Permit CITY OF TIGARD ELECTRICAL PERMIT
- 2 • COMMUNITY DEVELOPMENT Permit #: ELC2011 -00585
Date Issued: 10/20/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 2S102AD01800
Jurisdiction: Tigard
Site address: 8975 SW BURNHAM ST
Project: Gray's Automotive Subdivision: TIGARD HIGHWAY TRACTS Lot: 21
Project Description: TI
Contractor: PRO CIRCUIT ELECTRIC LLC Owner: CARL H JOHNSON FAMILY L P II
PO BOX 3948 BY JOHNSON, CARL H
WILSONVILLE, OR 97070 8965 SW BURNHAM
TIGARD, OR 97223
PHONE 971 - 563 -8211 PHONE:
FAX 503 - 266 -1349
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo /Purchase 10/20/2011 $85.86
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/20/2011 $10 30
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $96 16
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 obtain a co. of the r -s or direct questions to OUNC by calling 503 232 1987 or 1 800 33 2344
Issued By: _ i Permittee Signature: / aLa .
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 603.639.4175 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.
Electrical Perinit ApplicatioBECE1 V _ . , . . . . , ,
, F•OR' 0FFICE.USE ONLY •
City of Tigard OCT 2 0 2011 Received
13125 SW Hatt Ltivd., Tigard, OR 97223 DateB : /Q r � ' - t � o �
°
sT
Phone: 503.639-4171 Fax: 503.598.166 OF n Plan Review
l OFTIGARD Date/By: Other Permit:
TI6ARD Inspection line 503.639 4175 c �y Date Ready/ny_ J y Rt See Paget for
Internet: www tigard- or.gov BUILDING DIVISION Notified/Method: ' / �!9 Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /ucros checked blow)
IL] New construction , �dditionfalteration/replacement
Demolition El Other: ID Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards -
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
El 1 — and 2-family dwelling CommerciaUindustrial less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ Accessory building an for all other installations. buildings.
❑ Multi - family ❑ Master builder
- El Other: 0 Fire pump. CI installation of/5 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system larger separately derived system.
❑ Addition of new motor load of ❑ "A ^, "E ",'l -2 "t -3 ",
6375 j� ,�f! ,, f l00HP or more. occupancy.
Job no.: lob site address: $g7
t �tl f+?1` t ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: ❑ Heahlt -cote facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: G I T A^-- OrnaKa - ❑ Service or feeder 600 amps or more. .
Cross strect/directions to job :Re: FEE SCHEDULE
Description I pry. I Fee. I Total 1
New residential single -or multi - family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. R. or portion 33.92 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. II.) 67.84 2
�n/� ✓t ,, Limited energy, multi - family
S F-b( 'QNoJ i T1n'it' e r residential (with above so. it.) 67.84 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 1 2
❑ PROPERTY OWNER 0 TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 ` 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not , 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 1.4 rr
Business name:
each branch circuit 7.42 r 2
13. Fee for branch circuits
Contact name: without service or feeder fee, t I 56.18 • IS 2
first branch circuit
Address: Each add'l branch circuit 7.42 2
City / State/ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular
Phone: ( ) I Fax : ( ) dwelling, service and/or feeder 67.64 2
Reconnect only 67 84 2
E - mail: Pump or irrigation circle L 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: P L /1 C v= �. I Signal circuits) or limited -
11 energy panel, alteration, or
Address: y, ti ' LI p extension, Describe: Page 2 2
City /State/ZIP: tnJZ(50, e.._ OR, ' ' 7 D 0 Each additional inspection over allowable in any of the above
Phone: ("j () / t f 7 Per inspection 66.25
5 %3 g ( I Fax: (513) 7_4000 r39 Investigation per hour (1 hr min) 66.25
CCB Lie.: j � /�F�� I ( electrical Lic.: ' of L Sup L ie.: 5 o7 5 In dustria l plant per hour 78.18 i
t 1
Suprv. Electrician signature, required: L ELECTRICAL PERMIT FEES
Subtotal: $45--
Cl ,
Print name: 1 ?kf� /NJ ( l I Date: I O-� - Plan review (25% of permit fee):
v
Authorized signature:
t State surcharge (12% of permit fee):
TOTAL PERMIT FEE: 9,(6, , I c
Print name: I Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
4 Number of inspections allowed per permit.
I 'rtoilding5Permnsl$LC- Perm!App dac 10 /01109 440- 4615T(11Po5 /COM/WPB
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