Permit CITY OF TIGARD ELECTRICAL PERMIT
I It ,- COMMUNITY DEVELOPMENT Permit #: ELC2009 -00359
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/21/2009
T ... - Parcel: 2S102AD03450
Jurisdiction: Tigard
Site address: 8777 SW BURNHAM ST
Subdivision: Lot: 0
Project: City of Tigard
Project Description: Change card reader at fuel pump.
Owner: FEES
TIGARD, CITY OF & Quantity Description Date Amount
TIGARD WATER DISTRICT ET AL, 13125 SW
HALL BLVD 2 crt Branch Circuits 07/21/2009 $53.50
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 07/21/2009 $6.42
Electrical
Contractor:
SCOTT -CO ELECTRIC INC
P.O. BOX 92
BORING, OR 97009
PHONE: 503 - 668 -7111
FAX: 503- 668 -3104
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.92
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 thr ugh OAR 952- 001 -0100. You ma obtain a copy of the rules or direct questions to OUNC by calling 503 246.6699 or 1.800.332.2344.
i R(�J
Issued By: c�—_ .� Q Permittee Signature: � �. Q " V
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 an inspection that business day.
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 g FOR OFFICE IISE ONLY '. •
RECEIVE .�I ece ived C ie ` ^�� (lb City of Tigard a eeive
Permit No.: .J
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
"' Phone: 503.639.4171 Fax: 503.598.1960 JUL 2 0 Date/B : Other Permit:
T 'GA Inspection Line: 503.639.4175 2009 Date Ready /By: H See Page 2 for
Internet: www.tigard - or.gov Notified /Method: IBMI Supplemental Information
CITY OF TIGARD
TYPE OF WOR ILDING DIVISION PLAN REVIEW
❑ New construction Addition /alteration replacement
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more 0 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 0,CommercialIindustrial ❑ 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 AND LOCATION 7 7
& (n_10 fddition of new motor load of ❑ "A ", "E ", "1 - ", "I - 3 ",
1001W or more. occupancy.
Job no.:0y - 341- I Job site address: >i• ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: } ' ,/�
9 �J ❑ Health -care facilities. ❑ Supply voltage for more than
f G / + / Z ID Hazardous locations. . 600 volts nominal.
Suite/bldg. /apt. no.: � Project name: ❑ Service or feeder 600 amps or more:
FEE SCHEDULE
Cross street/directions to job site: - Description I Qty. I Fee. I Total
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'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family
C h erN , ` t, C;3 1-4 - f" CA-It- d if '. Doz. residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name:
v 401 amps to 600 amps 160.60 2
t I 6 --Cr— t1 9 ArtC{ 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: ( ) I 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
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: Scott-Co Electric, Inc. B. Fee for branch circuits
Contact name: Mark Stanko without service or feeder fee, t�[
'
first branch circuit 46.85 /v 2
Address: P.O. Box 92 • . Each add'l branch circuit I - , e
6.65 ; ,b 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Boring Or 97009 Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: (503) 668 -7111 Fax: : (503) 668 -3104 Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
- CONTRACTOR \ Sign or outline lighting 53.40 2
Business name: Scott-Co Electric, Inc. Signal circuit(s) or limited-
. energy panel, alteration, or
Address: P.O. Box 92 extension. Describe: Page 2 2
City/State /ZIP: Boring, Or 97009 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 668 -7111 Fax: (503) 668 -3104
Investigation per hour (t hr min) 62.50
CCB Lic.: 178098 Electrical Lie.: C328 Suprv. L' • j j 5S5 Industrial plant per hour 73.75
S-a Q °7, `7i1/� t t ( ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: � tO (d Subtotal: 53,. 3 . 0
Print name: Mark Stanko Date: Plan review (25% of permit fee):
�� b JU State surcharge (12% of permit fee): C Z
Authorized signature: TOTAL PERMIT FEE: 9.4z
This permit application expires if a permit is not.gqbtained within 180
Print name: Date: days after it has been accepted as cotfrplete.
• Number of inspections allowed per permit.
is \ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11 /05 /COM/WEB `'