Permit CITY OF TIGARD ELECTRICAL PERMIT
111 4
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00511
TIA.D 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Date Issued: 09/15/2011
G.R.
Parcel: 2S112AA00900
Jurisdiction: Tigard
Site address: 14140 SW 72ND AVE 100
Project: Polycast Subdivision: 1992 -007 PARTITION PLAT Lot: 1
Project Description: (1) 300 amp feeder
Contractor: CHRISTENSON ELECTRIC INC Owner: WALTON CWOR NELSON 13 LLC
111 SW COLUMBIA ST, STE 480 BY CTMT - WALTON RE TAX
PORTLAND, OR 97201 4678 WORLD PARKWAY CIR
ST LOUIS, MO 63134
PHONE 503 - 419 -3300 PHONE:
FAX 503 - 419 -3695
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 201 to 09/15/2011 $133 56
Specifics: 400 amps
1 ea 12% State Surcharge - 09/15/2011 $16 03
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $149 59
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 OV52- 001 -0090. You may obtain a copy of th= • -s or.direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344.
Issued By: • G��'° ��� fir., �-� 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.
SEP -15 -2011 THU 12:46 PM CHRISTENSON ELEC_RIC,INC FAX NO, 95034193695 P. 01/02
Electrical Permit Application A i USE FOR OFFICE ,c -
I. l yNl,y
711 City of Tigard ` "/.*- \ ' Received ` ��,,,,
s " 13125 SW Hall Blvd , Ti g ard, OR " y 3 \ y % \\ Dato/By: AC1 510 /371--- Permit No„ i^L� -YU' /f—
G� /�
Phone; 503.639.4171 Fax: 503.598 =1960 Plan Review
\ p n�} Date/Ely Other Permit;
T' 1 C:1 A R D Ins Line, 503.639 . `` ` l ` �! 4 Datc Ready/By duns' - 12 See Page 2 for • Internet: www.tigard or, gov S ' ( ..,,,k \ � ` t'� -, Notificd/Mct '7 Supplemental Information —
��o
' l'YPE OF R
I WOICf� v, \;tv _ , ,„ ' , • ' �� .�.��* ,,. „
..,:.. +; �.� , y , n , �PL A 1!j'! IiLa'VT�",1?V `, ■ �,, , ,r
❑ New construction Cddition /alteration /r_eps cVm' ent Please check all that apply (submit 2 sets of plans whtema checked below);
Ne.v ❑ Service or feeder 400 amps or more ❑ Building over throe .tones,
❑ Demolition ❑ Other: where the available fault current Q Marinas and boatyards
Cs'# I'hG / iiY OP CONSTRUCTION; exceeds 10,000 amps at 150 volts or 0 Floating buildings.
' w - less to ground, or exceeds 14,000 ❑ Commercial -ass agricultural
❑ 1 - And 2 - family dwelling ►r, 4•111mercial /industrial 0 Accessory building amps for all other installations, buildings
❑ Multi family ❑ Master builder 0 Other: ❑ Fire pump. ❑ Installation of 75 KVA or
IOU SITE INFORMATION AND LOCATION IOi\T ❑ Emergency system, larger separately derived system
❑ Addition of new motor load of 0 "A ", "E ", "1 -? ", "1 s ",
a/ `
Sob no. . Job site address: \1.\ \ L C) n .� J 100HP or more occupancy.
tf 11 // �"' "" -- ❑ Six or mare residential units, Q Recreational vehicle parka
City /State /ZI ; d _ 1 n CAI ❑ Health -care facilities ❑ Supply voltage far more than
\ pail, . _-„- 0 Haaaardous locations, 60o volts nominal
Suilelbldg.apt, no.: \ 10D Project nom - d l, Q Service or feeder 600 amps or more
t�,lat� ' FEE 'SCHEDULE
Cross street/directions to Job site: nrseri,,,i,m '".'. 9, J4 , Tefal
New residential single or multi family dwelling unit_
1'N. &111/ - 11 P 1 —1-- (p Includes attached garage.
Subdivision: Lot no.: 1,000 sq, ti, or less 1613.54 4
Ea add'I 500 sq. ft. or portion 33 92 1
Tax map /parcel no.: Limited energy, residential ---
' DESCRIPTION OF WORIC , . (with above sg. .)
75.00 2
— Limited energy. multi - family
411.6 4_1 Ih1* L(P.: 1 _, 1■ —tie ,) residential (with above sq. ft.) I 75,00 2
Services or feeders installation, alteration, and /or relocation
200 amps or ICES 100 70 2
' 0 PROPERTY OWNER i�' I7 N #NT - 201 amps to 400 amps 1 139,56 ( 2
Name: q01 amps to 600 amps 200,34 2
601 amps to 1,000 amps 301 04 2
Address: Over 1,000 amps or volts 552.26 2
City /State/ LIP:
Temporary services or feeders installation, alteration, and /or
m relocation ,
Phone:, ( ) F ax; ( , ) 200 am o les's - 59 . _ 1
201 amps to 400 amps 125,05 2
Owner installation: This installation is being made on property that I own which is not
401 amps to 599 amps 168,54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. �..._.. --
Rranch circuits - new, alteration, or extension. per panel
Owncr,signaturc: ' Date; , - A Fee for branch circuits with - ■ A ' I CA{� above service or feeder fee,
( E l , CONfr cT,PERSON _ branch circuit leach 7,42 2
Business name: ILA: * .r ' / t ' i. ' H. Fen for branch circuits without
— , service or feeder fee, first
56,1R 2
Contact name: ' " branch circuit
Each add'l branch circuit 7,42 2
Address: Miscellaneous (anti ice or feeder not included)
Each manufactured or modular ((
City /Stsltc /ZIP: dwelhnp,,, service and/orfeeder 67,54 2
Phone: ( ) Fax: ' ( ) Reconnect only 67.54 _ 2
Pump or irrigation circle 67,84 2
E -mail:
Sign oratitlineli5 67.24 2
CONTRACTOR Signal circuit(s) or limited-energy
Business name: � I ! A ` - + A1� d t `, `
panel, alteration, or extension. Page 2 2
Each additional Inspection over a(lawahle in any of the abov
Address; . ‘ `i 0, , ` ^ �._. t I p Additional inspection (I hr mm) 66 25/ hr
City /State /7_IP' Y„-1r, C,Q !x,
Investigation (1 hr min) — G6 18 / hr
Y.-MC, �/'1'`� r��.J lnduatfiul plant (1 hr mm) 7R I R/ hr
Phone: ��yy A _ -.et o% 1 '' Inspections for which no fee it �,--_...
�1� - —411. ' * gpeciFeally listed (vi hr min) 90,00 / / hr
hr
- CCR Lic_ "-'
• / mil! � : v , Lie ' ELECTRICAL PERMIT" FEES
Subtotal,
Suprv. Eleclrtcia t.L. I..n signature, required: '� il Jti�� - —,— v
L,w
_ � f_ Plan ieic (25% of permit fee):
Print name: Dale I State surcharge (12% of perms fee) 1 1
_ T _ OTAL PERMIT FEE: \ 1/6
Authorized signature: - ` 1 ' 'itii, petmif piflplicnti(m expires if n permit is not obtained within 180 i
__ Num6er o days after it has been accepted as complete.
Print name: Dale;
f inspections allowed per pea mil.
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