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Permit CITY OF TIGARD ELECTRICAL PERMIT . COMMUNITY DEVELOPMENT Permit #: ELC2009 -00225 T t GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/19/2009 Parcel: 2S114AA00200 Jurisdiction: Tigard Site address: 16285 SW 85TH AVE 403 Subdivision: DURHAM HALL BUSINESS PARK Lot: 0 Project: Souper Natural Pepper Heads Project Description: Add (10) branch circuits. Owner: FEES SHIPMAN, W H LIMITED Quantity Description Date Amount BY NORRIS & STEVENS INC, 621 SW 10 crt Branch Circuits 05/19/2009 $106.70 MORRISON STE #800 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 05/19/2009 $12.80 Contractor: Electrical JARMER ELECTRIC INC 5105 SW 45TH AVE #200 PORTLAND, OR 97221 PHONE: 503 - 246 -5381 FAX: 503 - 244 -8037 Type of Use: Class of Work: Type of Const: Occupancy Grp: Total $119.50 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 throu OAR 952 -001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. 1 Issued By: r� �`.J�/V A Perm ittee Signature: , \-5` _Qi 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'N Date: LICENSE NO. 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. Electric.al Perm Applicatio FOR OFFICE l' SE OtiLI • City of Tigard E CEIVED Received t /�� CJ7 Permit No.: (l c7� /'T , W � (0 !7' 1312 SW Hall Blvd., Tigard, OR 972 3 225 Date/By: Plan Review Phone: 503.639.4171 Fax: 503.598.196q 1 �1 �n lli Other Per Inspection Line: 503.639.4175 NIAY I. 2 L. . •_ Date Ready/By: urn ntit: : RI See Page 2 for Internet: .wto . ei 4i'gard:er.us Notified/Method: '�! Supplemental Information r TIGARD y a � SI\ rN PLAN REVIEW ❑ New construction �s • , 1 t o a lteration/replacement Please check all that apply: ❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l ['Hazardous location ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential ❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure ['Building over three stories ['Feeders, 400 amps or more ❑ Multi - family 0 Master builder 0 Other: JOB SITE INFORMATIO AN LOCATIQN ❑Occupant load over 99 persons ['Manufactured structures or � ❑Egress/lighting plan RV park Job no.: 9 5d U Job site address: I�, J P. ❑Health care facility ❑Other: �� Submit 2 sets of plans with any of the above. - City /State /ZIP: 1 1 0\a, u-ri g- y . a The above are not applicable to temporary construction service. 0 Suite/bldg. /apt. no.: [4 3 Project name: �� . - k eArAs D eacr ltl oe FEE* SCHEDULE p I Qty. I Fee. I Total . I •• Cross street/directions to job site: sou, per- , , A V� r ., f New residential single- or multi - family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'1500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular `, / dwelling, service and/or feeder 90.90 2 '4 d ei C 4 C1Lf 7 i t,1 bO ye V L02L- Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER I 0 TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City / State/ZIP: Temporary services or feeders installation, alteration, and/or Phone: ( ) Fax: ( ) relocation 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 600 amps 133.75 2 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each Business name: branch circuit 6.65 2 B. Fee for branch circuits Contact name: without service or feeder fee, / 46.85 `ylt .�� 2 Address: each branch circuit Each add'l branch circuit 9 6.65 59.,5 -5" 2 City/State/ZIP: Miscellaneous (service or feeder not included) Phone: Pump or irrigation circle 53.40 2 ( ) Fax. ( ) Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited- CONTRACTOR energy panel, alteration, or 'rjc) £ -r- extension. Describe: Page 2 2 Business name: " M ELECT va_r f. .L.A..)C-, Address: Si ' O 6 Y ,s r Sr e z Q • Each additional inspection over allowable in any of the above Po-/L7--;-,4 Per inspection 62.50 City/State/ZIP: - t) 4 © /e. c") 7 2 2 / Investigation per hour (1 hr min) 62.50 Phone: (J3) Z 53 6' i F ax: 2t/ �) -' Industrial plant per hour 73.75 tiI C9 ' (S03) �(- � J ELECTRICAL PERMIT FEES* CCB Lic.: 4;) 9 f Electrical Lic.: 26- / e/yc- Suprv. Lic.: 4//) Subtotal /042 -76 • Suprv. Elect icc ure, required: / - t y •%C.-3. „ 1 O Plan review (25% of permit fee) Print name: J'� � t'1 2 Q a c ' O ( State surcharge (r , permit fee) /og, R.) �__ .'� E " 7 J TOTAL PERMIT FEE // c/, 56 Authorized signature: /9 .',, ' t/ This permit application expires if a permit is not obtained within 180 ic days after it has been accepted as complete Print namQ)p� „, — l i Date: 5 'J. (' C) • Fee methodology set by Tri-County Building Industry Service Board •• Number of inspections per permit allowed. i:\ Building \Permits \ELC- PerrnitApp.doc 03 440- 4615T(10 /02/COM/WEB