Permit CITY OF TIGARD ELECTRICAL PERMIT
'7 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00048
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/20/2011
Parcel: 1 S 135BD00300
Jurisdiction: Tigard
Site address: 9735 SW SHADY LN 200
Project: Tigard Medical Mall Subdivision: TIGARD MEDICAL MALL Lot: 0
Project Description: (1) branch circuit for replacing circuit breaker.
Contractor: RC COSTELLO ELECTRICAL CONT INC Owner: MCFADDEN, ARTHUR L
PO BOX 336 BY ERIC SKLARZ
AURORA, OR 97002 621 SW MORRISON ST STE #800
PORTLAND, OR 97205
PHONE: 503 - 982 -7400 PHONE:
FAX: 503 - 982 -7400
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 01/20/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/20/2011 $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 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 rul- - • • •ted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952- 001 -0090. You may obtain a co. of th- ules or • 1 -ct questions to OUNC by calling 503.232.19 00.332.2344.
Issued By: Permittee Signature:
L 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 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.
... . . .
„
Electrical Permit Application .
• • : . FOR' OFF E; E
, -
: .
''': ', .-,. City of Tigard Received i
Date/I3 . i AfgAr
fii, . • 13125 SW Hall Blvd., Tigard, OR 97223 -
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 '9 Date/B . Other Permit:
A1 0- ) Inspection Line: 503.639.4175 :C) Date Ready/By: Suns: Ell See i age 2 for
,.,«.• ''." - Internet: www tigard-or.gov '. Notified/Method: Eft -,. Supplewental Information
c‘ r)(A\
. - .. .. . . .
/ATE' OF WORK, %:" 1.- - . . • . ' 'FIAS;r'ittVikWI'
• , . ..
0 New construction t ',*;
Addition/alteratiOn replaccAG x0. Please check all that apply (submit 2 sets of plans w/i ems checked below):
0 Service or feeder 400 amps or more 0 Buildin,, over three stories.
0 Demolition 0 Other:
si * ()X. where the available fault current 0 Marina, and boatyards.
'.:W.f..„ ..,-.K ..
r.Q.F.C9 1 4Z. , _ exceeds 10,000 amps at 150 volts or 0 Floatin mildings
' - less to ground, or exceeds 14,000 0 Comme ial-use agricultural
0 I- and 2-family dwelling Commercial/in ab rial EJ Accessory building amps for all other installations. buildin. '.
El Multi-family 0 Master builder EI Other: 0 Fire pump. 0 Installat in of 75 KVA or
larger si arately derived system.
4:4* ::'-.;:. ' . ,,.': ".::- . 0 Addition of new motor load of
- -
r o 0
Job no.: Job site address: Cf J 3 s cu s body 100HP or more. oc cy
Li i . 0 Six or more residential units. 0 Recreat coal vehicle parks.
---
City/State/ZIP: i I F 0 Health-care facilities
0 Hazardous locations. 0 Supply )Itage for more than
o ,_
600 voles nominal
te.e3Idg./apt. no.: 200 Project name OW
s D Service or feeder 600 amps or more
cud .4..4. I P/a2A ,,,. - - - ------- - --. ----- . '- - - - , -- -
0 agiffMtaM
Cross street/directions to job site:
Description j Qty. I Fe , 1 Total
— New residential single- or multi-family dwel ng unit.
Includes attached garage.
Subdivision: Lot no.• 1,000 sq. ft or less 10154 4
I addl 500 sq ft or portion 33j92 I
Tax map/parcel no.:
Limited energy, residential
7:1J00 ?
... ',IJESdlIPTION OF' WORK (with above sq fi.) 1
Limited energy, multi-family
7: I 00 2
rep la oz. c i r cu i - A- b re& Ker--- residential (with above sq ft )
Services or feeders installation, alteration, ald/or relocation
200 amps or less 100 70 2
Er ' PROPE,141q4,INE ' '?' : ' . ' , : • - 0. TENANT
. 201 amps 10 400 amps 13: 56 2
401 amps to 600 amps 200 34 2
Name: ,
601 amps to 1,000 amps 30 104 2
Address: Over 1,000 amps or volts 551' 26 2
Temporary services or feeders installation, .teration, and/or
City/State/ZIP:
relocation
Phone: ( ) Fax: ( ) 200 amps or less 5136
— 1
201 amps to 400 amps 12:108 2
Owner installation: This installation is being made on property that I own which is not
401 amps to 599 amps 16' 54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extensiv , per panel
Owner signature: Date: A Fee for branch circuits with
- .,.•. . ,„„ . • above service or feeder fee,
U :APPLICANT . . ti: PERSON •
each branch circuit ' ,42 2
—
B. Fee for branch circuits without
Business name:
service or feeder fee, first 1 56.18 s e 2
Contact name:
branch circuit
Each add'I branch circuit 2
Address: Miscellaneous (service or feeder not include')
Each manufactured or modular
6' )84 7
City/State/ZIP:
dwelling, service and/or feeder
Phone: ( ) Fax: : ( / Reconnect only 6 184 2
Pump or irrigation circle 6" :4 2
E
, . Sign or outline lighting 6' .:4 2
.. . . . „ .. .. „ .. . . . „
. .2', : . .,, -,,,.';':, • CINTRACTOIR' .,.., ,, ,.1.,_, . , . ' . . . Signal circuit(s) or limited-energy
_ --. _panel, alteration, or extension Pa1," 2 2
Business name: - R . C C. as-Fe E j . (-ILA_ i LA) in _ —Lev-- Each additional inspection over allowable i ny of the above
Address: 7P0 Th 33 t, Additional inspection (1 hr min) 66.4/ hr
Investigation (1 hr min) 66.1/hr
City/State/ZIP: 1 0 -- q - 7 0 0 - 2...
Industrial plant (1 hr min) 78.18/ hr
Phone: ( 50 3 ) qe2_'7L Fax: (50 qg 2. _-- i Inspections for which no fee
90.4/ hr
specifically listed (Y2 hr min) is
CCB Lie.: S Electrical Lie.: 3 - 3 t-i if Suprv. Lie.: 3 q 3z s , :v .-. yyfw - 4: oxlmitastaaf
it 1 ) 1011/11 Subtotal ', s G .)
Suprv. Electrician sigtpie, required: 19.___
- Plan review (25% of permit fee)
Print name: ei_ C a 4...e I I
CY. Date: / 1 al / 1( State surcharge (12% of perm 6 :i it fee)
TOTAL PERMIT FEE ' (:::, 2, .012i
Authorized signature:
This permit application expires if a permit is not btained within 180
days after it has been accepted as to plete.
Print name: Date: * Number of inspections allowed per permit
1.\Building\Permits\ELC.PermitAnn.doc 07/01/10 4404615T(1 I/05/CONI/WEB