Permit N . , CITY OF TIGARD ELECTRICAL PERMIT
. ','�' COMMUNITY DEVELOPMENT Permit #: ELC2012 -00098
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/14/2012
Parcel: 2S114AA00200
Jurisdiction: Tigard
Site address: 16285 SW 85TH AVE 403
Project: Souper Natural Subdivision: 1993 -078 PARTITION PLAT Lot: 2
Project Description: Replace panel.
Contractor: FRAHLER ELECTRIC CO Owner: WH SHIPMAN LIMITED
11860 SW GREENBURG RD BY NORRIS & STEVENS INC
TIGARD, OR 97223 621 SW MORRISON STE 800
PORTLAND, OR 97205
PHONE: 503 - 639 -4627 PHONE:
FAX: 503 - 639 -4673
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 02/14/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 02/14/2012 $12.08
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
Required Items and Reports (Conditions)
This permit ' ' . -. •'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be do - in accordance with - pproved 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 l.., eq. res you to follow the rules adopted by the Oregon Utility Notific- enter. Those rules are set forth in OAR
95 001 -0010 through OAR 952 oil-0090. may obtain a copy of the rules or direct questions to OUNC by - . 503.2 . 987 or 1.800.332.234'
I •ued By: k. / Permittee Sign. ure: / L. A' _ i t
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' OF f' r c4 Date:
or
LICENSE NO.
_ — -- Ca11.503.639.4175.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 FOR OFFICE USE ONLY
' City of Tigard r Received 4 Arier
Date/By: A 1 Permit No.:
1 . 13125 SW Hall Blvd., Tigard, ,A4 ,C01 to.' Plan Review
Phone: 503.718.2439 Fax: 503. ' 89'960 , q m1 Date/By. Other Permit:
T IGARD Inspection Line: 503.639.4175 ... 1 A LA" Date Ready/By: luris: FIl See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
....," f■=7T)
5 - :i::;w - ,?fAt.x4rtraitawEcvrrw,4;7;Aiki4'r--r?.c-:
EI New construction .
onstruction Addition/alteratiofrepl men r*'. I /Ce si t
[21 Please check all that apply (submit 2 sets of plans w/items checked below):
tyji.... 0 Service or feeder 400 amps or more 0 Building over three stories.
O Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 0 Commercial-use agricultural
O I- and 2-family dwelling [2] Commercial/industrial D Accessory building amps for all other installations buildings.
O Multi-family . 0 Master builder 0 Other 0 Fire pump 0 Installation of 75 KVA or
ID Emergency system. larger separately derived system.
§li
-,-- ;. .r, - — '' - ,,,- l ,,„4:-,,,
,-,....,.. - , ' ,441,-4-:"„W , 0 Addition of new motor load of 0 "A", "E", "1-2", "1-3",
Job no.: 69193 . Job site address: 16285 SW 85th AVENUE 100HP or more. occupancy.
0 Six or more residential units 0 Recreational vehicle parks
City/State/ZIP: TIGARD, OR 97224 0 Health-care facilities. . 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal
Suite/bldg/apt. no.: 403 Project name: SOUPER NATURAL 0 Service or feeder 600 amps or more.
- :Afkifvflsgokilff.'''f ,, v7V%t:Lisi54 - it
Cross street/directions to job site: Description I Qty. I Fee. I Total 1 "
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 .
Ea. addl 500 sq. ft or portion 33 92 1
Tax map/parcel no.: , Limited energy, residential
75.00 2
' 10450
(with a b ° v e sq. ft . )
Limited energy, multi-family
75.00 2
REPLACE ELECTRICAL PANEL residential (with above sq ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 100.70 100.70 2
AiliVIS OPIXOTagr, iii it; 0 = ': -'' --17-rfultrAl1. ilifOr*A 201 a m p s t o 400 amps 133.56 2
401 amps to 600 amps ' 200.34 2
Name:
601 amps 10 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 installationis 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
"i! ' ** 4:4"* " fa w4fit4e 4 •:' , ' --- =:-' 3- ' ii31-061410tWirlit-Wif-Tz above service or feeder fee,
7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first
56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 I 1 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
Sign or outline lighting 67 84 2
- a Signal circuit(s) or limited
Business name: FRAHLER ELECTRIC COMPANY panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 11860 SW GREENBURG ROAD . Additional inspection (1 hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City/State/ZIP: TIGARD, OR 97223
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 639 Fax: (503) 639 ' Inspections for which no fee is
90 00/ hr
specifically listed ('/ hr min)
CCB Lic.: 37410 Electrical Lic.: 34 Suprv. Lic.: 5110S Lae,AV:fiiiiKfatktaAL7tWitWgRr.$MWOf::;':;=';W'
Subtotal: 100.70
Suprv. Electrician signature, required:
Plan review (25% of permit fee):
Date: 02/13/12 State surcharge (12% of pemlit fee):
Print name: ADAM ETHERINGTON 12.08
TOTAL PERMIT FEE: 112.78
Authorized signature:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit.
I ABuilding\ Permits \ELC-PermitApp.doc 07/01/10 440-4615T(11/05/COM/WEB