Permit w q CITY OF TIGARD ELECTRICAL PERMIT
1111 2 , '- COMMUNITY DEVELOPMENT Permit #: ELC2011 -00189
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/12/2011
Parcel: 2S 101 DC00200
Jurisdiction: Tigard
Site address: 13535 SW 72ND AVE 165
Project: Workflow One Subdivision: 72ND AVE OFFICE BUILDING Lot: 0
Project Description: (2) branch circuits for TI
Contractor: RC COSTELLO ELECTRICAL CONT INC Owner: PNWP LLC #2
PO BOX 336 BY PACIFIC NW PROP LTD PTNSP
AURORA, OR 97002 PO BOX 2206
BEAVERTON, OR 97075
PHONE: 503 - 982 -7400 PHONE:
•
FAX: 503 - 982 -7400
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 04/12/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/12/2011 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $7123
Required Items and Reports (Conditions)
This permit is ' - • • subject • he regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done i = ccordance with appro -d . - ns This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. A ENTION: Oregon law •uires o • follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 0010 thro , h OAR 952 -0r r r •0. /u obtain a copy oftheru
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s or direct questions to OUNC by calling 503.232.1987 or 2.2344.
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Issue • - ✓ 1—
L 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
l7
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 OFFICE USE ONLY
_� 7 Q
- City of Tigard Received A. i Permit No.: ` ��C GSA
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U PI
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : other Permit: 4'
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: funs: 63 See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE 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 ❑ Other: 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
❑ 1- and 2- family dwelling UKommercial/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.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: / 3 S 3 S Si 2 . h d .hut 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: I 0 r K .0 U N ❑ Service or feeder 600 amps or more.
job site: Description FEE SCHEDULE
Cross street/directions to
J I Oty. 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. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
I p Limited energy, multi - family 7500 2
V r6i (. 1. (5 1 f ct,, 11 .5 - ' ire cQ• M c residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ 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 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first / f S
Contact name: branch circuit 56 . l 8 7 2
Each add'l branch circuit I 7.42 ?• Y 2
Address: 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
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: Ct Cos -i-e, l to EEelc �c w0 r - panel, alteration, or extension. Page 2 2
[• Each additional inspection over allowable in any of the above
Address: 0, 'Q 0 x '3 3 6 Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: (Lein O t a Z.. Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (SA wa Fax: (S o)) 4V.- 0 / Inspections for which no fee is 90.00 / hr
specifically listed (%: hr min)
CCB Lic.: Cri( Z Electrical Lic.: -3_310 Suprv. Lic.: "4•54,,, ELECTRICAL PERMIT FEES
Subtotal: � ?j . -
Suprv. Electrician signature, required: f c:2.....,
Plan review (25% of permit fee): ��
Print name: � C Cs4e 1I. Date: Ll /ia I State surcharge (12% of permit fee): -2. Co 5
TOTAL PERMIT FEE: 7/ • oZ 5
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: • days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\Building\Permita\ELC- PermitApp.doc 07/01 /10 440- 4615T(11 /05 /COM/WEB
Electrical 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:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
H Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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