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Permit 7/2/// kpr)-kr-free pecr C424/ffer/n)Gcl CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2011 -00407 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/20/2011 Parcel: 2S 102DB00500 Jurisdiction: Tigard Site address: 8815 SW OMARA ST Project: Tigard Senior Center Subdivision: Lot: Project Description: (2) branch circuits. 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 2 crt Branch Circuits wo /Purchase 07/20/2011 $63.60 Specifics: Service or Feeder 1 ea 12% State Surcharge - 07/20/2011 $7.63 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $71.23 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 OAR 952 - 001 -0090. You may obta', . • of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.' gob 1 Issued By: si _ — Permittee Signature: — - 4 1 0 i . .G/ _L... A / '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. CITY OF TIGARD ELECTRICAL PERMIT - COMMUNITY DEVELOPMENT Permit #: ELC2011 -00407 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/20/2011 Parcel: 2S102DB00500 Jurisdiction: Tigard Site address: 8815 SW OMARA ST Project: Lower Fanno Creek Park Subdivision: Lot: Project Description: (2) branch circuits. 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 2 crt Branch Circuits wo /Purchase 07/20/2011 $63.60 Specifics: Service or Feeder 1 ea 12% State Surcharge - 07/20/2011 $7.63 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $71.23 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 OAR 952- 001 -0090. You - opy of - - • or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: 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. Jul. 20. 2011 9:56PM a - li No. 7759 P. 1 Electrical Permit Applicat o' _ - A n)lt.OI lIch, rash: ONI Y City of Tigard JUL 2 0 2 • Received . �I/ Permit No.: • • 13125 SW HAIL B., Tigard, OR 9 2 3 e1 Plan Review Ph 1Vd one: 503.718.2439 Fax: 503.598! 19 .. \d d balelli : Other Permit: I' I GAR R l) Inspection Line: 503.639.4175 ; \ to Dale Ready/By: Ms: El See Page 2 for Internet: www.tigard- or.gov - ' "" ' Notified/Method: p Supplemental Information TYPE OF WORK PLAN REVIEW Please check all that apply (submit E sets of wlitems checked below): El New construction r Addition /alteration /replacement ❑ Service or feeder 400 amps Or more ❑ Building over three stories. Q Demolition © Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or LI Floating buildings. less to ground, or exceeds 14,000 Cl Commercial -use agricultural ❑ 1 - and 2 family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family _ ❑ Master builder ❑ Other; ❑ rbe pump. ❑ Installation of75 ICVA or JOB SITE INFORMATION AND LOCATION Cl Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1.2 ", "I.3 ", Job no.: I Job site address: 58 (5 Omc r& ,..9. I or more. occupancy. ❑ Six x o or r more residential units. ❑ Recreational vehicle parks. City/State/ZIP: -- �7 r� El facilities. ❑ Supply voltage for more than 1 �).r Quc q P`K" ❑Ifiasardousloca(ions. 600 volts nominal, Suite/bldg. /apt, no.: v Project name: ❑ 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 168.54 4 Tax map /parcel rte.: Ea. add'I 500 sq. ft. or portion 33.92 I Limited energy, residential 75.00 2 DESCRIPTION OF WORK (With above sq. ft.) Limited energy, multi- family _ 75.00 1 f)'' ' ^N _ '{' _ C�, i A- residential (with above sq. ft.) ' Services or feeders installation, alteration, And /Or relocation , 200 amps or less 100.70 2 Li PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 Name: 401 a mps to 600 snips 200.34 2 "7 0,4- a .. 601 amps to 1,000 amps 301.04 2 Address: \ '' Ls oMOrra s �- Over 1.000 amps or volts 552.26 2 City/State/ZIP: � ] r ^ Temporary services or feeders installation, alteration, and /or Ci " " 0 rat Q.Q3 relocation Phone: (' 133) • Fax: ( ) 200 amps or less 59.36 t � ���( 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 salt, least, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 161.54 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: 1 CI erir ,a,( C ' ef B. Fee for branch circuits without t i ' �� service or feeder fee, first Contact name: ' 04. 41.6,stf branch circuit 56.12 r 2 , Each add'l branch circuit 7.42 j 2 Address: 1 L.t N6- ( Q6,1). sb (b 41.- z1 S Miscellaneous (service or feeder not included) ` � Each manufactured or modular City/State/ZIP: �t . y\ (' j) t,' P jr.- �A C18 (r (.p dwelling. service and/or feeder 67.84 2 %t � .� • t I ( ) Reconnect only 67.84 2 Phone: ( o v) (-(•-• r ] Fax: Pump or irrigation circle 67.84 2 E - mail: C 1. 12 (Y1 re11 er'r.1-n (--C .L.,,( (511" Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited - energy Business name; ' ( - r v - r d ,A, panel, alteration, l inspection extension. Page 2 2 t'`L L t I� I 4- Each additional insp over allowable in any of the above Address: 3 • V `' t_ (o . 3 i ' Additional inspection (1hrmin) 66.25/ City /State /ZIP: � ( t V Q-t t _)P 9 g Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 72.18/hr Phone: ('3 ) 61 Li ,,. ` Fax: ( ) Inspections for which no fee is 90,00/ hr specifically listed ('A hr min) CCB Lic.: i ( Electrical Lie.: CI ') _ Suprv, Lic.: L--�5 ELECTRICAL PERMIT PEES _ Suprv. Electrician signature, required: /► �P Subtotal:, �(f /��� Plan review (25% of permit fee): Print name: M / St.r \j Date: 7 , / s. 1 ( State surcharge (12% of permit fee): io3 I TOTAL PERMIT FEE: - 36:1. , 32... Authorized signature: This permit application expires If a permit Is not obtained within 180 ` days after It has accepted as complete. Print name: C) i• (mil /I Gss 0.4/ Date: '7 .1g ,-1 ( • Number of inspections allowed per permit, I;l auileina1permiLs 'LC- l'ertettApp,doo 07/01/16 440- 4615'rltuo5(COMAVES