Permit CITY OF TIGARD ELECTRICAL PERMIT
s COMMUNITY DEVELOPMENT Permit #: ELC2010 00565
T I G A R P 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/22/2010
Parcel: 2S101 DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY, STE# 100
Subdivision: FARMERS INSURANCE Lot: 0
Project: ACS
Project Description: Electrical for TI - requires plan review.
Owner: FEES
TRIANGLE POINTE LLC Quantity Description Date Amount
901 NE GLISAN ST #100
PORTLAND, OR 97232 1 ea Services or Feeders - 200 10/22/2010 $100.70
amps or less
PHONE: 503- 297 -8791 1 ea Services or Feeders - 201 to 10/22/2010 $133.56
400 amps
2 ea Services or Feeders - 601 to 10/22/2010 $602.08
Contractor: 1000 amps
COCHRAN INC 14 crt Branch Circuits w /Purchase 10/22/2010 $103.88
7550 SW TECH CENTER DR. #220 Service or Feeder
TIGARD, OR 97223 1 ea Signal circuit or Limited 10/22/2010 $75.00
PHONE: 503 - 234 -6564 Energy Panel
FAX: 503 - 238 2098 1 ea 12% State Surcharge - 10/22/2010 $121.83
Electrical
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $1,137.05
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. 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 - . _ r direct questions to OUNC by calling 503.246.6.99 or 1.800.332.2344.
Issued =y: 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 503.839.4175 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 RECEIVED FOR OFFICE USE ONLY
City of Tigard (� Received �+
4 ( r . T J f Dale/ Rv: /0 i f0 ; �i• Permit No `/ // 00 J -�
13125 SW Hall Blvd., Tigard, OR 97223 flan C Review
)
Phone: 503.639.4171 Fax: 503.598.1960 lok -s v Other A - 7 1, , 20 7
DaleiBy: l9'V fJ
T 1 GA R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready- /13y: Juris fa See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified /Method: IO ` 1,0 T6 Supplemental Information
TYPE OF WORK ar-1it� r Cr./ PLAN REVIEW
❑ New construction ddition /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 tault current ❑ Marinas and boatyards.
CATEG RY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
less to ground. or exceeds 14,000 ❑ C:otmnercial -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.
�1 �� ❑ Addition °filen. motor load of ❑ "A" "E" "I -2" °I_; 1 S� 100HP or more. occupancy.
Job no.: 2- .lob site addres ?3 �t� %0
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ^, 0.5 OR 97223 ❑ Health -care facilities. ❑ supply voltage for more than
❑ azard loc. 600 volts nominal.
Suite /bldg. /apt. no.: / 0 Project name: . j / .ea/„L J' (f j PS ervice ous or feeder ations 600 amps or more.
CJ (J �-1 FEE SCHEDULE
Cross street/directions to job site:
Description P I Qty. I Fee. -
I 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'l 500 sq. 0. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. It.) 75.00 2
l Limited energy. multi- family 75.00 2
�,e�, 4-.10.r ��,� ?S . f 1..fi. ?..00 AA. residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
2(1(1 amps or less 1 100.70 t ow n 0 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps ( 133.56 03.s 2
Name:
401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 2'`i„,.... 301.04 602 . 2
Address: Over 1,000 amps or volts 552.26 2
r Temporary services or feeders installation, alteration, and /or
City/State/ZIP:
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 1or 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 ❑ CONTACT PERSON above service or feeder lee, (1-i- 7A, l f 03 •i5S 2
each branch circuit
Business name: Gr, M� C�,S C (
( - �� 13. Fee for branch circuits without
eJ" s v� � service or feeder fee, first 56.18 2
Contact name: branch circuit
Address: Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 67.84 2
Phone:
( ) Fax:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy 1 Business name: h can panel, alteration, or extension. Page 2 1p e
.� 2
l • ! Each additional inspection over allowable in any of the above
Address: - 1550 C < W ( h �( r #22 0 Additional inspection (I hr min) 66.25/ hr
�� (� Investigation (1 hr min) 66.25/ hr
�
City /State /ZIP: O& r� "f 72- Z Industrial plan) (1 hr min) 78.18 / hr
Phone: 603) 23q— ( Fax: (3 ) o 2 9 g ' Inspections for which no fee is
specifically listed ('/ hr min) 90.00 / hr
CCB Lic.: - 7223( - 7223(.42_ � Electrical Lic.:375 4.
Suprv. Lic.: ELECTRICAL PERMIT FEES
■
u
Suprv. Electrician signature, required: \C._ �
Plan review (25% of per btotal: fee): . Sara 1. t
Print name: yP, ,ne \ ` k Date: State surcharge (12% of permit tee): t 70
TOTAL PERMIT FEE` �t`
Authorized signature:
This permit application expires if a permit is not o faired within 180
days after it has been accepted as complete.
Print name: C► /,g_LES 4 ys Al/ 774 Date: * Number of inspections allowed per permit. 7 05- 1:'' Building Perm IB
its .0 - Perm itApp.dnc 07;01.10 4 40 - 46157(11 '(1=•('OM WEB 1/ s •
YElectrical Permit Application - City of Tigard
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*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ 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
❑ 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: 1.
*No licenses are required. Licenses are required
for all other installations
1: \ Building \Permits\ELC- PermitApp.doc 07/01/10