Permit CITY OF TIGARD ELECTRICAL PERMIT
a . COMMUNITY DEVELOPMENT Permit #: ELC2010 -00464
T i GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/01/2010
Parcel: 2S101AA02900
Jurisdiction: Tigard
Site address: 12123 SW 69TH AVE
Subdivision: WEST PORTLAND HEIGHTS Lot: 20
Project: HSBC
Project Description: (2) branch circuits and (1) low voltage data telecommunications system.
Owner: FEES
TIGARD CORPORATE CENTER Quantity Description Date Amount
LIMITED PARTNERSHIP, 15325 SW
BEAVERTON CREEK CT 1 ea Limited Energy 09/01/2010 $75.00
2 crt Branch Circuits 09/01/2010 $63.60
PHONE: wo /Purchase Service or
Feeder
Contractor: 1 ea 12% State Surcharge - 09/01/2010 $16.63
Electrical
COCHRAN INC
7550 SW TECH CENTER DR. #220
TIGARD, OR 97223
PHONE: 503 - 234 -6564
FAX: 503 - 238 -2098
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $155.23
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. At 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 • • •' • 52- 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.
O
Issued By. /.L��- �i . 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' 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 `` �� FOR OFFICE USE ONLY City of Tigard �V Permit No.: p_ , , 6
, 13125 SW Hall Blvd., Tigard, OR 97223 r ��% flan Review
C Phone: 503.639.4171 Fax: 503.598.196 � / N . 1 Date/By: Other Tennis:
__. t
l' 1 G A R D Inspection Line: 503.639 .) 1 ate early /By: luris: ® Sce Page 2 for
•
Internet: www.tigard or.gov eC,\ ��+ C dtMethod: •r—,„4 Supplemental Information
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TYPE OF WORK -4 fi � PLAN REVIEW
A �
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ddition /alteration /repla6010 -
n\) '' ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Other: 4.1 . where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 15(1 volts or ❑ Floating buildings.
less to ground. or exceeds 14.000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling o mnercial /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
El Emergency system. larger separately derived system.
g2' ❑ Addition of new motor load of ❑ "A "E I.2 .. 13
.I 1 . : (07 (o'2) Job site address: is /�3 o I(H1HI' or occupancy.
l ❑ Six or more a rest residential units. ❑ Recreational vehicle parks.
/a - 1 ere_ r e t^ 72-2- Health -care facilities.
Clt /$tatC /ZIP: , ,' J( / ❑ ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: / t S 6J / ❑ Service or feeder 600 amps or more.
F` xJ FEE SCHEDULE
Cross street /directions to job site: Description I Qrv. 1 Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. 0. or less 168.54 4
Ea. add'I 500 sq. 0. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. 0.) 75.00 2
�-
Liniitedenergy. multi-family
UOtCe - ici Q6 / e-tec--1-0?_al residential (with above sq. 1).) 7500 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 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
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 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ) PERSON above service or feeder fee, 7 4� 2
1 each branch circuit p'
Business name: m �S C Oh A'•yam B. Fee for branch circuits without 5&' IO
�l V t service or feeder fee, first
Contact name: 1 (�, A l branch circuit 56.18 2
Each add'I branch circuit ( 7A2 9 }-- 2
Address: 3 CLANS> Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State /ZIP: dwelling, service and /or feeder 67.84 2
Phone: (503 )/ .7 - 1 00 Fax:: (503 ) Z3 ' - 2Q9 / Reconnect only 67.84 2
A Q 1 ,� ;^ (� Pump or irrigation circle 67.84 2
E -mail: �V l V C �� , r (C� , Gp r\ Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy 5 ,�
Business name: panel, alteration, or extension. 1 Page 2 7 _
�� n Each additional inspection over allowable in our of the above
Address: 1 5 50 S ,W ! T eGh C e(l r *2,20 Additional inspection (I hr min) 66.25/ hr
Q Investigation (I hr min) 66.25/ hr
City /State /ZIP: ( r� 1` ' 72_ Z J Industrial plant (1 hr min) 78.18 / hr
Phone: 503 )2 3 / 5 ,c_/ Fax: (i3 )2 2_09 ' Inspections for which no fee is 90.00 / hr
37546? specifically listed (%2 hr min) _
CCB Lic.: — 12 .. ( 3(42 ... Electrical Lic.: C Suprv. Lic.: 3447_5 ELECTRICAL PERMIT FEES
, Subtotal: .
Suprv. Electrician signature, required: VC Plan review (25% of permit fee): • No
Print name: y� p ,,� k t. - Date: State surcharge (12% of pennit fee):
K ` TOTAL PERMIT FEE: . Sal-
Authorized signature: This permit application expires if a permit is not oht ned within 180
days after it has been accepted as complete.
Print name: Date: + Number of inspections allowed per permit. /
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