Permit l •
CITY OF TIGARD ELECTRICAL PERMIT
I : COMMUNITY DEVELOPMEN Permit #: ELC2009-00484
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/16/2009
Parcel: 1 S135BD00300
Jurisdiction: Tigard
Site address: 9735 SW SHADY LN 200
Subdivision: TIGARD MEDICAL MALL Lot: 0
Project: Aesthetic Medicine
Project Description: (1) branch circuit for condensor
Owner: FEES
MCFADDEN, ARTHUR L Quantity Description Date Amount
BY ERIC SKLARZ, 621 SW MORRISON ST STE
#800 1 crt Branch Circuits 09/16/2009 $46.85
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/16/2009 $5.62
Electrical
Contractor:
WILLAMETTE HVAC
3075 SW 234TH AVE. #206
HILLSBORO, OR 97123
PHONE: 503 - 628 -6841
FAX: 503- 848 -2597
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $52.47
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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699p-1.800.332 a 344.
Issued By: /C0/ Permittee Signature: u // //►
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 an Inspection that business day.
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.
•
/r " Electrical Permit Application Foiz OFFICE Usl oNL.,Y -
• Cl of Tigard Received Permit No.:
a 131 Hall lvd., Tigar�:':' D an Review ( � e o �� ��y .
C Phone: 503.639.4171 Fax:: 5 i 2 E IVED
DateBy: Other Permityy +�09' -GO #,J).
T I G n K D Inspection Line: 503.639.4175 Date Ready/By: 3 u' ://tt Fl See Page 2 for
Internet: www.tigard - or.gov SEP 16 2009 Notified/Method: ICa' Supplemental Information
TYPE � PLAN REVIEW
❑ New construction ®Addityq rtirTIGARD
iGn �r ` ' S�t Please check all that apply (submit 2 sets of plans w /items checked below):
VVV u ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: 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 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 ",' l -2 ", "I -3 ",
Job no.: Job site address: 9735 SW Shady Ln IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 200 Project name: Aesthetic Medicine ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 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 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) ' 75.00 2
Reconnect Condenser Limited energy, multi - family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1 , ,
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
. each branch circuit 6.65 2
Business name: same as below B. Fee for branch circuits
without service or feeder fee, 1
Contact name: first branch circuit 46.85 2
Address: Each add'I branch circuit 6.65 2
Miscellaneous'(service or feeder not included)
City/State /ZIP: Each manufactured or modular 90.90 2
Phone: dwelling, service and/or feeder
( ) F ax: : ( ) Reconnect only 66 :85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Willamette HVAC Signal circuit(s) or limited -
energy panel, alteration, or
Address: 3075 SW 234 Ave Ste 206 extension. Describe: Page 2 2
City/State /ZIP: Hillsboro OR 97123 Each additional inspection over allowable in an of the above
Per inspection 62.50
4 4/ Phone: (503) 628.6841 Fax: (503) 8)8.2597 ✓ / Investigation per hour (I hr min) 62.50
CCB Lie.: 56951 Electrical Lic.: 363 RE ,/ Suprv. Lic.: 4025LEB Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 4' , e pf
Print name: Mike Sicard Date: 9/16/09
Plan review (25% of permit fee):
State surcharge (12% of permit fee): 5 , ( ,Z
Authorized signature: TOTAL PERMIT FEE: 5 . y 7
This permit application expires if a permit is not obtained within 180
Print name: Mike Sicard Date: 9/16/09 days after it has been accepted as complete.
• Number of inspections allowed per permit.
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