
0 0 Service or feeder 400 amps or more El Building over three stories.
Demolition 0 Other: where the available fault current El Marinas and boatyards.
‘,.... . ,
tATEGORY . : - • exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 Cormnercial-use agricultural
0 1- and 2-family dwelling e aCommercial/industrial 0 Accessory building 0 amps for all other installations. buildings.
0 Multi-family 0 Master builder El Other: 0 Fire pump. 0 Installation of 75 KVA or
. 0 Emergency system. larger separately derived system.
. . JOB SITE AND LOCAtION '' . .
.. . 0 Addition of new motor load of
Job no.: 3(/ 5-g n Job site address: /6 28 c-- st kr rike. 100HP ar MOte.
0 Six or more residential units. occupancy.
0 Recreational vehicle parks.
City/State./ZIP: 7
g /A"; cle 9 722Y 0 Health-care facilities.
0 Hazardous locations. 600 Supply voltage for more than
/
600 volts nominal.
Suite/bldg./apt. no.: /0 / Project name: R z . 0 Service or feeder 600 amps or more.
:Pti SCHEDULE •
Cross street/directions to job site: Description I Pty. I Fee. I Total I •
New residential single or multi-family dwelling unit.
Includes attached garage.
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Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map/parcel no.:
Limited energy, residential
PteSig . --'..,...-'..,...,
(with above sq. ft) 75.00 2
• Limited energy, multi-family
itliri, 4, / All e-re ('?/?/ 0 vlet-7 . residential (with above sq. ft.) 75.00
2
Services or feeders installation alteration, and/or relocation
200 amps or less 80.30 2
. . . . ., .
. . ., 0 : - .1.- .. . in 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 Installadon, alteration, andlor
:
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
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
0 APPLICANT I / 15 - CCiNTACT PERSON .. ' above service or feeder fee,
6.65 2
each branch circuit
Business name: , Xt #4, B. Fee for branch circuits
without service or feeder fee, /
46.85 96
Contact name: 6
first branch circuit r 2
Address: • Each addl branch circuit / _ 6.65 A t.:_r_ 2
Miscellaneous (service or feeder not Included)
City/State/ZIP: Each manufactured or modular
90.90 2
dwelling, service and/or feeder
Phone: (9)3) 3 zo 7 z s - z__ Fax: : ( ) Reconnect only 66.85 2
E-mail: Pump or irrigation circle 53.40 2 .,
• • - . • . .. CONTRACTOR ' ... .. Sign or outline lighting 53.40 2
Signal circuit(s) or
Business name: name: WEST SIDE ELECTRIC CO.'
Address: 1834 SE AVE.
energy panel, alteration, or
extension. Describe: Page 2 2
8
CitylState/ZIP: PORTLAND, OR 97214 Each additional inspection over allowable in an • of the above
Per inspection 62.50
Phone: (503) 231-1548 I Fax: (503) 736-0677 Investigation per hour (1 hr min) 62.50
CCB Lie.: 13306 I Electrical Lic.: 26-1.35C Suprv. Lie.: 4654S Industrial plant per hour II 73.75
': : ' --
Suprv. Electrician signature, required: ,Q .5;74°' Subtotal:
Print name: RANDALL ROBERTS Date: 9/Z a? Plan review (25% of permit fee):
State surcharge (12% of permit fee): 6 t
Authorized signature TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
a• Number of inspections allowed per permit.
I: \BuildinipPermits1ELC-PemsitApp.doc 05/23/06 4404615TO 1./05/COMAVEB