Permit CITY OF TIGARD ELECTRICAL PERMIT
1 r
` -- COMMUNITY DEVELOPMENT Permit #: ELC2011 -00093
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/15/2011
Parcel: 1 S 136DA01102
Jurisdiction: Tigard
Site address: 11576 SW PACIFIC HWY
Project: Spec Space Subdivision: Lot: 0
Project Description: Reconnect only.
Contractor: Owner: ANDERSON, MELDREN W CREDIT SHELT
ANDERSON, CRAIG J TR
PO BOX 3092
GRESHAM, OR 97030
PHONE
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 02/15/2011 $67.84
Specifics:
1 ea 12% State Surcharge - 02/15/2011 $8.14
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 • 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 No fic- ion Center. Tho ules are set forth in OAR
952 - 001 -0010 through • ' r 2- 001 -0090. You may ob -'• _ - -•y oft - - - • direct questions to OUNC by callin 5rc .232.198 or 1.8' r.33'.234�
Issued B. ��- =�� . Permittee Sign ature -- I% /� . Iti/
A ir
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 �� FOROFFICE USE ONLY
`J
Cl of Tigard ���� Received •
/ Date/B : , r Perm No. �'LL • i ( g
° 13125 SW Hall Blvd., Tigard, OR 972 -, Q r� / Plan Review
Phone: 503.639.4171 Fax: 503.598.1. t `t Date
Other Permit:
f I G A It D Inspection Line: 503.639 s J Date Ready /By. ® See Page 2 for
Internet: www.tigard � � ) � ��GP $�`' ptified/lvtefhod: Supplemental Information
TYPE OF WORK tt Rl ��O' VN,' PLAN REVIEW
❑ New construction ❑ Addition/alteration /r C:' s t Please check all that apply (submit 2 sets of plans w /items checked below):
111 Demolition 111 Other:
❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
CATEGOR7J OF CONSTRUCTION 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
['Addition of new motor load of ❑ "A ", "E ", "l -2 ", "1 -3 ",
9 /
Job no.: Job site address: / �ps� I or more. occupancy.
/f / 9 3 d ! ❑ Six x o o r r more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: r/ Or...-- 22-_3 / ❑ Health - care facilities. ❑Supply voltage for more than
t of ` , !i !(( / ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: S n y � S � ❑ Service or feeder 600 amps or more.
ii/ G �c FEE SCHEDULE
Cross street/directions to job site: """� -- Description I Qty. I Fee. I Total
,� {�f New residential single- or multi - family dwelling unit.
a G., -,_sr Q/j*? / e -7 Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
• Ea. add'l 500 sq. ft. or portion 33.92 • 1
Tax map /parcel no.:
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family
75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
El OWNER ❑ TENANT /..) amps to 400 amps 133.56 2
/� 401 amps to 600 amps 200.34 2
Name: �� / / S� t��/ 'SO/✓ /' / r�.
l 601 amps to 1,000 amps 301.04 2
Address: // � S - � � � � wi Over 1,000 amps or volts 552.26
r t 2
V� / E'i, 7z 22 Temporary services or feeders installation, alteration, and /or
City/State/ZIP: � / ,(9,552 � relocation
g ,•" /kc 200 amps or less 59.36 1
Phone (� ) (..e.2_ 7fi� --40/e_ Fax: ( )
01 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
❑ APPLICANT I ID CONTACT PERSON above service or feeder fee, 7.42 2
_ each branch circuit
Business name: y) l B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
l
t e connec only .
Phone: ( ) I Fax: : ( ) Reconnect l 67.84 07,11 2
• Pump or irrigation circle 67.84 2
E - mail: -
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name:
panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City/State /ZIP: Industrial plant (1 hr min) 78.18 / hr
Phone: ( ) I Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (Va hr min)
CCB Lie.: 1 Electrical Lie.: I Suprv. Lie.: ELECTRICAL .PERMIT FEES
Suprv. Electrician signature, require .
Subtotal:
i / Plan review (25% of permit fee):
Pitrifn� • : /l � • �. , ,� Date: State surcharge (12% of permit fee): -. f L (
vc li TOTAL PERMIT FEE: r�-
Authorized signatures — . , /
r "
/ / / This permit application expires if a permit is not twined within 180
! t / 'w // days after it a has been per accepted permit as complete.
Print name: � ®�i��Y' Da tO: �/ ` Number of inspections llowed
/ (
I:\ Building \Permits\ELC PermitApp.doc 07/01/10 440 4615TO l /05 /COM/WEB
( .
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
I Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
TI Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY_:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
Fl Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Building\Permits\ELC- PermitApp doc 07/01/10