Permit v CITY OF TIGARD ELECTRICAL PERMIT
11/4 . 2 : COMMUNITY DEVELOPMENT Permit #: ELC2009-00612
T [ GAlz D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 11/13/2009
Parcel: 2S102CB02300
Jurisdiction: Tigard
Site address: 13240 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Pacific Medical Group
Project Description: Add /alter (6) branch circuits.
Owner: FEES
PACIFIC PROPERTIES Quantity Description Date Amount
BY MARTIN JOHNSON, 13200 SW PACIFIC
HWY 6 crt Branch Circuits 11/13/2009 $93.28
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 11/13/2009 $11.19
Electrical
Contractor:
COCHRAN INC
626 SE MAIN ST
PORTLAND, OR 97214
PHONE: 503 - 234 -6564
FAX: 503 - 238 -2098
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $104.47
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 wit
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 503.246.6699 or 1.800.332.2344.
Issued By: 6 l 0 A ilk cU UV C1 ' Permittee Signature: 47
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 protect.
Approved plans are required on the job site at the time of each Inspection.
FROM COCHRAN- BROADWAY (THU)NOV 12 2009 7:14 /ST, 7: 13 /Nes. 7500000353 P 1
• is r
e
Electrical Permit Appl Foil 01.1.1( 1.: f.h: o\I.‘
City of Tigard 3JCENE Received
DaterB : 1 Pennit No.: C YY • . 0 t a .
1 14 • 1 3125 SW W Hall Blvd., Tigard, OR 97273- Plan •
Review
' 2 Phone: 503.639.4171 Fax: 503.598.1960
�Q 1 1 2 2009 Dale/By: Other Permit:
T I C. A IL l) Inspection Line: 503.639.4175 Date Ready /By: rte ® ' See Page 2 for
Internet: www ttgald or gov T Notified Method ( IC Supplemental Information ■
f T.IGAR
❑ New construction El Addition /alter ;3a�',Iltent Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
tk v ^p . - § exceeds 10.000 amps al 150 volts or ❑ Floating buildings.
._._. .. - -„. (rON _. >_ .::,. t,_ _,_
less to gmund, or exceeds 14.000 ❑ Commercial -use agricultural ❑ 1- and 2 - family dwelling ❑Commercial /industrial El Accessory building amps for all other installations. buildings.
Ill ❑Masterbuilder ❑ Other: ❑ Fire punmp. ❑ Installation of75KVAor
-- ,.. ❑ Emergency system. larger separately derived system.
JOi$ ITE 'INRORMATION ND. L A OCAT .IOAJ R- .... ❑ Addition of new motor load of ❑ "A" "E" "I -2" "I -1"
e Jobno.:14 ID57 ❑ or Job site address: / J.6 Poe( 100 or more. occupancy.
� " / Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: P: u (-d Or_._. ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal.
Sutte!bldg. /apt.no.: v I Project name: aCr t it WI Ok,n ❑Service or feeder 600• imps or more.
"
Cross street /directions to joh site: Description i qty. . Fee. 1 Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add', 500 sq. 11. or portion 33.92 1
Tax map /parcel no.: H residential
L0 :_03 - "�'i .; Limited ere res r t abov sq. ft.) rd 67.84 2
v Limited energy,
1 1/15 `( & V S (,multi-family ft) 67.84 2
(( residential with above. tt.
Services or feeders installation, alteration, and/or relocation
200 amps or Tess 100.70 2
bPERTY .. ' .. ` .. _ • :, _ ._-_ 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/ZIP: Temporary services or feeders installation, alteration, and /or
relocation _
Phone: ( ) Fax: ( ) 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 1 25.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch cileuits with
Q,,AERL C--ANP Z i L4_"? above service or feeder fee,
7.42 2
each branch circuit
-'
Business name: Sa v a S Cor)ty ctipv 13. Fee for branch circuits
Contact name: without service or feeder fee, 56.18 / 2
first branch circuit
Address: Each add•I branch circuit S` 7,42 37. / 2
Miscellaneous (service or feeder not included)
City/State/Z1 P: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or inigation circle 67.84 2
: -._ „- ; r ctigi tACIY • a ',_, - t M ; Signor outline lighting 67.84 2
Business name: 0 Oc-h Yr h , v. Signal cirtuit(s) or limited-
energy panel, alteration, or
Address: 6Z(,., tSEma .v) s-k. extension. Describe: Paget 2
City/State/ZIP: F {4. �hd 01q._ 7Zl Each additional inspection over allowable in any of the above
( 5 (35) 1.3 4 .5 ro4 Fax: ( ) Z3 $ 4-e 1 ,�
Per Investigation 66.25
Phone: Investigatioon per hour (I hr min) 66.25
CCB Lic.: 7 29 4 Electrical Lic.: 37544,, C Suprv. Lic.: 31 - 11,5 Industrial plant per hour 78.18
Suprv. Electrician signature, required: <"``' Subtotal: q 3 2B
Plan review (25% of permit fee):
Print n ame: ‹�� B /,, '� r U Date: l I d -` State surcharge (12 %ofpermit fee): / (. i f
Authorized signature: 1 � TOTAL PERMIT FEE: /U!J_ i./
This permit application expires if a permit is not obtained within 180
Print name: I Date: after 11 has been accepted as complete.
. Number of inspections allowed per pennit.
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