Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00113
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02!23!2012
Parcel: 1 S136DA00101
Jurisdiction: Tigard
Site address: 11410 SW 68TH PKWY
Project: PERS Subdivision: PFAFFLE PLAZA CONDO Lot: GCE
Project Description: Installing UPS and separate panel UPS.
Contractor: CHRISTENSON ELECTRIC INC Owner: OREGON, STATE OF PUBLIC
111 SW COLUMBIA ST, STE 480 EMPLOYEES' RETIREMENT FUND
PORTLAND, OR 97201 11410 SW 68TH PKWY
TIGARD, OR 97223
PHONE: 503 -419 -3300 PHONE:
FAX: 503 - 419 -3695
FEES
Quantity Description Date Amount
2 ea Services or Feeders - 200 02/23/2012 $201.40
Specifics: amps or less
1 ea 12% State Surcharge - 02/23/2012 $24.17
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $225.57
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 ma - • . • • • the rules or direct questions to OUNC by calling 50 .1987 or 1.800.332.2344..
Issued By: _ _��� ✓� •ermittee 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' 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 she at the time of each inspection.
FEB -22 -2012 WED 10:42 AM CHRISTENSON ELECTRIC, INC FAX NO, 95034193695 P. 01/02
il
— -- Application � I�(>li rr(i'r. list: i1Nl.l
ElectriealL,Permit App �� Reccivcd
City of Tigard �� ` j p� r %�� —�'
1 . 33125 SW Hall Blvd,, Tigard, 0:.: �d c�' .Q Odter Bonk; ` = Sec Page Z for
Phone: 503,639,4171 Fax: 503 " :' y
503.639.4175 •C �C?�CJ�,. DateltettdylBy' � Supplentenmllnformation
Line: ``
Inspection Notified/Method:
'f ii; :1 > '
. wow u md•or gov � : ' °�, _ _ 3�'�3���' "'Pk� °C,
Internet: S �. • . _ • - .. G� S >;" •;.y . .
p plans w/i _ .
'•; �; <r:':- ._. check all that apply tams checked below):
::... � �....;. - .. .: .. '... :it;..:��w4�11' � c 2 s ate
'.._
p� of P )'
New construction • Addition /alteration/ a , • ant ['service er feeder 400 amps or more CI Building over three stories.
where the available fault current (J as Marin and boatyards.
Demolition •leer: exceeds 10,000 amps of 150 volts or ❑Floating buildings•
ommereial4ne a cultural
..:. :' . . 4 0Q 1C Pp jS' IVOIM 4'•:: - . ..: %: -• less w eraund or exceeds 14,000 [3 C eri
amps far all other installations. buildings. installation of 75 KVA or
[] 1- and 1 2- f(uniiy dwelling W.' omtnereiallindustrial ❑Accessory building ❑Fire Pump• larger separately derived �'swn-
■ er builder ❑ Other: []Emer system•
CI Multi-family motor load f 1
Jab no.
❑ A dd i t i on dam m a Q °A^ ••E" "1
.. .:. `..;.: f0;$�;S)t:IIF:;;�IVFOR ... . � ;� ' •„ ,...- ,• arcs • • pI!(•.AND t,OCA'll�l'C. � dxcupaney.
t00Hr or El Recreational vehicle parks.
lob Site address SW / pot - — 1 ❑ Six or more idemi units, 1.3 ae
Supply voltage for more rh
❑ Ncalth -can facihtiG, 600 volts voltage
' .' / • ❑ Razardoui locations,
/,.l /J � ` O fader 600 amps or more.
Projectname r / ❑ Service or f psor a ai� : . ,_:. • Suite/bldg./apt. no.: J ' :` :' ' • ' • • �' � '� ��
L.. ree. Toga!
Ireuri Ion
Cross street/directions to job sin: _ New residential single - or multi- family dwelling unit.
includes attached garage. 168.54 �
IJ r ... tom' � >: 3 d 1.000 sq, tl; or less
�
Subdivision' Lot no.:
Ea, ilk 500 sq. R or portion 33.92 II 6 �
Limited energy. residential 7. II
Tax map /parcel no.: Lim
_ :r_:.; above ted y. rest
.• DgSgi FTiON'OF. '::' ':: >:'•' . '' Limited energy. multi 67,84 ' -
residential (with above u1. It)
� a' �f1 �'. ..t �� ' - Services or feeders installation. alteration. andlor relocation
200 amps or leas 100.70 , n
301 amps to 400 amps 11.11 133.56 �
[] ' `PrtOPF1tTX'. T' , Q" 11!l 40I amps to 600 amps - 200.34 Q
Name: .----• .----• 601 amps to 1.000 amps 301.04 11111 111
•
Over 1,000 amps or volts 552,26
Address: - Temporary services or feeders installation, alteration, and/or
relocation 5936 �
PhononState/ZiP: e: ( ) '�'
Ph 200 amps or less IIII
Pax: ( ) 201 amps to 400 amps 125.08 Ell
Owner installation: This installation is being made on property that I own wh i s no 401 599 amp 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits- new. alteration, or extension, • er_panel A. pee for branch circuits with
Owner signature: Date: above service or feeder fee. 7.4_ 2
G(p13tI'. . 1lt RSON ' • each branch circuit
- Q ' .a � B. Fec Car branch circuits without • e /y. I service or feeder fee, first 56.18 2
Business name: 'i,1 1 ,�, i� �A r • F ec for
circuit
7.42 2
Contact name: _ Each atld'I brunch circuit -
Miscellaneous (service or feedereluded
Address: Each manufactured or modular 1111 G7,84 2
dwellin • service and/or feeder 2
Phone: Reconnect only 67'84
I 67.84
P ( ) {Fax• ' ( ) Pump or irligution circle
Sign or outline lishting 67.84 2
E - mail: Signal circuit(s) or limited energy •
^ • • '' • anal, alteration or extension.
2
,,� • bo I � Each additional inspection over allowable in an of the above • �f �.'L�I1'�� • -rte 66.25/ hr
♦ Additional inspection (1 hr min)
Address. �r II�III , D investigation (1 hr min) 6b35/ hr
Industrial plant (l hr min) 78.18/ hr
City /Statc/Z1P: • W /
' � . 0 Inspections for w hi c h n fee is 40,00/hr
/ 1y specifiwlhtlisted (Vi
min)
- P CB (1 _ � _ . . . , . : El1,Et'.1CRICAI,• PERMIT ; F,ES:' • • .:..::.'•'
CCB Lit .:I s lr�<< +` Subtotal: �.��r
/� Plan review (R5% o permit fee):
Suprv. Electrician signature, required: ) M
D ate: i
State surcharge (f 2% of permit fee): Print mane: - ` � / of II Al �b1 / 'TOTAL PERMIT FEE; _ dil
7 'hla permit application eapdres if a perncit is not alit 5. e n 47
Authorized signature: days after it has been accepted as complete.
Date: I N umber of inspections nnowed per permit.
Print name: — '
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