Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 00012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/05/2011
Parcel: 1 S 134AD06202
Jurisdiction: Tigard
Site address: 10500 SW NIMBUS AVE T
Project: Solid Rock Subdivision: Lot: 0
Project Description: (1) branch circuit to reconnect replaced rooftop unit.
Contractor: COCHRAN INC Owner: ROBINSON, CONSTANCE A &
7550 SW TECH CENTER DR. #220 ROBINSON, LYNN ET AL
TIGARD, OR 97223 BY KG INVESTMENT MGMT
10240 SW NIMBUS AVE #L3
PORTLAND, OR 97223
PHONE: 503 - 234 -6564 PHONE:
FAX: 503 -238 -2098
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 01/05/2011 $56.18
Specifics:, Service or Feeder
1 ea 12% State Surcharge - 01/05/2011 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports (Conditions)
This permit ' ' • - • •'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all o applicable la • II work will
be done accordance with -. •proved plans. This permit will expire if work is not started within 180 days of iss nce, or ' w• k is spended f • re the 180
days. • ENTION: Oregon I- , -q 'res you to follow the rules adopted by the Oregon Utility Notificatio Center. ' , os: - • h in OAR
952 -00 -0010 throw • h OAR 952 -' -0090 You - - obtain a copy of the rules or direct questions to OUNC by calling 503.2' .1987 or 1.81 1.332.
Issue.
�j —LL _, k - �� ∎i c _ 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 INST LLATION ONLY
SIGNATURE OF SUPR. ELEC' - /1 r Date: /A%
LICENSE NO. 347/‘( 5
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
trical Permit A lication FOR OFFICE USE ONLY
City of Tigard Received 5 !a & E jai f
Permit No.: ,
Date /By: eter9C
• ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C . Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit: 1...( to /e De q v
1' 1 C. A It 17 Inspection Line: 503.639.4175 Date Ready /By: kris: El See Page 2 for
Internet: www.tigard- or.gov Notified /Method: Supplemental Information
YPE OF WORK PLAN REVIEW
❑ New construction Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
El Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I - and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of75 KVA or
JOB SITE INFORMATIO AND LOCATION ❑ Emergency system. larger separately derived system.
le) 'F Addition of new motor load of ❑ "A ", "E "l - ", "l -
Job no.: 1 �Dl h L ; � 1,
Job site addre §s: C ANO
— i 5)L I os. c
��S ❑ Six or or r moo re a residential units. ❑ R ecreational vehicle parks.
City /State/ZIPr tip` 'Ti U R 97 z z ❑ Health -care facilities. ❑ Supply voltage for more than
ll� 1 ['Hazardous locations. 600 volts nominal.
Su e/bldg.yapt. no.: II r Project name: _ _ ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: r•)‘...1 7 240CA Description I Qty. I Fee. I Total I •
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'I 500 sq. f1. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family
I5 , I — � A Q„y�a e or C 6.1.._ _ residential (with above sq. ft.)
75.00 2
( � ' � O . Services or feeders installation, alteration, and/or relocation
4 � V\
tS C - - T '7 ` (/ - Ion u v `Jc-. .- 200 amps or less 100.70 ' 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 1 / J L5 601 amps to 1,000 amps 301.04 2
Address: l� I 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 above service or feeder fee,
❑ CONTACT PERSON each branch circuit 7.42 2 •
Business name: Me.. Cls C or1 eiZ�� B. Fee for branch circuits without
4 service or feeder fee, first 56.18 !Jtp.�� 2
Contact name: D4�f1 E. (t d _� branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State/ZIP: dwelling, service and/or feeder 67.84 2
Reconnect only 67.84 2
Phone: ( 71) Z� -, 42_5-q Fax: : ( )
E - mail: Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: can panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: ' l 5 50 51/4 ( ec h 1 /� e n . ,1i, ( #22, Q Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: `� 6_ (-� O 9 i 72 Z Investigation (1 hr min) 66.25/ hr
I� Industrial plant (I hr min) 78.18/ hr
Phone: X703) 2_3(.1 (p5 ,c/ Fax: ( ),3 ) 2 ZQ 9 ' ' Inspections for which no fee is 90.00/ hr
specifically listed (V2 hr min)
CCB Lie.: -1 2_ 9 Z Electrical Lic.: 3 7 5Lit s „ C Suprv. Lic.: ELECTRICAL PERMIT FEES
/
Suprv. Electrician signature, required: ` �
Plan review (25% of permit Subtotal: fee): . Ct. `%
K
Print name: P Cl e \ ` n \ Date: I (� r ID State surcharge (12% of pennit fee): ( :7
' \ l TOTAL PERMIT FEE: 62_12
Authorized signature:
This permit application expires if a permit is not obtained within ISO
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per pennit.
1: \Buitding PennitApp.doc 07 440 4615T(11'05,COMiWEB