Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00152
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/24/2011
Parcel: 1 S135DD03301
Jurisdiction: Tigard
Site address: 11945 SW PACIFIC HWY 250
Project: Jo -Ann Fabrics Subdivision: Lot: 0
Project Description: TI
Contractor: BERGELECTRIC CORP Owner: TIGARD PLAZA LLC
6026 NE 112TH AVE. 8320 NW HWY 99
PORTLAND, OR 97220 VANCOUVER, WA 98665
PHONE: 503 - 255 -1818 PHONE:
FAX: 503 - 255 -1919
FEES
Quantity Description Date Amount
1 crt Branch Circuits w /Purchase 03/24/2011 $7.42
Specifics: Service or Feeder
11 crt Branch Circuits wo /Purchase 03/24/2011 $130.38
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 03/24/2011 $16.54
Electrical
Type of Const:
Occupancy Grp:
Total $154.34
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 • • ' 952- 001 -0090. You ay obtain a copy o ‹Ores or dir t questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ■ /.G! _ s! Permittee Signature: — t.,/-
�� 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 � , FOR OFFICE USE ONLY
�
City of Tigard � Dat :: Received ` ,� 112121111BEIMI
13125 SW Hall Blvd., Tigard, OR G ` ` � `
' • Phone: 503.718.2439 Fax: 503. V Plan Review
Date/B : Other Permit:
I i c ., : ., Inspection Line: 503.639.4175 � .. ,r' Date Ready/By: BI See Page 2 for
Internet: www.tigard - or.gov \ V' Notified/Method: N Supplemental Information
(
TYPE OF n..1 , u PLAN REVIEW
❑ New construction XAddition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below).
❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY 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
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION i 1 LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 -3 ",
Job no.: I Z11 .11 Job site address: \ \ cj<4i ' > Pe..e i4sc_ I y , Z ❑ looHP or more. occupancy.
Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: /�, n ❑ Health -care facilities. ❑ Supply voltage for more than
T( > I. a ' "l� 22'�
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no. Project name: bnC ) T ; ^ _ ❑ Service or feeder 600 amps or more.
Sv J Sc��rvn �f'. 1 14 zL �� FEE SCHEDULE
Cross street/directions to job site: 'J — j 5 C Description i
an I Qtr. I Fee. I Total I `
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: l 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
- 10 l� t' rfl' 1 residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
1'/ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
�� 401 amps to 600 amps 200.34 2
Name: c - wC - 3- Fritt' C 1 • - O }Yl.. ‘ ti1(7 C) 601 amps to 1,000 amps 301.04 2
Address: cbtrnl A- `kf Over 1,000 amps or volts 552.26 2
City/ State/ZIP:
Temporary services or feeders installation, alteration, and /or
1��1;�7n 0 N 4,l f.` s
Phone: (8e,?) 739 _ 44 1zo 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
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 ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: Bergelectric Corp B. Fee for branch circuits without
service or feeder fee, first I 56.18 a o pp�� 2
Contact name: oaf - her tt i ri m an branch circuit V
Each add'I branch circuit 11 7.42 p) 1, L 2
Address: 13650 NE Whitaker Way Miscellaneous (service or feeder not included)
City/State/ZIP: Portland Ore on 97230 Each manufactured or modular 67.84 2
tY g dwelling, service and/or feeder
Phone: (503) 255 - 1818 Fax: : (503) 255 - 1919 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: YI\tNP 1Cimc‘n@ b 'i' � e. ti 11
• `� Sign or outline lighting 67.84 2
_ CONCTO i ._. Signal circuit(s) or limited - energy
Business name: Bergelectric Corp panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 13650 NE Whitaker Way Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Portland Oregon 97230 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 255 - 1818 Fax: (503) 255 - 1919 Inspections for which no fee is 90.00 / hr
specifically listed (' /z hr min)
CCB J. ic.: 110521 Electrical Lie.: 37 - 682C Suprv. J.ic.: 5485S V ELECTRICAL, PERMIT FEES
Suprv. Electrician signature, required: a Subtotal: of fee): ?)--1. N.-" Plan review (25 /o of pe
Print name: ` rl /,�,) Date: 3/e 31 1 1 State surcharge (12% of permit fee): 1LD.-\
TOTAL PERMIT FEE: � , ? Authorized signature: T his perm application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: ,.. A.1, a4. her Or I d rn n Date: c�i1 g 3/ j i * Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440-4615T(11/05/COM/WEB