Permit p CITY OF TIGARD ELECTRICAL PERMIT
!PI " • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00605
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/22/2012
Parcel: 2S102DA00200
Jurisdiction: Tigard
Site address: 8720 SW BURNHAM ST
Project: City of Tigard Subdivision: BARNUM PARK Lot: 9
Project Description: (1) car charger installation
Contractor: JARMER ELECTRIC INC Owner: TIGARD, CITY OF
5105 SW 45TH AVE #200 13125 SW HALL BLVD
PORTLAND, OR 97221 TIGARD, OR 97223
PHONE: 503 - 246 -5381 PHONE:
FAX: 503 - 244 -8037
FEES
Quantity Description Date Amount
2 ea Services or Feeders - 200 10/22/2012 $201.40
Specifics: amps or less
1 ea 12% State Surcharge - 10/22/2012 $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 O j R - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: i� i f AtCit Permittee Signature: O I4IPLI CJ I ID LI
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.
10/22/2012 12:38 5032448037 JARMERELECTRIC PAGE 01
]Electrical Permit AgplicatioRECEIVED - i fir, (uric 1 I NI (1 \I N
14 City of Tigard 0 lQ(. a- � - ooi os
'a 13 1.25 SW Hall Blvd., Tigard, OR 97223 2 2 2 Plan Review
Phone: 5017182439 Fax: 503.598. Dete/B . Other Nardi: Inspection Line: 503 .639A 175 OF TIGARD Here Rosily/By: rte: la ws rage x for
Internet: www.tdgerd- or.gov -
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❑ New construction - ' 7 ..4 Addition/alteratlon/replacement Plaasa aback en that ply (fe6mle j efts of plans w/ ehxlmd bahaw):
❑ Service a feeder 400 amps or more D Building over three rtoriea.
❑ Demolition ❑ • , er. where the available iiIt ewyene D 1.4sriaes mad boatyards.
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,34.,, �:i:a, -,« ,.��, i '.. + ' i c. , ■ = t , - 1 „ ' v, , (� a t rt , ,:,r i , 6 ix weeds ID,000 amps et ISO vole ❑ toattng buildings. ..i`,x� y,.. {. .fc.�e._,.c ,; _ . x, . :.� '_La1 ....:.- JoLC•1`sj,r•'t .,. x,.H..":.,. :. -X''r ,rr�
• 1:11 1 - and 2- family dwelling a ';.• Conunerclal/industrial I ❑ Accessory building lam
ataps br other installs ions. O buildings. -use s
o Multi ' ❑ Master builder ❑ Other: ❑ Firs pump. ❑ Imbibition of 75 KVA or
"; !;; --, .,. K : ,,.,.. r ._. ^, .,y yr' _ s - 47 ' ,.rr 4. :-.. C:i ' x -7 D Etnr rp1 y system. larger s psrstc1y derived system. •nc. ;..:_;: .
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.,..:.:. x' -::,: ��...:;: a - ,• ;�. x ,.. . _ 4G ° ❑ Addhies strew meter load of (] °A ". "E", "1- 2 ". "1 -3 ".
Job n0. .� Job site . • • - +' 1♦ � :v.. J � . �. ' ! o six or more residmeisl units. ❑ Reereseien.l vehicle parks.
City/StBtr ZIP: C I ' b , ' t�� ❑ Health-care belling". D Supply voltage for mare than
in ur -.. fa _ D Hand= lemelon". 600 volts nominal.
Suite/bldg./apt. no.: Project name: ❑ Sarviee or feeder 600 ®p" or more.
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Cross street/directions to job site: n. �. F,..
New residential single or multi - dmlly dwelling unit.
Includes attached saner.
