Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2013 00180
T [GA.RL) 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/21/2013
Parcel: 2S102AD03450
Jurisdiction: Tigard
Site address: 8777 SW BURNHAM ST
Project: City of Tigard Subdivision: TIGARD HIGHWAY TRACTS Lot: 22
Project Description: (2) branch circuits for HVAC split system in conference room
Contractor: HUGHES ELECTRICAL CONTRACTORS INC Owner: TIGARD, CITY OF
10490 NW JACKSON QUARRY RD 13125 SW HALL BLVD
HILLSBORO, OR 97124 TIGARD, OR 97223
PHONE: 503 - 647 -2221 PHONE: 503-639-4171
FAX: 503 - 647 -7754
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 03/21/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/21/2013 $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 9 2 -001- 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
I
Issued By: Permittee Signature: ® I\ \ 4 PPv .3 r e_ / ' 7D &L
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.
From: 03/21/2013 14:27 #386 P.002/003
REC
Electrical Permit Applicat EIVED ion FOR OFFICE LSI; ONLY
.
City of Tigard MAR 2 1 2013 Received ,.. 2 i /3 6. .. / ....
Da ■ r : -*" Permit No.: i .... - 00 I • a
13125 SW Hall Blvd., Tigard, OR 97223
.1111 Plan Fteview t
i
' a Phone: 503.718.2439 Fax: 503t9frir(OF TIGARD Date/B : Other Permit: Al e.,412 , - 00 IS t -
TIGARD Inspection line: 503.6394175 Date Ready/By: Jura: 0 See Page 2 for
Internet: w"wi.tiftard BUILDING DIVISION Notified/Method: Supplemental Information
'' "-- 4YRE OfAVOiUt - - :-..-,-," ; : :-'-= -- i.'' -.- - . ..-:= _;:a' ' r.' , 4".4:a444.7•FA...Vit4f"': /,'
ID New construction Ej Addition/alteration/replacement Please check all that apply (submit a sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available bull current 0 Marinas and boatyards.
#A7P ' ''' 1 exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 0 Commercial-use agricultural
El 1- and 2-family dwelling 121 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
12 Multi-family 0 Master builder 0 Other: ['Fire pump. ID Installation of 75 KVA or
larger separately derived system.
-r , -,' - '''' .. : l" `.. :ii :.''. ":5- '1- "i ''' --'''''-: 0 Addition of new motor load of 0 "A", "E", "1 "1-3", DEmencyayatem
Job no.: 13A140 1 Job site address: 8777 SWBurnham Street 100HP or more. occupancy.
ID Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: Tigard, Or. 97223 0 Health-care facilities 0 Supply voltage for more than
I:I Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: 1 Project name: City of Tigard CIService or feeder 600 amps or more.
''''-fl :'• i',' .. .':''' itg-15.C,06
Cross street/directions to job site: Description 1 Qtr. I Fee. 1 Torsi I •
New residential single- or multi-family dwelling unit. ,
Includes attached garage. . ,
Subdivision: 1 Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. addl 500 sq. ft. or portion 33.92 1 1
Tax map/parcel no.: Limited energy, residential
75.00 2
"-..DiS0f0TIO•ratoWig* - -
• ' ' ' 1 ' ':'-''' ' '' "" ' (with above sq' ft.)
'''" : ' - ''' -'' ' '''''''"' '''''''' - . ' A ' Limited energy, multi-family
75.00 2
Install I circuit for new HVAC split system in conference room residential (with above sq. ft) ,
Services or feeders installaflon and/or relocation
200 amps or less 100.70 2 i
It e s " . - ..1. -.. ' , ,.. , ‘. . c viiiii.t.:. :..., ,..-.. .-..:,,, :--:: 201 amps to 400 amps 133.56 2 i
Name: 401 amps to 600 amps 200.34 2 ,. 1
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2 :
Temporary services or feeders Installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 own which is not
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
above service or feeder fee,
Q. :P. .,, ,. ,.., . _. ,T.',:ftS.91 ,„ ,--„ , .. eac b ranc h c 742 2
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56.18 56.18 2
Contact name: branch circuit
Each addl branch circuit I 7.42 7.42 2
Address: Miscellaneous (service or feeder not Included)
Each manufactured or modular
''.
City/State/ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) 1 Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
_ Sign or outline lighting 67.84 2
IN i .4 ':' ' : , ',... 4.1 , -'.''. '' ':'' Signal circuit(s) or limited-energy
panel, alteration, or extension. Page 2 2
Business name: Hughes Electrical Contractors
Each additional inspecdon over allowable in any of the above
Address: 10490 NW Jackson Quarry Rd Additional inspection (I hr min) 66.25/ hr
City/State/ZIP: Hillsboro, Or. 97124 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr I •
Phone: (503) 647 Fax: (503) 647 Inspections for which no fee is
90.00/ hr
;
specifically listed Ch hr min) 1 •
CCB Lic.: 49850 Electrical Lic.:
,...511pro-.-Lic-.: 5350 00.8: l'
Subtotal: 63.60
Suprv. Electrician signature, required: )
Plan review (25% of permit fee): i
I
Print name: David Trapp Date: 3/21/13 State surcharge (12% of permit fee): 7.63
TOTAL PERMIT FEE: 71.23
I
Authorized signature:
This permit application expires it a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit
Bliniklineeimits \ELC.PermitApp.doc 07,01/10 440-4615T(11/05/COMAVEB i
1
r
From: 03/21/2013 14:26 #386 P.001/003
ELECTRICAL CONTRACTORS
10490 NW Jackson Quarry Rd Hillsboro, OR 97124
Phone (503) 647 -2221 Fax (503) 647 -7754
hec @hugheselectrical.com
F A X C O V E R S H E E T
TO: CITY OF TIGARD PERMITS ATTN: PERMITS
FAX: (503) 598 -1960 PHONE: (503) 718 -2439
FROM: STEVE JASNOCH DATE: 03/21/13
RE: PERMIT APPLICATION
No. of Pages including cover: 3
Message:
Attached is a permit application, along with the credit card authorization form. Please let me know if
you have any questions.
Thanks,
Steve Jasnoch
stevej@hugheselectrical.com
}
r I r
{ {f