Permit CITY OF TIGARD ELECTRICAL PERMIT
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2 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00106
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02!23/2011
Parcel: 1S135BB00500
Jurisdiction: Tigard
Site address: 10487 SW CASCADE AVE
Project: Bedmart Subdivision: Lot: 0
Project Description: (3) branch circuits.
Contractor: STONER ELECTRIC Owner: RAM /CASCADE CENTER LLC
1904 SE OCHOCO BY ELLIOTT ASSOCIATES INC
MILWAUKIE, OR 97222 901 NE GLISAN ST
PORTLAND, OR 97232
PHONE: 503 - 462 -6500 PHONE:
FAX: 503 - 659 -4968
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 02/23/2011 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/23/2011 $8.52
Type of Use: COM Electrical
Class of Work: ALT 71 Investigation Fee (Equals 02/23/2011 $71.02
Permit Fee)
Type of Const: 1 ea Investigation 12% Surcharge 02/23/2011 $8.52
Occupancy Grp:
Total $159.08
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 OA 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 50 32.1987 or 1.800.332.2344.
r AP ^7
Issued By:4/ — /r_ — it ' ��� Permittee Signature: ��___ _ _ ` r
L--
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.
Feb. 22. 2011 3:21PM . Electr ic)p No, 6848 P. 1
,1%ViN
Electrical Permit Appl 1 , , l,l, (ii It :1 N t r\ I l
City of Tigard q ti V _
a 13125 SW HallBtvd., Tigard, OR 97223 c ` r
• II Phone: 503.639.4171 Fax: 503.598.1960 +< OlherPeamiC
11, : A R n 1nspoclion Lane: 503.639.4175 Date Ready/By: bet lice Pages for
Internet: www.tigard- or•gov NolifiediMethod; WA Supplemental Inform allon
TYPE OF WORK PLAN REVIEW, ' -
/ Plan tack all that apply (submit a sets of plw Amax ax domed below):
II New eonstnrctlort Addition/alteration/replacement /ZI Building over stories.
El Demolition `Other ❑ where the availablte u1tcurent fl Marinas se boa ards.
CATE(OR f OP CONSTRUCTION .. 10,030 amps at 1 volts or ❑ Floating buildings.
V less to grand, or exceeds 14,000 ❑Canmereial -oe. agricultural
❑ 1- and 2- family dwelling ,., Commcrcia�ndu ❑ Accessory building stops for all other installations. buildings.
El Multi-family [1 Master builder ❑Other ❑pke pumic 0 Installationof 75 KVAor
' JOB SITE INFORMATION Ate LOCATION ❑ AfYOi B ' m. "A", r,"1 telyderivodsystaa-
QAddiGmofruw moor ladof ❑ "A ",'8',"1- 2','1-3",
Job no.: j l Job site address: Ay87 SS O 46' 100I->P amore. occupancy. a
5ixmatareaidenlisluniR Q0.weationalvehicle
City/State/ZIP ‘ : el ❑ 11ralOrcare(edlaiex ❑ Supply vdtegeCa more dun
❑ Hazardous locations. 602 t oltanamurel-
SuiteJbldgJapt. no.: l Project name: K ❑ Service or feeder 600 amps or more.
- ERR SCIIRDULE
Cross street/directions to job site: n1po - 14ty. I p e a I row I
New residential single or multi - family dwelling unit.
Includes attached garage. _
Subdivision: f Lot no.: 1,000 sq. or lass 168.54 �� 4
Se- - add'I 500 sq. ft or portion 33.92 1
Tax map/parcel no.: Limited energy. residential p__.
i)86CTtliTION OF WORK ' (with above ao. n.) 75.00 2
Limited eeaeay, multi - family 75.00 2
R ,4 Z e ikr -/,)6, r¢.5 c , <--/-»p residential (with above sq. n.)
(� Services or feeders InstallatIon, and/or relocation
K 1 1...) 1 3 Le - rj > , r �/ /l/p-3 Lg- 200 amps or leas 100.70 [ 2
E) PROPERTY OWNER l ❑ TENANT , 201 amps to 400 maps 133.56 2
Nye 401 amps to 600 amps 200.34 2
601 ampt in 1,000 amps 301.04 2
Address: Ov 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary servkeS or feeders Installation, alteration, and /o
relocation _ _
Phone: ( ) Fox: ( ) 200 amps or leas 59,36 1
101 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for gale, loose, tent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168 2
Branch circuits - nevi, alteration, 6r eYtension, er panel
Owner signature: Data: A. Pee for branch circuits with '
El APPLICANT ' I ' Q C'ONI'ACE PERSON above branch orfaadar foe 7.42 2
- each branch circuit
Business name: a. Fco for branch eimuits without
service or feeder fee, first 1 56.18 , 2 , ti
Contact name: branch circuit
Each eat brand, circuit Z 7.42 , 2 gt . ri
Address: Miscellaneous (service or feeder not Included)
City /StatdZlP: - Bach manufa o modular 67 84 1 2
dwelling, service and/or foods
Phone: ( ) I Fax: ; ( ) Reconnect only 67.84 2
E Pump or irrigation circle 67.84 7 -
Sign or outline lighting 67.84 2
. . CONTRACTOR - (a)
Signal circuitor limited -cuer _
13usiness STONER ELECTRIC INC, panel, alteration, or extension, Ile 2_ . . 2
- Each additional inspedion over allowable In env orthe above
Address: 1904 SE OCHOCO Additimal inspection (Ihr 66.25/hr' .
Investigation (1 hr,rrm) 66.2srhr
City /StntdZlQ M ILWAUKIE r OR 97222 Industrial plant (l hr min) 78.18/hr
Phone: ( 503) L : ( 503) 659 -4968 Inspections for which no fee is
90.00/hr
apeciaaily listed (Si hr min)
CCs Lie.: 44823 ] Eleotrical Lie.: 26 -122C I Suprv. Lio.; 3496S ELECTRICAL PERMIT ES
� ) Subtotal: /di2., g.' 71 - (3).
Suprv. Electrician signature, required: /h+ .4.. 1 ..~1 _ Plan review (25 %ofponnitfeo):
Print name: MICHAEL FALCONER Date: Siete surcharge (12%of permit fco): 1.-7.25S T/ 5)-
TOTAL PERMIT FEE: 71 ,
Authorized Signature: Thle permit application expires lfa permit to nol obtained within 180
Print name: Date: days after It has been steepled as complete.
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