Permit q CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00397
1GAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/15/2011
T
Parcel: 2S110DB00703
Jurisdiction: Tigard
Site address: 15348 SW PACIFIC HWY
Project: Les Schwab Subdivision: Lot:
Project Description: (1) branch circuit for light poles.
Contractor: LA LONDE ELECTRIC LLC Owner: LES SCHWAB TIRE CENTERS OF PORTL
PO BOX 2220 STORE ACCOUNTING
ESTACADA, OR 97023 PO BOX 5350
BEND, OR 97708
PHONE: 503 - 969 -8491 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 07/15/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/15/2011 $6.74
Type of Use: COM Electrical
Class of Work: ALT 56 Investigation Fee (Equals 07/15/2011 $56.18
Permit Fee)
Type of Const: 7 ea Investigation 12% Surcharge 07/15/2011 $6.74
Occupancy Grp:
Total $125.84
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 • • ' •52 -001 -009' You •• - • • • e. - ules or direct questions to OUNC by calling 503.232. 87 or 1.800.332.2344.
Issued By: i/ �f� �i Permittee Signature:
4r10 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 Y� FOR OFFICE USE ONLY
City of Tigard ® � Received permit No.:
q 13125 SW Hall Blvd., Tigard, OR 97 ' ` DateB : 7 r l ' ■ /L
��
J Date/By:
Plan Review
Phone: 503.639.4171 Fax: 503.598.1' .1\ t q > Other Permit:
TI G ARD Inspection Line: 503.639.4175 \�� r ' a ate Ready /By: inn 6:1 See Page 2 for
Internet: www.tigard-or.gov J ` ' ` � t? ��e tified/Method: 'Pqe Supplemental Information
TYPE OF WORK � ` • � �\ PLAN REVIEW
❑ New construction Addition/alteration/re We - nt Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. . larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
lOOHP or more. occupancy.
Job no.: Job site address: 3L Si... PA.c► * f C. HO' ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: (44„ c C ! —2Z1, ❑ Health -care facilities. ❑ 600v nominal. r more than
— 1 ❑ Hazardous locations.
Suite /bldg. /apt. no.: Project name: L Sc..4 1 ✓a 6 17 ,,,$ ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee, I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. � Olt ft.)
> y
,( Limited energy, multi - family 75.00 2
/l/� `
In/ '.,'r / residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation _
200 amps or less 80.30 2
.PROPERTY OWNER' ' ❑ TENANT . 201 amps to 400 amps 106.85 2
Name: �, 401 amps to 600 amps 160.60 2
149 < St -1,G. j / a'&.. G ...... - -aLa . 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
- City/State /ZIP: Temporary services or feeders installation, alteration, and/or
• relocation
Phone: ( ) Fax: ( ) 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 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ a APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, ,46:-(5.1
,4 - 85 c-y 1 F 2
,� Qt first branch circuit (! j}
Address: An M 'J 1 " Each add'I branch circuit 6.65 2
*Idv, IA Miscellaneous (service or feeder not included)
City/State /ZIP: V Each manufactured or modular
�� dwelling, service and/or feeder
Phone: 90.90 2
( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR . . Sign or outline lighting 53.40 2.
Business name: Signal circuit(s) or limited-
� .It L' E /' - C - energy panel, alteration, or
Address: p. flax Z,z„L� extension. Describe: Paget 2
City/State /ZIP: E's p c4,0 e l Z
1 — Each additional inspection over allowable in any of the above
° C Per inspection 62.50
Phone: ('g ) e g et 1 I Fax: ( ) A-/4 Investigation per hour (1 hr min) 62.50
CCB Lie.: -7ygsy Electrical Lie.: C . Suprv. Lie.: - 243 72_s Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: ',.��� Subtotal: ( . I t" .K .4._
Print name: Date: ," Plan review (25% of permit fee):
57i�,t" C.A. A)-0y ��� �� State surcharge (8% of permit fee): (P , 7+'1 1C
Authorized signature: G..e._ z4 A..c. TOTAL PERMIT FEE: a / a sri > This permit application expires if a permit is not obt ned.within 180
Print name: -7e 1 r � e -e_ Lit / ■ r i ia-e- Date: 7s 1 .� // days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\ermits\ELC- PermitApp.doc 05/23/06 440- 4615T( I I /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:
❑ Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
-
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
•
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\Building \Permits \ELC- PermitApp.doc 03/23/06