Permit •
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00085
TIQARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/07/2012
Parcel: 2S102AD02200
Jurisdiction: Tigard
Site address: 8900 SW BURNHAM ST
Project: Burnham Business & Storage Subdivision: TIGARD HIGHWAY TRACTS Lot: 21
Project Description: Reconnect only.
Contractor: Owner: BURNHAM BUSINESS & STORAGE LLC
9500 SW BARBUR BLVD STE 300
PORTLAND, OR 97219
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 02/07/2012 $67.84
Specifics:
1 ea 12% State Surcharge - 02/07/2012 $8.14
Electrical
Type of Use: COM
Class of Work: OTR
Type of Const:
Occupancy Grp:
•
Total $75.98
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes an• all of /r 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, o if wor is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Cen r <•se rules .re set forth in OAR
952 - 001 -0010 through 0' : 952- 001- 0090 m cobfe _ _ • :1
• • les or direct questions to OUNC by calling 503.232 1?:7 • .332.2344.
Issued By: , '�i Permittee Signature: I .4 .41
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.
Electrical Permit Application �9
City of Tigard
FOR OFFICE USE ONLY
#(.4" � p Received - O yI
DateB : J Permit No.: - l}l �
Q
13125 SW Hall B Tigard, OR ....... 2j '�rL D a te /Ry
.11 q ` Plan Review
I • Phone: 503.718.2439 Fax: 50319_814960 A .- Other Permit:
Inspection Line: 503.639.4175 Date ReadyBy: turfs: ® See Page 2 for
T fG A R D Notified/Method: - 7 X:C Supplemental Information
Internet: Line:
' ''� rjP tJ� G e- pp
TYPE OF WOs�, --\
R IC Co,' .PLAN REVIEW
❑ New construction ❑ Addi ' alterati�Ofh(tl&la�Ce
i a ` ment Please check all that apply (submit 2 sets of plans w /items checked below):
Uve�
❑ Demolition they: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
CATEGO OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling 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 ", "1 - ", "1 - ",
t j 0 ;n `� `n \ `^ yt n 100HP or more. occupancy.
Job no.: Job site address: (� "I ► Y 1 11 t I 1 Y V I �`
/
0 Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: / f �n V� �� 11 a'a r .�e C i � ❑ ❑ Health-care facilities.
❑ Supply voltage for more than
• J // Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: I Project name: i� 1 . r� ❑ Service or feeder 600 amps or more.
" ����� � IY �` FEE SCHEDULE
Cross street/directions to job site: 11 ! D li V Description ►' I� p 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 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.:
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft )
I Limited energy, multi- famil 75.00 2
( „ r �, }l-� 1 residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
[PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: t to �/y) y\ G1 yvl y2hi > qty 6 7 51 -b 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: VI O U � \1\,/ yvl'((ii y1/1 s- -. Over 1,000 amps or volts 552.26 2
City/State /ZIP: "` (J( poi ( O (/�'`' 7b Temporary services or feeders installation, alteration, and /or
relocation
Phone: ('>ij \ '?) /I . ') - Fax: (tot. ) X'�' W I U D 200 amps or less 59.36 1
v 201 amps to 400 amps 125.08 2
Owner installation: Thi i tallatio's being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, t, o frtt
i g e rdin g to ORS 447, 449, 670, and 7 1.
Branch circuits – new, alteration, or extension, per panel
Owner signature: I Date: v A. Fee for branch circuits with
❑ APPLICANT I tl., CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: '7V\Vy) \An9Y, )vL110 ?snot— B. Fee for branch circuits without
� q`n /�,, service or feeder fee, first
Contact name: 4\ "I l v' Y "I I �'"r �' Y branch circuit 56.18 2
(� 0 0 7� t VI IM Miscellaneous edd n branch circuit 7.42 2
Address: V � �� Miscellaneous (servic or feeder not included)
City /State /ZIP: -nu twat, DK 0,��2� Each manufactured or modular 67.84 2
- J dwelling, service and/or feeder
Phone: ('�j(�'' Qtly 1 . 7')'71 Fax: : ( ) Reconnect only. 1 67.84 Co 1 4 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name:
panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00/ hr
specifically listed (%z hr min)
CCB Lie.: Electrical Lie.: Suprv. Lic.: ELECTRICAL _PERMIT FEES
Subtotal: 40 -
Suprv. Electrician signature, required: _ Plan review (25% of permit fee): —
Print name: Date: State surcharge (12% of permit fee): _ i l i
TOTAL PERMIT FEE: p
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440- 46t5T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
•
❑ Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1.\ Building V'ermits\ELC- PermitApp.doc 07/01/10