Permit CITY OF TIGARD ELECTRICAL PERMIT
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f; COMMUNITY DEVELOPMENT Permit #: ELC2009 -00114
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/06/2009
Parcel: 2S102AD02200
Jurisdiction: Tigard
Site address: 8900 SW BURNHAM ST
Subdivision: BURNHAM TRACTS Lot: 6
Project: Burnham Business and Storage
Project Description: Electrical reconnect for space F25.
Owner: FEES
BURNHAM BUSINESS & STORAGE LLC Quantity Description Date Amount
9500 SW BARBUR BLVD STE 300
PORTLAND, OR 97219 1 ea Reconnect Only 03/06/2009 $66.85
PHONE: 1 ea 12% State Surcharge - 03/06/2009 $8.02
Electrical
Contractor:
PHONE:
FAX:
Type of Use: COM
Class of Work: OTR Type of Const:
Occupancy Grp:
Total $74.87
Required Items and Reports (Conditions)
This permit is . -. . .'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done i accordance wit approved plans. This permit will expire if work is not started within 180 days of issuanc., or,if work is suspended for more the 180
days. A ENTION: Oregon req ir-s you to follow the rules adopted by the Oregon Utility Notification • enter Thos- rules are set forth in OAR
952 -001- 010 through OAR 95. r 61-01; �ou may obtain a copy of the rules or direct questions to OUNC by calling 503.24.:69• •r 1.800. yC2,2344.
Issue Permittee Signature: . �' IL
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 Appli alt.i �' i FOR OFFICE USE ONLY •
1 .
City of Tigard ' " `' Date/By: d al 2 CP og / PermitNo.: ��Ll �oo9 -ez., //
_ q 13125 SW Hall Blvd., Tigard, OR ' i .? 30 6 2009 Plan Review
Phone: 503.639.4171 Fax: 503. ":. '60 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready /By: Juris ia See Page 2 for
Internet: www.tigard- or.gov � � OF TICaAR D
Notified Method ' / /(� Supplemental Information
.. mir rt1\11C1niq
: TYPENUFWURK d' _ —PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
El New construction 21 Addition /alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
`" ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
- " ,CATEGORY. OF '- CONSTRUCTION 'f exceeds 10,000 amps at 150 volts or CI Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling Eg 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 ", "l - ", "1 - ",
`^' `,, 100HP or more. occupancy.
Job no.: Job site address: U 0 S� V �11�1/11 r `[!1 m Sfi ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: 12 Health-care facilities. ❑ Supply voltage for more than
ty State /ZIP: � ( f IV I //^, ` Y O �� ��� CI Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: JJJ - Project name: CI Service or feeder 600 amps or more.
l 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'I 500 sq. ft. or portion 33.40 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
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: 4 \ � 1 � 401 amps to 600 amps 160.60 2
G n \n 'nn 601 amps to 1,000 amps 240.60 2
' Address: D� u u S ` V v r 15 �� 11 V1 Y V' I- Over 1,000 amps or volts 454.65 2
City/State /ZIP: .11 (A ll 0Vi U ql 7/2) Temporary services or feeders installation, alteration, and/or
relocation
Phone: (''S O 5 ) V 9) Ol - 'ei 71 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
Owner signature: Date: Branch circuits — new, alteration, or extension, i er panel
g A. Fee for branch circuits with
❑ APPLICANT - ' _ CONTACT PERSO above service or feeder fee, 6.65 2
R �/ I /147 �--�! each branch circuit
Business name:
!JN Y l' ��Lj �� S I U V (/ B. Fee for branch circuits
�
, ' without service or feeder fee,
Contact name:
1 1 1 , °^ I � {�
1 I I" 1 V first branch circuit 46.85 2
Address: 0" I u b t�� toy 0 I m Si" Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: -IA 0\/71)(0k u� i r^ I" y 7 Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: ( '7 ) U a ?"--/ ?"--/ ; ( ) ') '' � ,
I Reconnect only l _ 66.85 j. )_ ,t f 2
E -mail: ��, Pump or Irrigation circle 53.40 tt�DUU 2
- , CONTRACTOR '. . .' ,' ', Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( )
Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT' FEES.`,.' ,
Suprv. Electrician signature, required: Subtotal: 0(P ,
Print name: Date: Plan review (25% of permit fee): .{--
State surcharg 2, of permit fee): t° c s
Authorized signature:)( a TOTAL PERMIT FEE: 7 Q
Print name: I ate Date: 'Z)/0/411 This permit application expires if a permit is not obtained thin 11
� ��� Within
days after it has been accepted as complete.
* Number of inspections allowed per permit.
I: \Building \Permits\ELC - PermitApp doc 05/23/06 440- 4615T(1 I /05 /COM /WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
F RESIDENTIAL WORK ONLY:` , ;
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
'' WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
PI Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1. \Building \Permits \ELC- PermitApp.doc 03/23/06