Permit CITY OF TIGARD ELECTRICAL PERMIT
° PERMIT #: ELC2007 700575
COMMUNITY DEVELOPMENT
DATE ISSUED: 8/15/2007
TeA_R_D; 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S101AA - 02900
SITE ADDRESS: 12123 SW 69TH AVE ZONING: MUE
SUBDIVISION: WEST PORTLAND HEIGHTS LOT : 020 JURISDICTION: TIG
PROJECT: H 5 g
Project Description: 4 branch circuits.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAUPANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
• 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 3 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
TIGARD CORPORATE CENTER BROADWAY ELECTRIC - COCHRAN INC
LTD PARTNERSHIP 626 SE MAIN
ATTN: GREG SPECHT PORTLAND, OR 97214
BEAVERTON, OR 97006
Phone: Contact #: PRI 503 - 234 -6564
FAX 503 - 238 -2098
FEES
Description Date Amount Reg #: ELE 37 -546C
[ELPRMT] ELC Permit 8/15/2007 $66.80 LIC 72942
[TAX] 8% State Surcharge 8/15/2007 $5.34 SUP 3447S
Total $72,14 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: ^ Permittee Signature: 91
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'N: 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.
• r
Electrical Permit x r ' , l FOR OFFICE USE ONLY
�' I •
City of Tigard ' ` [�=eari Date/By: d 107 Permit No. te• Gds ,Op c
13125 SW Hall Blvd., Tigard, OR 97223 PlanRevie
Phone: 503.639.4171 Fax: 503.598.196 AI if 1 4: y � . DateB : Other Permit.
Inspection Line: 503.639.4175 � J .L t l LUU ( �• e'/J Date Ready/By: Juris 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
C,.11.d . ,V .R �f A� 1 A
f0 P L A N REV
❑ New construction efat!i Please check all that apply:
❑Service over 225 amps, comm'l EHazardous location
❑ Demolition ❑Other:
., , P
El over 320 amps rating B over 10,000 sq. ft. ,
CATEGORY, OF• CONSTRUCTION -- of 1- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
[..] Multi - family ❑ Master builder ❑Building over three stories ❑Feeders, 400 amps or more
❑ Other:
❑ O persons nu red structures or
c cu an p t load over 99 e rsons V k to
JOB`SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV pa
Job no.: 00g70 ti- Job site address: 121 Z3 301 6 9' A,.� ❑Health -care facility ❑Other:
` Submit 2 sets of plans with any of the above.
City /State /ZIP: ( i 1 a I'd £7/ The above are not applicable to temporary construction service.
Suite/bIdg. /apt. no.: A Project name: e c...., FEE SCHEDLLE
Description Qty. Fee. Total
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
• -'1 •
DESCRIPTION , 0. ivoRI{ .. - ;. , Each manufactured or modular bran (t� Gy 1 G�C (�._1 tS dwelling, service rs installation, feeder 90.90 2
Four b Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
® PROPERT'Y' ❑. TENANT,
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) •
2 00 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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
APPLICANT "1 , CONTp1CT PERSON A. Fee for branch circuits with
Y j J / - ..__ , service or feeder fee, each 6.65 2
Business na e. hat itr 1 1 y 1 J4 branch circuit
!/ " V , v ::: Fee for brnch circuits �•.�
::a � 4vice or feeder fee, h circuit G C2
anch circuit � 6.65 J • "! ' 1
City /State /ZIP: 51) 3' 407 q ga..) Miscellaneous (service or feeder not included)
� 7 j) X54 -� Pump or irrigation circle 53.40 2
Phone: Fax:: ( )
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
- ..... - . - _
' : 'CONTRACTOR -, , • energy panel, alteration, or
extension. Describe: Page 2 2
�,.o (A W � ` e c...\-- Business name: J.
Each additional inspection over allowable in any of the above
Address: C 2_ (' 5 (_ a\,,, Per inspection 62.50
City/State /ZIP: ? 4 -k ta ..,,, 09- CO 2 ■Li , Investigation per hour (I hr nun) 62.50
Phone: (,03) 234 —(05 , y 2 �2
C Fax: (503) 3- c
� `s Industrial plant per hour 73.75
",ELECTRICAL : PERMIT `FEES* ,
CCB Lic.: 7 2,`kL{ Electrical Lic.: 5%,,c... Suprv. Lic.: 3.44`1_5 Subtotal & O
Suprv. Electrician signature, required: Plan review (25% of permit fee)
l ` l / State surcharge (8% of permit fee) ,3 y
Print name: n
`�e.v\er `(1 F�—�O • Date: 7 / q
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
is \Buildino \ Permits \ELC- PermitAno.doc 12/03 440- 46 15T(10 /02/COM /WEB