Permit ., CITY OF TIGARD ELECTRICAL PERMIT
II ''I;` COMMUNITY DEVELOPMENT Permit #: ELC2011 -00576
Date Issued: 10/18/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel: 2S113AB00600
Jurisdiction: Tigard
Site address: 16125 SW 72ND AVE
Project: St Judes Subdivision: COUNCIL VIEW ACRES (LOTS 21 -44) Lot: 30
Project Description: (1) feeder and (4) branch circuits in clean room.
Contractor: CHRISTENSON ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES LP
111 SW COLUMBIA ST, STE 480 ATTN: N PIVEN
PORTLAND, OR 97201 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 -419 -3300 PHONE
FAX 503 - 419 -3695
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 10/18/2011 $100 70
Specifics: amps or less
4 crt Branch Circuits w /Purchase 10/18/2011 $29 68
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 10/18/2011 $15 65
Electrical
Type of Const:
Occupancy Grp:
Total $146 03
Required Items and Reports (Conditions)
This permit is is • - • -ct to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will
be done in : ccordance with - ..roved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days AT ENTION Oregon law = • • -s ou to follow the rules adopted by the Oregon Uti • • ^ ;: er Those rules are set forth in OAR
952 -001 6010 thr •ugh OAR 952 -0090 'ou ay obtain a copy of the rules or direct questions to OUNC by calling 503 r 1 800 332 . , •=1 I
Issu =d By: , 1 I Permittee Signature: ._ "
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' _� ,4'Y f itriffr' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
OCT -17 -2011 MON 03:24 PM CHRISTENSON ELECTRIC, INC FAX NO. 95034193695 P. 01/02
Electrical Permit Application 1.'1112 OFFICE I ISE O,N1.1
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City of Tigard �' f Ec E 1
H ats/$ i / D �e // • / Permit C ka0 /I a
r 13125 SW ITa1l Blvd., Tigard, OR 97223 Plnn 1Yevlew
t I ' Phone: 503.639.4171 Fax' 503 598.1960 O C T ry At - outer Permit'
l' l c.i r\ It Ll Inspection Line: 503.639.4175 I 41'e a Re ndy/Qy. NOR, 53 Sec Pegs 2 for
Internet; www.tigard or•gov Notified/Method. Supplemental Information
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": .',1'Y );OF' W liK �r , 411x;, ', �'l'.il�,ha!,ii,;i;;,4;i, r " , ., '.;', : : ''
•'� � ,,,. ' r � , ' r,"' ;„1.', ,1 ( 'fig p 4 'rl-�,l_ :, _ � -.... ta'': �i.,,�i�w.�lt�v��r��`,�,,. , :. :,�'. - ,,
['New construction Addition /alteration/rep cY frt G L„/7 y �O�t N Please check all that ripply (submit ?/ sets of plans whtcros checked below)
Q Service or feeder 400 amps or more El Building ever three stories.
❑ Demolition Other: whore the available fault currant ❑ Marinas and boatyards
CATi;,6ORY OF' CONSTRUCTION ', . , exceeds 10.000 amps at 150 volts or El Floating building,
r lass to ground, on exceeds 1 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations, buifdingt•
❑ Multi - family aster builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system, larger separately durived system.
"' .1011 SFi'E`INFORM*TION: AND LOCATION Addition of new motor loud of
(
Job no.' Job site tuldress:F♦ 4/fl , A toorll'or morn. occupancy,
Six or more residential units, ❑ Recreational vehicle parks
City/State /Ella ❑ FIeahh -earn fccilmus it Supply voltage fir more than
ti, Q t Inxardous locations, 600 volts nominal
Suite /bldg, /Apt, no.: Project name, CI Service or feeder 600 amps or more
' 7 AL" L „,,., : rEt't ieiiULE
Cross street/directions to job silt.: _ ,
,) r . t 11 �' ,, ... ♦v DetariMinn Qty. I Fee. 1 Total 1 +
� 1 New residential single- or multi - family dwelling unit.
r 4, w t t`1' Pea-50 /3 Includes altad led garage.
Subdivision: 1 Lot no,: 1,000 sq ft, or less 168,54 4
En, add'! 500 sq. ft. or portion 33,92 1
Tax map /parcel no.: Limited energy, residential 67,84 2
' DE$CR1PTION OF'WORIC (with above sq. ft,)
—
Limited energy, multi family 2
I' Al JIM _ 1 . >> • ei residential (with above sq. ft.)
67
.. I , �'
Services or feeders installation, alteration, anJlur relocation 10.46 ./ —.Mk n.- 200 amps or lass l 100.70 ibD 110 2
. :.
PR �
� ' 1- Y' - ' 1 +— ii, TENN'1�' 201 amps to 400 amps 133 56 _ 2
Name: u 401 amps Co 600 amps 200 34 2
—
_. 601 amps to 1,000 amps 301,04
Address' Over 1,000 amps or volts 552.26 2
City/State/ZIP: !Stale /ZIP: Temporary, services or feeders installation, altentlion, and /or
y relocation
Phone: ( ) Pax: ( )
200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owiler installation: This installation is being made on property that 1 own which is not - --- - -••-
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 am to 599 amps 168 T 2
Branch circuits- new, alteration, or extensinn panel ______
A A. FCC for branch circuits w ith l y
Owner signature; __- .......� ___._,.. u4
LIC CONTACT Date: � a bove service or feed
Q, 4iN ❑ NTr�CT ]PICRS r f 7,42 2
each branch client!
Business name: • ',. B. Fee for branch circuits wuhorrl
L I1 A '" «'� service or feeder tee, Oral
5618 2
Contact name: branch circuit
- ^•-- Each add'1 branch circuit I 7 42 2
Address: Miscellaneous (service or feeder Itot included)
Ci !State /G1P: Each manufactured or modular 67 84 2
h dwellanh. Service and /or feeder
Phone: ( ) 1 Pax; : ( ) Reconnect only 67 84 2
-- --- Pump or irrigation circle 67 84 2
E -mail: - r _,m __ Sit;nor outline !Wiling 67,84 2
, An , • CONTRACTOR _ Signal circuit(s) or balled- energy
Business name. I I 1 panel, alteration, or extension. - __ P a ge 2 2
._ - �j� � �- •� ;! -,' Each additional inspection over allowable in any of the above
Address: 1 1 'P Additional inspection (I hr mm) 66,25/hr
' - , — r- , ; Investigation (I hr mm) 6625/ hr
Ciiy /Shale / %1P; A ` I D' c' p�y = Industrial plant (1 hr min) 70,10 / hr
Phone; F l 14 n or — Inspections for which no fee Is 90,00/ hr
specifically listed O hr mm)
CCB Lie.' 45 Electrical Lic. I a , Su rv. Lie. �� , , I41.,FC'f'RICAI:' PERMIT IEEE y ,/
�. ., _ / Sublet - -, 1 t�-
Suprv. Electrician Signature, required: —
r r r e pl review (25 %o fpernut fcc):
Print name: i , , 1 D e: Stale Surcharge (12%of permit fee)' 1 t=
TOTAL PERMIT FEE 1C) i
Authorizcd signature. _ Thin permit application ceprr if permit is nut',htri red within 18
name.
Pate: days after it has been accepted as cnmplele , J A
t Number al'ins :. allnwerl per permit
1 \n \PLC- rei fiii App Pao. 11001/0•1 411.1'1151'01i i/('OM/w[n # /i/le•°3