Permit I, CITY OF TIGARD ELECTRICAL PERMIT
1 11 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00199
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/15/2011
Parcel: 25101 DA01000
Jurisdiction: Tigard
Site address: 7100 SW FIR LP
Project: Paragon Tile Subdivision: Lot: 0
Project Description: (4) branch circuits for lighting retrofit.
Contractor: MCCOY ELECTRIC CO INC Owner: PARAGON INVESTMENTS LLC
2014 SE 9TH AVE 7100 SW FIR LP
PORTLAND, OR 97214 TIGARD, OR 97223
PHONE: 503 - 234 -7521 PHONE:
FAX: 503 - 234 -9473
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 04/15/2011 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/15/2011 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 -0090. You ma ohtaia a cogg of the r = direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: — _ - Permittee Signature: �_ i
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.
E1eAp r. 15. ti2011 i 8: 25AN McCoy Electric Co. No. 4384 P. 1
I l . =
.F.t..l R OFFICE IIS . .
Ili City of Tigard � � � � ' �0G0Ned FOR
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Rev i ew
Phone: 503.639.4171 Fax: 503.598:1 ll �� j � �Qk Other Permit:
Datr 1J1
T I t A It f) Inspectlon Line: 503.639.4175 1 �J i Date Ready/By: MU; nil SeeYage 2 for
Internet www.tigard- or,gov Q� 1 • ' ` ' ' , odRvtethod: 7J ' Supplemental Information
TY OF W O �1 1 ,`i , ..... t ; BY!APJy i>;EVIEVY': ., .:,.
I=1 New construction g Addit1on(ancration/rOk C1r G Please cheek all that apply (submit a sets Of ptansw/items checked below):
``, v ❑ Service or feeder .100 amps ormore 1] Building over three stories.
['Demolition Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OR l ONS'fRtlCTIQN exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
leas to ground, or exceeds 14.000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building ainpu for all other installations. buildings.
El Multi-family Q Master builder El Other; ['Fire pump. ❑ Installation of71 KVA or
JOB t 1 W1i01(kl+ffATON AND LOCATION ❑ Emergency system. larger separately derived system.
_
Job no.: Q Additionof newmotorloadof ❑ "A',"H', "12 ", "1 -3 ",
1)5 33 d( Job site address: V W 9 1 V /1 C t 1 Fir Loop 10011P or more. occupancy -
W /10 V l t/
❑ Recreational vehicle parks
❑ $ix or more residential units.
City/State/ZIP: (4119,_ il 5 OR ❑ Health -cute facilities. ❑ Supply voltage for more than
J -� Llitwvdous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Pero 5 v ie r l { ( ❑ Service or feeder 600 amps or more.
Cross street/directions job site: ,Namptlen )?Err[S . , l
l Qty. I Pee. 1 Total I •
New residential single- or multl•amily dwelling unit.
Includes attached garage. .
Subdivision: I Lot no.: 1,000 sq. ft. or teas + 168.54 4
Tax map/parcel no.: Ea- add'l 500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION OF 'WOEK (with above au. ft.)
L i
e vo r
Limited energy, multi- family
2
Li Q g Y residential (with above e sq. q. ft.) _ 75.00
J 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 L000 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
reloca lion
Phone: ( ) I Fax: ( ) 200 amps or less 1 59.36 1
201 amps to 400 amps I25.08 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, ncr panel
Owner signature: Date: A. Fee for branch circuits Wilt
❑ APPLICANT I Cl CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B, Pee for branch circuits without I 1 Q
service or feeder fee, that 56.18 Dtb . { 0 2
Contact name: w branch circuit �},
Address: Each add'l branch circuit 'l 7.42 ,� 1 ,X 2
Miscellaneous (service or feeder not Included)
City /State/ZIP: Each menuf etnred or modular 67.84 2
dwelling, service and/or feeder _ _
Phone: ( ) Fax; : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
_
E m0.11: Sign or outline lighting 67.84 2
CONTRA OR Signal circuit(s) or limited - energy
Business name: u t, 0 t G C, pano% alteration, or extension. Page 2 2
Each additional Inspection over allowable in any of the above
Address: 1I lq 5' 9 Additional inspection (1 hr min) (((/// t' 4
66.25/hr '
City/State /ZIP: U I
( t /) /v o Investi (1 hr min) 66.25/ hr
LA Industrial plant (1 hr min) 78,18/ hr
Phone. ( I ( 17) u ''1 t5 `�l Fax: '-'` ( 1 ` 1)"1 V 6 i�� inspections for which no fee is 90.00 / hr
✓ ✓ ✓ ✓✓ specifically listed ('d hr rain) _
CCB Lic.: Ov - 1 1 I Electrical Lie.: a o' , , Suprv. Lie..: 5 ") $5 ELECTRICAL PERMIT FEES
Suprv. Electrician signa required: t Subtotal:
` If Plan review (7S% of , smelt fee):
Print name: �,t ���"'NNN I � 4 Date: 1 1 1$/ (a State s urcharge (12% o f permit fbe): 9 • 1.4 I
��� ( TOTAL P2RM1T PEE: { 1 1, ( j
Authorized signature: This permit application expires Ir permit is not obtained within 160
days after it has been accepted as complete.
Print name: Date: s Number of inspections allowed par permit_
I: iluildinaVermitAELC-PermitAPp .dOC 07/01/10 440.4615T111/0StCO..AVEB