Permit 11 CITY OF TIGARD ELECTRICAL PERMIT
111111 2 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00520
T f GARD 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Date Issued: 09/21/2011
Parcel: 2S102CC00500
Jurisdiction: Tigard
Site address: 13500 SW PACIFIC HWY
Project: Firestone Subdivision: Lot:
Project Description: (1) branch circuit for additional lighting.
Contractor: OREGON ELECTRIC CONSTRUCTION INC. Owner: MERCER INVESTMENTS LLC
1709 SE 3RD AVE 629 NW SEAN CT
PORTLAND, OR 97124 BEND, OR 97701
PHONE. 503 - 234 -9900 PHONE:
FAX. 503 - 234 -1001
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 09/21/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 09/21/2011 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 through 0' : 952-001-007 o u may obtain a copy of th =r direct questions to OUNC by calling 503 232 1987 or 1 800.332 2344
Issued By: //. r_ �1 " •..- _ s� T Permittee Signature: <-.. — ' / ��
400 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.
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Electrical Permit Application \� F „...._., ._......,,,,____,,,,,.. .. „.....,„_,..
i FOR OFI iC1L USL ONLY,, ' F
City of Tigard and Received
5f , 1.1 l % .0 Date/B r7 I Permit No..
13125 SW Hall Blvd., Tigard, OR pp�7�2g3 1. ��� ..4 —
t� t ,e, Plan Review
IN
Phone: 503.718.2439 Fax: 503.598119t0, ' ;3,\1 Dat
Other Permit:
Inspection Line: 503.639.4175 ,
,.:;ii-6.,,N K D � ,,���;p , �: t ,,, ate Ready/By, H See Page 2 for
c -
< Internet: www.ttgard- or.gov J , A .. \ , ,J' Nolified/Method; C Supplemental Information
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;- 'r' - TYPE` ' ,W.OR1C' - ;��.�� � PLAN ` REVI -..
❑ New construction ® Addition /alterationireplcement Please check all that apply (submit sets of plans w /items checked below).
V .a - ❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑ Other: where the available fault current
❑ Marinas and boatyards.
, , CATEGORY OF'CONS ` exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 0 Commercial -use agricultural
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder 0 Other: ❑ Fire pump. ❑ Installation of 75 KVA or
,, :. • , - � ��,�- . - ❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND, ❑Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no,: 80622 Job site address: 13500 SW PACIFIC HWY 1001II' or more. occupancy
❑ Six or more residential units 0 Recreational vehicle parks.
City/State /ZIP: TIGARD OR 97223 ❑ Health -care facilities. 0 Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: FIRESTONE 0 Service or feeder 600 amps or more.
Cross street/directions to job site: ncscriptien FEE $OI y, I Fee. I Total C
' New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add't S00 sq, ft or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
'.DESCRIPTI(ON OF WORK - - . , - ' , ` (with above sq. ft.)
Limited energy, multi - family 75.00 2
ADD LED LIGHTING residential (with above sq. IL)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
0 PROPERTY OWNER , ❑ TENANT.. 201 amps to 400 amps 133.56 2
Name:
401 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
Temporary services or feeders installation, alteration, and/or
City/State /ZIP:
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
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 sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
`APPLICANT - .' 0- CONTACT, PERSON : , ', above
each b service ranch circuit or feeder fee 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 5618 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address; Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
CONTRA i OR" , ' : ' , • Signal mrcmt(s) or limited- energy
Business name: OREGON ELECTRIC GROUP panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 1709 SE 3" AVE Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: PORTLAND OR 97214 Investigation (1 hr min) 66.25 / hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 234 - 9900 Fax: (503) 535 - 2763 Inspections for which no fee is 90.00 / hr
specifically listed ('Y hr min)
CCB Lie.: 203 Electrical Lic.: 26 -95C f Suprv. Lie.: 4549S ' ;' ;. ELECTRICAL•.YERMIT`FEES':.,,; ',,,
e Subtotal: 56.18
Suprv, Electrician signature, required: ( 111k ����
l ,.• Plan review (25% of permit fee)
Print name: RICK MCELLIOTT Date: 9 -21 -11 State surcharge (12% of permit fee): 6.74
IW 1Z TOTAL PERMIT FEE: 62.92
Authorized signature: C This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: RICK MCELLIOTT Date: 9 -21 -11 * Number of Inspections allowed per penult.
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