Permit
W
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2009-00590
1► 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date issued: 11/03/2009
Parcel: 2S 110DC02300
Jurisdiction: Tigard
Site address: 11535 SW DURHAM RD C-1
Subdivision: Lot: 0
Project: Liberty Tax
Project Description: (3) branch circuits for TI
Owner: FEES
HIP WILLOWBROOK LLC Quantity Description Date Amount
BY TAX DEPARTMENT, PO BOX 2708
PORTLAND, OR 97208 3 crt Branch Circuits 11/03/2009 $71.02
wo/Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 11/03/2009 $8.52
Electrical
Contractor:
RC COSTELLO ELECTRICAL CONT INC
PO BOX 336
AURORA, OR 97002
PHONE: 503-982-7400
FAX 503-982-7400
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $79.54
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. A O Oregon law requires you to follow the rules dopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-00 -0010 through OAR -001-0100. You may obtain a copy of the rulaes or direct questions to OUNC by calling 503.246.6699 or .0.32.2344.
Permittee Signature: y
Issue
~ C-/
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.
Electrical Permit Application OR OFFICE USE ONLY
City of Tigard Date/Bc~ 7,3 7~ Az Ncnnit No ~1.1f)o 570
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/B-: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: Ju 0 See Page 2 for
ME MInternet: ww'w.tigard-or.gov Notified,[Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction L ] Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
❑ 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", `1-2", "1-3",
IOOHP or more. occupancy.
Job no.: Job site address: I I y C ,-I (I El Six or more residential units. ❑ Recreational vehicle parks.
JACity/State/ZIP: ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suit ldg./apt. no.: Project name: (,kJ ~p . 6,--,,, El Sertiice or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to jo site: -j:~lr. 1 Description Q Fee. Total
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
Limited energy, multi-family
t ; ( residential (with above sq. ft.) 75.00 2
t 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, er panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name: 2
first branch circuit I y~y US
Address: Each add'I branch circuit Er6T 1 J 2
Miscellaneous (service or feeder not included
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax:: ( ) Reconnect only 66.85 2
E-mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 5140 2
7 Signal circuit(s) or limited
energy name: energy panel, alteration, or
Address:' extension. Describe: Page 2 2
City/State/ZIP: ' U/a rc_ C' C ] Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (509 q a 2 ~L Ur Fax: (503) g1f-3 ! ~)r l ~ I Investigation perhour (I hr min) 62.50
CCB Lic.:Electrical Lic.: 3 -3 1-14C Suprv. Lic.: 3Z 39_ 5 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: I / _ Subtotal:
Plan review (25% of permit fee):
Print name:~o v i 1 J Date: ie? `S State surcharge (12% of permit fee): t
Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 189.-
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I~\Building\Permits\ELC-PermitApp.doc 05/23/06 440-4615T(11/05/COM/WEB
A ELECTRICAL PERMIT
CITY OF TIGAR®
` k C - COMMUNITY DEVELOPMENT Permit #: ELC2009 -00590
T GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/03/2009
k. ' z ,$ Parcel: 2S110DCO2300
Jurisdiction: Tigard
Site address: 11535 SW DURHAM RD C -1
Subdivision: Lot: 0
Project: Liberty Tax
Project Description: (3) branch circuits for TI
Owner: FEES
HIP WILLOWBROOK LLC Quantity Description Date Amount
BY TAX DEPARTMENT, PO BOX 2708
PORTLAND, OR 97208 3 crt Branch Circuits 11/03/2009 $71.02
wo /Purchase Service or
PHONE Feeder
1 ea 12% State Surcharge - 11/03/2009 $8.52
Electrical
Contractor:
RC COSTELLO ELECTRICAL CONT INC
PO BOX 336
AURORA, OR 97002
PHONE: 503 - 982 -7400
FAX: 503- 982 -7400
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $79.54
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. A - , 0 : Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 -0010 through OAR • : - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 0 . . 32.2344.
.4
Issue. : • ' ►- ...� _ _ ► 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' \ � _T ('( 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.
1 1 .!;:ctrical Permit Application FOR OFFICE USE ONLY
Received � � �t-s
City of Tigard Date/By: / 3 0q Permit No.: 2 5 0
ga III 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review "v`�
a ' Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T 1 G r\ R D Inspection Line: 503.639.4175 Date Ready /By: �b� / jS /� 0 See Page 2 for
Internet: www.tigard - or.gov Notified /Method: / CI, Supplemental lnformation
HYP OF WORK PLAN REVIEW
❑ New construction LN Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ 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 I�,� 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. A
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
} II 10OHP or more. occupancy.
Job no.: Job site address: 5 , 4J �VC'/'1 IM L,{. ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
( bldg. /apt. no.: L' �' -� Project name: W t I I K ❑ Service or feeder 600 amps or more
0l� N FEE SCHEDULE
Cross street/directions to jo site: Mc, t i ` 1../t Description 1 Qty 1 Fee. 1 Total 1 •
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] 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
b CC (AC ii (' I jr t/ )4- a •-rj r (? c c 0 4 a t l e f residential (with above sq. ft.)
1 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, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, (
Contact name: '�� 54),/q .�Q
first branch circuit � L/655 2
Address: Each add'I branch circuit 2 .Fr.6s' 13 J 1 2
Miscellaneous (service or feeder not included) 7. Y7,.
City/State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: c �)� ` Q L -� �i L C Signal circuit(s) or limited -
U � / C y n 7 e, (;' �, energy panel, alteration, or
Address: O l�c➢ 4 3 -s
extension. Describe: Page 2 2
City/State /ZIP: gut, r, OR q 900? Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (5 0 3) q8 z _19 00 Fax: ( 503 ) q82... f v. it; 1 Investigation per hour (1 hr min) 62.50
CCB Lic.:19g402 Electrical Lic.: 3.3L/4 c Suprv. Lic.: 3/139_ s Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES 71. O ')--
Suprv. Electrician signature, required
Print name c /� Subtotal: {7
f ,. , v . C _le IL, Date: / 1 / 2 Plan review (25° permit fee): / •�
S / I State surcharge (12 /0 of permit fee): t
Authorized signature: TOTAL PERMIT FEE: (�5 .
This permit application expires if a permit is not obtained within 18 - l
Print name: Date: days after it has been accepted as complete. '"t
* Number of inspections allowed per permit. '
P\ Building \Permits\ELC- PermitApp.doc 05/23/06 440 -4615T(l l /05 /COM/WEB
Electrical Permit Application City Tigard - Ci of Ti and '' W
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL; WORK ONLY
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n B • urglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n B • oiler Controls
n Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
n O ther
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \ Building \Permits\ELC- PermitApp.doc 03/23/06