Permit 'm . CITY OF TIGARD ELECTRICALPERMIT
° t » Permit #: ELC2010 -00322
COMMUNITY DEVELOPMENT
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/30/2010
I1firARiy Parcel: 1S136DD05300
Jurisdiction: TIGARD
Site address: 11850 SW 67TH AVE, STE# 210
Subdivision: TIGARD TRIANGLE COMMONS Lot: 13
Project: American Family Insurance
Project Description: (2) b_[aach_cir_cuits for TI
7/2/2010: REPRINTED TO CORRECT SITE ADDRESS.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date. Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 2 crt Branch Circuits 06/30/2010 $63.60
wo /Purchase Service or
PHONE: 503 - 624 -6300 Feeder
1 ea 12% State Surcharge - 06/30/2010 $7.63
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
Classof Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
Required and Reports (Conditions)
• This:Oafiit 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 Notificattbri Center. Those rules are set forth in OAR'
952 - 001 -0010 through 0 952- 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: Permittee Signature: OA/ /9P/ /C , �O
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 omthe:job site until completion of the project.
Approved plans are required on the job.site at the time of each inspection.
•
Electrical Permit Applicatlion i ` `• ' FORtOFFICI USE ONL1 s at t
1' Received Q .�., '1.!,:;,.:.::...4.'
111 City Of Tigard. Date /1 C o o o Permit No.. t ad .. ' 0. 4 13x2
73125 SW Hall Blvd., Tigard, OR 97223 Plan'Review /
21 1,:.,,:, Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: ! ,AotQ.-- OOl i60 •
1"1 C, A R D Inspection Line: 503:639.4175 Date Ready/By; lens: El :See P ige•2 for
' Internet: www.tigard- or.gov pp ei
Nottfied/Method: Su' lementallnfo, rmation
. t T YPE OF WORK PLAN ,REVIEW
❑.New construction 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 El Other: where the available fault current: ❑ Marinas atid:boatyards.
•
•CATEGORY OF; CONSTRUCTION exceeds 10;000 „amps at 150 volts' or ❑ Fl buildi
less to ground, or exceeds 14,000 ❑ Gommermal- use'a gricultural
El 1'- and 2- family dwelling [1Comtnercial /industrial ❑ Accessory building amps for all other installations. ,buildings
❑ Multi- family ;❑ Master builder ❑ Other: ❑ Firepump. ❑ installation of75,KV'A'or.
. - . • • , •- meency system y derived system
rg. system. larger separately
JOB:SITE [INFORMATION :AND LOCATION.- ❑ E I t 1
. •.' . .._ . 'AND .. new motor load of l
El of n ❑ A ", "E ", 1 2 ' 3 ",
Job no.: Job site address: .- . ,5 �! ,,,,- t. 100HP or more. occupancy.
• - �s� -�. J S: ❑ Six or more res un ❑ Recreational vehicle parks.
City /State /ZIP: f/ t ?SO Sid 427 4 - e -- 0 facilities. ❑ Supply voltage for more than
s ' ❑ Hazardous locations. 600 volts nominal.
e/bld /a t no.: .. Project name: 1 /fie e 1 ; r , / ❑ Service or feeder 600 amps or more
g P J T i { A n/J :i FEE • SCHEDULE; .
Cross street/directions to job site: = Sv/•'a4 beiiiiption Qty. 1 Fee. I Total l "
New - residential single- or multi- family dwelling unit.
includes;attachedgarage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea add'I500 Sq. ft. or portion 33.92 I
T ax map /parcel -no.: Limited'energy,; 67 84 2
•. DESCRIPTION OF ,, ; r ' " » - t + •,1 (with above sq. ft)
/ r / / Limited energy, Multi-family 67.84 2
25 Prier" Prier” 61
', YC r,/ r C4 -tom e - e Geer a GJ residential (with above sq. ft.)
Services or feeders installation, alteration, and/or' relocation.
w` —T' 200 amps! or -less 100.70 2
f.: O 201am sto•400am s 133.56 2
® PROPERT t., ❑TENANT, '' . •P P
401 amps to 600 amps 200.34 2
Name: 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: ( ) Fax: ( ) 200 amps or less 59.36 1
t 201 amps to 400 amps 125.08 2.
Owner installation: This installation is being made, on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 arrtps'to 599 amps 166:54 2
Branch circuits— new, alteration, or extension; per panel
Owner signature: Date: _ A. Fee for.branch circuits with
❑ - APPLICANT „ I CONTAGI PERSON' ' • - _ above service or feeder fee -
7.42 2
each:branch circuit
Business name: B. Fee for branch circuits•without
service:orfeeder fee, first / 56.18 2
Contact name: branch circuit
. Each add'l:branch circuit / 7.42 2
Address: Miscellaneous (service or feedernotincluded)
Each manufactured or modular
City/State /ZIP: dwelling, service.and/or feeder . -2
6
Phone: ( ) Fax: : ( )
Reconnect only .67.84 • 2.
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 . 2
;.CONTRACTOR ,., •. ?':,; Signal'circuit(s) or limited energy
Business name: ' C `� panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the•above
Address: /' 0 13 ox 3 3 •(O Additional inspection (1 hr min) 66.25/ hr
i0. � 6317007.— investigation (1 hr min) 66.25 / hr
City/State /ZIP:
RV N I n d ustrial plant (1 hr min) 78.18/ hr
Phone: ( ,) qg 2,• '71.� F (,50 '3) ` �'- 1 Inspections'' for which no fee is
90.00/ hr
.- specifically listed ( % =.hrmin)
CCB Lic.: 07/...! Electrical Lic.: 3_34.0i C_ Suprv. Lic.: 3/ 3/1-%5 ,'- 4ELECTRICAL,TERMIT';FEES . . -'.•,,,;
Suprv. Electrician, signature, required:
;�,;�,�
Plan review (25% of perm Subtotitfee)al: : 6 3, Coo
�� r% .--
Print name: 0, �• . G � / L Date: G p State surcharge (12% of permit fee): '7 . �o • TOTAL PERMIT FEE: . '7/
Authorized 'signature: 7
This permit application expires if a permit is not obtained within 180'
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
1.\Buildirig\Peiniits\ELC- PermitApp.doc 10/01/09 440- 4615T(l 1 /05 /COM/WEB
Electrical Permit Application City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
REShDENTIAL`WORK .O,NL : ,
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heati g , Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
C :CQNIMERCIAL WORK ONLY ' .
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ 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
I:\ Building \Permits\ELC- PermitApp.doc 10/01/09