Subdivision: I Lot no.: 1,000 sq. it or yeas . 168.54 4
Tax map/parcel no.: Ea. add'/ 500 sq. R or portico 33.92 1
1 t • Lim, ited energyres al 75.00 2
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- n ��� Limited energy, multi 75.00 2
- �i i/ n. �'GSL_ ' - _ .` ' ► real fain above era. it )
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Services or feeders clea qon, and/or
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200 amps or lees 100 7D 2
rr'�" s L ' 1 � . ryy .. ' € ,v� r v.. : • _'r '1 c r 201 ample t0 4110 atnpe 33.56 2
-
rfi t ,:7 n_ ` , .c:.::� -... 7 1.__.. y f } - r.:a., fi4c ": ..c v :;sue_ 5 +._{ f. .:.w 401 amps to 600 amps 200.34 2
Name:
, _ 601 amps to 1,000 amps 301.04
Address: Over 1,000 stops or volts 552.26 i 2 -
City/State/ZIP: Te services or feeder installation, alteration. and/or
relocation
Phone: ( ) I Fax: ( ) 200 an or lees - 5936 I 1
Owner installation: This installation is being made on property that I own which is not 201 to 400 scups 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 map" 168.54 2
Brandt ciradb - new, alteradon, or extension, r panel
Owner signature: • Date: A. Fee for breach circuits with
t , , L 1 - "Z. 4 ' ter+ g a - � above service or feeder i e,
�, a - w , n , Sx } t, , r i ti f. each branch circuit 7.42 2
4.;: n7,. t�a._L�.,. ,�, ?i, act �: _.ut�..ne Din:L 3.'� °a.,n, ri .�a,.r.,.�.s.a,.�.. xa..,.�c�. _.d� <.i..0 .. ..:L
B. Fee for branch circuits witlmatt
Business name: service or feeder fie, first 56.I8 2
Contact name: blench circuit
Bach add'l branch circuit 7.42 2
Address: Miseo laneous (aerobe or feeder not Included)
City/State/ZIP: Bach mrendhctured m modem
dwelling, service and/or feeder 67.84 2
Phone: ( ) [Fax::( ) Reconnectaab 67.84 2
Pump or irrigation circle 67.84 2
B mall Si or oauliae lighdag 67.84 2
Ln r - ti7.. l r rp . R yl <. 'r" -^-1 cx o t lw , sE,_ : i ! 3 n� '.t �$-;;!,-,:.
+;.i'r :- !Si . f l i�4� ;i:f, i ic P fi „i::ti. Y �. ,,. z >, .: ( _ . 1 k, 1.d), It f .. f,, I,t'_ . t ii n F ,.' ", L „ ! ',,;.tt . •31 : S►873al arm*) or limited- cnerg„}f
panel, altaradon, or extension. Business name: ` j K 6 44 /_� - ,►.C'. - Each additional Inspection over allowable lnany the above
2
Address: " 1"' A dditional inspection (1 br min)
.fir -; s�� �;�. _ � � � 1 66.25/ hr [
^, / 2 lnvesdgadon (I hr min) 66.25/ br
City/State/ZIP:
r,, -a C '; l7 < I Iadusaial plant (I hr min) 78.18/ hr
Phone: ( /`, ") ) j 4 1 4 ' j ? ! ' f. Fax (f ) .- 1/ - 'G j 7 Inspections for which no fee is 90.00/ hr
-: 1 listed 46 br min
CCB Lie.: el, q J (I Electrical Lic -:14 /i /4 . Sup • Lie.. 4 ' . '5 a ,. t; .. .. u ti. ...4_ 4. _ ._. ic.,:w.. n .. :k
Subtotal: ir !
Suprv. Electrician signature, required: .
-
Plan review C25% of permit foe):
h State a 12% of permit fee):
Print name: .17'2. /- �. i r ? r '� ; 44. a" !,� Date: `b �y/ surehar6 ( l>�
�-- TOTAL PERMTF FEE: el 5)
Authorized signature:
Thb Pgrmtt application implies if • permit N Her / 1 0,„ Ma 180 -
Print name: Date: days alter It has been accepted so complete.
• Nambcr of taspeetloea allowed per permit.
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