Permit •
CITY OF TIGARD ELECTRICAL PERMIT
S • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00662
T WARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/20/2012
Parcel: 2S 101 AC01600
Jurisdiction: TIGARD
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Site address: 7000 SW HAMPTON ST 216
Project: Empire Marketing Solutions Subdivision: BEVELAND NO.2 Lot: 18 -19, P
• Project Description: (2) branch circuits to connect furnace
Contractor: COCHRAN INC Owner: NEIMEYER, JOHN
7550 SW TECH CENTER DR #220 15 82ND DR STE 210
TIGARD, OR 97223 GLADSTONE, OR 97027
PHONE: 503 - 234 -6564 PHONE:
FAX: 50.3- 238 -2098
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 11/20/2012 $63.60 ' •
Specifics: Service or Feeder
1 ea 12% State Surcharge 11/20/2012 $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 OA 52 001 -00 . You may btain a co y of the rules or direct questions to OUNC by calling 503.232 987 or 1.800.332.234 7
Issued By: Permittee 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 site at the time of each Inspection.
01 ECEivED 10:14:2 0.2012
Electrical Permit Applica rc11i c)r.l�rt h: I sl; c),r.,.
City of Tigard Received
n(�II 2 Dat&By: � � 1 �iT PennitNo L vo n
13125 SW Hall Blvd., Tigard, OR 97227 O V 2 0 2012 ''�` �� �� �'
Phone: 503.639.4171 Fax: 503.59 .1960 Date/By: Other Permit:
"I' I (i A u 1 Inspection Line: 503.639.4175 �I T Plan Review
Date Ready /By: mr: El See Page 2 for
Internet: www.tigard . v Notified/Method: i
i
I C. Supplemental Information
I
TYPE:OF � 01 �
... ..W. ,OhK:
❑ New construction Addition /alteration/ replacement Please check all that apply (submit j, sets of plans wfitems checked below):
❑ Demolition Apr ❑ Service or feeder 400 amps or more ❑ Building over three stories.
r „ _ - where the available fault current ❑ Marinas and boatyards.
I ` ' ' CA k. op CONSTRUCT ION.; ,' .:. . .....:; .. '.:.,..` amiss at 150 exceeds 10,000 am
_'' :. '•. :;..;;. ..' . 000 or ❑ Comm g .ue buildings.
14
less w ground or exceeds 14.000
❑ I- and 2- family dwelling Commercial /industrial ❑ Accessory building a buildi 0 Co agricultural
mps for all other installations, buildings -u
.
❑ Multi- family Master builder ❑ Other: ['Fire pump. ❑ installation of 75 KVA or
.JOB. SITE INFO AND LOCATION system.
Emergency system larger separately derived I
• ... ,•� . . , ... • . ❑ AdAidon of new mo tor load of ❑ "A^ ••E• •1_2^ mil_ ;•
rk 100H or more. oc
Job no.: 15 Job si te address: � � wpancy.
D S 7000 - s /���� �� ` � - Z) ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: �l Lc, - it, , l J G. J O 2. Q �} y z y - ❑ Health -care facilities. ❑ Supply voltage for more than
�l ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: v/.0 /d) /4j., 4 f -,Site tie .. ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: 50 ^ 7 y�eQ ,Ar1 r . . aa.'. FEE' SCH EDULE , ; ` .;
-RAJ -1 - o } - 1 - Dereri. non .•,� Kirmuscominztiaisal
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less 168.54
Tax map /parcel no.: Ea. add'I 500 sq. R. or portion 33.92
Limited energy, residential
DESCRIPTION OF WORK (with above sq. R.) 75.00
Limited energy, multi - family 75.00
1.1961 Z P#11140 - tone t ' rur II 0-1/ te_ residential with above • . f.
Services or feeders installation alteration, and/or relocation
200 amps or less 100.70 2
❑ . PROP OWNER ''.•:: •... , ❑ 'TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State/ZnP Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) F ax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
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 -
❑• APPLICANT : 61 CONTACT PERSON abo s erv ice f eeder fee 7.42 2
cl- �,^ each branch circ uit
Business name: JO-t-M�.. [a rj' C.'( \ \ B. Fee for branch circuits without
service or feeder fee, first
Contact name: ' �Ori e \ C_�Nh ,
branch circuit % 56.18 g b 2
Each add'I branch circuit _ ` 7.42 7 cj. L 2
Address: Miscellaneous service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwellin: service and/or feeder 67.84 2
Phone: 6 ) . ZZ 1 ? > (p0 Fax:: d l 2I7 q Zt $2., Reconnect only aill 67.84 _
Pump or irrigation circle 67.84
roacKeD +civ erftAe ,Lc7m �
CONTRACTOR Sign or outline lighting IMI 67.84 _ •
/'� �� Signal circuit(s) or limited -ener
Business name: �--OL�� ct el, alteration or extension. gy ■ _
'.t Each additional In • action over allowable In an of the above
Address: '15 5Q 5 W -( e., \
h ( In r- `t -- # 0 Additional inspection (I hr min) MI 66.25/ hr _■
City/State/ZIP: L{ (� (..k l 972 Z ■ 3 � Investigation (1 hr mi 6786.2518// . hr h
J Industrial plant (I hr min) - II r
Phone: 503 ) 2 3 q _ 10E-56c/ Fax: (.i3 ) 238 ,- 20 ■ 90,00/ hr .
Electrical Li
c.: /� iL � Od Inspections for which no fee is
r7 s eciticall listod('bhrmin)
CCB Lic.:
�2 p IL/Z. El '7
5 /c,( Suprv.Lic.:3 -+4 ,51 . ,.''i ri'; . :':EfEf:TRI,CAL:PERMIT:`FEES:, .
Suprv. Electrician signature, required: Subtotal:. , Z .
Plan review (25% of permit fee):
Print name: .. Q . , . . . ' K a i , D a t e : l( 20 / Z State surcharge (I2% ofpennit fee):
i
Authorized signature / _ TOTAL PERMIT FEE:
` - il - • � f :& / / � /� Thls permit application expires if a permit la not obtained within :0
Print name: 1 � ��� Date: " G/ n,' days after it has been accepted as complete.
V r 2....... • Number of inspections allowed per permit.
I: Permit ..
a sloe 07,01.10 4404615T(11.05•COIWWEB
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01 10:15:06 11 -20 -2012 313
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
COMMERCIAL WORK ONLY: .
Fee for each commercial $75.0
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
E l Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other. installations
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