Permit 4 CITY OF TIGARD ELECTRICAL PERMIT ti
` j .'.. COMMUNITY DEVELOPMENT Permit #: ELC2011 -00179
T f G.ARE) 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/06/2011
Parcel: 2S102DA00401
Jurisdiction: Tigard
Site address: 13125 SW HALL BLVD PERMITS
Project: City of Tigard Subdivision: Lot: 0
Project Description: (4) branch circuits for cubicles.
Contractor: MR ELECTRIC OF CLARK COUNTY Owner: TIGARD, CITY OF
14300 NE 20TH AVE. D102 -313 13125 SW HALL BLVD
VANCOUVER, WA 98686 TIGARD, OR 97223
PHONE: 360- 574 -7200 PHONE:
FAX: 360- 546 -2158
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 04/06/2011 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/06/2011 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through4411PPirOAR 952- 001 -0090. You m- - • •. • • • • • • e rules o -Gt questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: l� / _____..-.-- � � Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Apr. 6. 2011 1:46AM No. 6743 P. 2
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received .
• 13125 SW Hall Blvd., Tigard, OR 97223 Da � r�� l '1
� Plan Review
Phone; 503.71$.2439 Fax; 503.598.1960 Date/& ; OrherPermit:
(I t i A u u Inspection Line: 503.639.4175 Date Ready/By: E7 See Page Z for
Internet: w vw.tigard- or,gov Notified) 4ethod: F ► Supplemental lnformelioh
M E OF WORK PLAN REVIEW
❑ New construction Addition/alteration /replacement Please check all that apply (submit eels of plans wlilems checked below);
❑ Service or feeder 400 amps or more D Building Over three stories.
❑ Other:
❑ Demolition where the available fault current ❑ Marinas and boatyards,
CATEGO OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14.000 ❑ Commercial-use agricultural
TM ❑ I- and 2- family dwelling Commercial /industrial 0 Accessory building g amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of75KVA or
JOB SITE INFORMATION AND LOCATION ' El Emergency system. larger aeparately derived system.
❑ Addition of new motor load of ❑ "A ", "5", "1 -2 ", "1.3 ",
Job no.! 1l r `1 Job site address: Q 10014P or more. occupancy.
� " 'i\ ❑ Six or more residential traits. ❑ Recreational vehicle parks,
City/State /ZIP: " '' , . r - V . `�1 'r � ❑ Health -care facilities. 0 Supply voltage for more than
`1 1 !� ID Hazardous locations. 600 volts nominal.
Suite/bldg. /apt, no.; Project name: -r 4 . ❑ Service or feeder 600 amps or more.
Cross strcct/directions to job site:
FEE SCHEDULE
Darcdprlon LW I Poe. T Total I•
New residential single. or multi- family dwelling unit.
Includes attached garage.
Subdivision: - M I Lot no.: 1,000 sq. (t or less 168.54 4
Ea, edd'l 500 sq. ft- or portion 33.92 1
Tax map %parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above stn It) 75.00 2
Limited energy, multi - family 75.00 2
ksr_CAL- residential (with above sq, ft,)
Services or feeders Installation alteration, And /or relocation
200 amps or less 100.70 ` 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: Q } 401 amps to 600 amps 200.34 2
V (. 601 amps to 1,000 amps 301.04 2
Address: I r Over 1,000 amps or volts 552.26 2
City /State /ZIP: ''1 CV7 a �_ Temporary services or feeders installation, alteration, and/or ' \ r _ elocution
Phone:J� l 49 Fax: {, -()o/ LP 0 200 amps or less 59,36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 am 125,01 2
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 frith
❑ APPLICANT CONTACT PERSON • above s o r feeder fcc,
each branch circuit 7.42 2
Business name: �� J AS r l 1 B. Fee for branch circuits without
, a service or feeder fee, first 1
Contact name: . kr t h�_� s C branch circuit l 56.18 2
A J� l Each add'I branch circuit 1 3 I 7.42 I 12 i
Address: \ t - . L ' " Miscellaneous (service or feeder not included)
City /State /ZIP:V�� 0 eNr 1\ ` 1 1.06 1P Each ma service and/or or r feeder 67.84 2
_ t dwelling service and/or fcedcr
Phone: G ) Z° (0 — SS I Fax: : ( r r - - �sQ Reconnect only 67,84 2
11 D Pump or irrigation circle 67.84 2
E - mail: &seaV l e C k`ri c cc • Lb
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
DWN:.
Business name: ,,., � C��C.. panel, alteration, or extension. _ Page 2 2
1 uLtr\cp A. \ � �e h.. t •`Gle t=. Each additional inspection over allowable In any of the above
Address 1I.4 3O( C. 77 _ . 02. „ -313 Additional inspection (1 hr min) ' 66,25/ hr
City /Stae /ZIP ,� r� Ct),\Ay e V � � n Investigation (1 hr min) 66,25/ hr
i n du st r ial plant (1 hr min) 78.18 / lit
Phone: ( - %)'�uii tc S n Fax: g\,00 ) SU O z t Sg Inspections for which no fee is
TO • specifically listed (id hr ruin) 90.00 / hr
CCB Lie. \ i 0 Electrical L; c,: A Suprv. Lie.: �S' • ELECTRICAL PERMIT PEES
Suprv. Electrician signature, required: Subtotal: �,
Plan review (25% of permit fee):
Print name :, cA. / k w , Date / State surcharge (12% of permit fee): 9 ,14 1
.tall TOTAL PERMIT FEE: r
Authorized signature �r � f ��'
g , - AN A. tsrali "�;�r �t Tbis permit application expires if a permit Is not obtained within 180
Print flame ^ �� ' Date: �. • days after it has been accepted as tomptote.
I s � J ` Number of inspections allowed per permit.
t' Building \PermIrsiELC- PormitApp.doc 07/01/10 140.4615T(II/Oa /COM /WEB