Permit CITY OF TIGARD ELECTRICAL PERMIT
I COMMUNITY DEVELOPMENT Permit #: ELC2012 -00277
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/11/2012
Parcel: 1S136DCO2504
Jurisdiction: TIGARD
Site address: 7275 SW DARTMOUTH ST 120
Project: Great Clips Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: Wire receptacles at stations and counter
Contractor: HILLSBORO ELECTRIC LLC Owner: AMERICAN INDUSTRIES INC
21185 NW EVERGREEN PKWY #110 1750 NW FRONT AVE STE #106
HILLSBORO, OR 97124 PORTLAND, OR 97209
PHONE: 503 -439 -9666 PHONE:
FAX: 503 - 601 -3680
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 05/11/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/11/2012 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 0 52- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 5 or 1.800.332.2344.
Issued By: .) %. y
Permittee Signature: 'v f AsolticiP tig
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.
May 1012 09:11p p.1
Electrical Permit Applicatilt � �� R ecei k ed
FOR OFFICE USE ONLY
1, •
City of Tigard Da,cBv: GG 12 Permit No.: j� MA 17
111 13125 SW Ball Blvd., Tigard, OR 97223n^ 1 1 2 012 Plan Review
B Phone: 503.639.4171 Fax: 503.598.196t,' DateBv. Other Permit: gap 2W 3,' payia
7 1 c ,i 1: D Inspection Line: 503.639 ^� TI �1 Date ReadyBy: kids-. 53 See Page 2 for
Internet www.tigard-or C 1� 11 1133Tt Notified/Method; 41 (p Supplemental Information
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9y 1�99 r r. pits11,9 , 1 N
TYPE OF Iiiii1 C • •, ' , PLAN REVIEW
❑ New construction Il Addition /alteration/replacement Please check all that apply (submit 2 acts of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition ❑ O ther: where the available fault current ❑ Marinas and boatyards. .
CATEGORY OF CONSTRUCTION ' exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds i4,C00 ❑ Commercial -use agricultural
❑ I - and 2- family dwelling Commercial /industrial ❑ Accessory building amps far all other installations. buildings.
0 Multi-family Master builder ❑ Other: ❑Fire pump. ❑ Installation of 75KVAOr
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.'
❑ Addition of new motor load of ❑ "A ", "E ", "I -2" "1 -3 '
Job no.: ?O 8 Job site address: 7 a -75 5 (.0 7"i to(.. IOOH' morn.
occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: J r6 04 . G �� ❑H facilities. ❑ Supply voltage for morethan j
J ❑ Hazardous dous locations. 600 volts. nominal.
lip bldaJapt. no.: 42 Project name: G( EC } ' 11) C I 5 ❑ Service or feeder 600 amps or more. 1
FEE SCHEDULE
Cross street/directions to job site: Description I Qtr. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: ; 1,000 sq. A. or less I 168.54 4
Tax map/parcel no.: l Ea. add'l 500 sq. it or portion I 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION ` T (with above sq. ft.)
I OF WORK C
W I r. ruephc er5 a 3- 5 ia � .ts Limited energy, vial (with above residential (with above sq. f .) 75.00 2
Services or feeders Installation, alteration, and/or relocation
tP b4"., _200 amps or less 100.70 j 2 I
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 13356 ! 2
Name: 401 amps to 600 amps 20034 2
. 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State/Z1P: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
Owner installation: This installation is being made on property that I own which is not 201 amps m400amps 125.08 2
intended for sale, lease rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 166.54 2
Branch circuits - new, alteration, or extension, ear panel _
Owner signature: Date: A. Fee for branch circuits with
• ❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7 4� 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first J 1 56.18 s. 2
Contact name: branch circuit 1
Each add'I branch circuit I I 7.42 7, y1 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: /Sta[e!Z]P Each manufactured or modular 67 84
tY : dwelling. service and/or feeder
Phone: ( )
Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle ; 67.84 2
E -mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal ciratit(s) or limited- energy
Business name: panel, alteration, or extension. 1 Page2 2
Hillsboro Electric, LLC Each additional inspection over allowable in any oftheabov
Address: 21185 NW Evergreen Pkwy #110 Additionat inspection (1hrmin) 66.25/ hr
CitylStaleJZ1P: Investigation (I hr min) 66.25! hr
Hillsboro / OR / 97124 Industrial plant (1 hr min) 78.18/hr
Phone: ( 501 4 3 9 - 9 6 6 6 I Fax: ({ 0) 601-3680 , inspections for which no fee is - 90,0pr hr
` specifically listed (%s hr min) _
/CCB Lit.: 134481 44 trical Lic.: 3 4 � 4 9 C Suprv. Lie.: ! i ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: j ! / Subtotal: t o ? , to 0
f tihezees Plan review (25% of permit fee): r--
P rint name: TlX U i �, Date: s --- i0 -- f a State surcharge (12% of permit fee): 7, L 3
Authorized signature: " TOTAL PERMIT FEE: d7 f ,3
This permit application expires if a permit Is not obtained within 181)
•
Print name: I Date: d ays after it has been accepted as complete.
• Number o inspections allowed per permit
tnuilding%PermntE.
ic- PerrnitApp doe 07/01/10 l : 44Cael5Tt1 I/a5/COi,t/WEB