Permit ,, CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00476
Date Issued: 08/24/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1 S136DA00101
Jurisdiction: Tigard
Site address: 11410 SW 68TH PKWY
Project: PERS Subdivision: PERS SITE Lot:
Project Description: Electrical work associated with HVAC upgrade.
Contractor: MCCOY ELECTRIC CO INC Owner: OREGON, STATE OF PUBLIC
2014 SE 9TH AVE EMPLOYEES' RETIREMENT FUND
PORTLAND, OR 97214 11410 SW 68TH PKWY
TIGARD, OR 97223
PHONE: 503 - 234 -7521 PHONE:
FAX: 503 - 234 -9473
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 201 to 08/24/2011 $133.56
Specifics: 400 amps
8 crt Branch Circuits w /Purchase 08/24/2011 $59.36
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 08/24/2011 $23.15
Electrical
Type of Const:
Occupancy Grp:
Total $216.07
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. ATTENTI• •. •re.•n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 rough OAR • •2 -00 u may obtain a copy of the rules or direct questions to OUNC by calling 50 . '87 or 1.800.332.2344. ,
Issued B • IiI� — Permittee Signature: • / 7 i7
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:
NTRACTOR IN)S'TAA'L�LAATION ONLY
SIGNATURE OF SUPR. ELEC' i -40—C 0�' Qy 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.
Aug. 24. 2011 1: CCPM McCoy Elect r ic Co. No. 6207 P. 1
Electrical Permit Applicatifiqcc9vEt ,0,4(),n „ ()NIX
ii A5 ---- 4 i :
City of Tigard u a kim ...g .., ,, t,„,„. Received
Dawn : tffillillik Til Permit No.: tee 5/76
IN
: " 13125 SW Hall Blvd., Tigard, OR 9722J r. 2 4 2011 Plan Review
; Phono: 503.718.2439 Fax: 503.598.19W u Date/B : Other Permit: Hee a ...1
Inspection Lille: 503.639.4175 Dale Ready/By; Anis; El See Page 2 for
'1 l(iAIW
Internet: www.ligard CITY OF TIGARD Notified/Method: Supplemental information
1 ., .::'io.:■.'f'. - ;:.'•!4:"... , ': ri".14:--U . TYPE tik , 914L j , , :., .:!. 2 ..i•tr*:9*..., V wTQ
111 New construction /Addition/alteration/replacement Please check all that apply (submit 1 seta of plans wiitems checked below):
ID Service or feeder 400 amps or more 0 Building over three stories,
0 Demolition 0 Other: where the available fault current CI Marinas and boatyards.
: afar ., :,coy?6,..,, 7','.7i1:, : . ,::, exceeds 10,000 amps at 150 volts or D Floating buildi.,gs,
Y ' ..,%'` .; — ..,,. -4... .A .,,A..:- . • : :, :' 1 , -;..1'..J.. ;.-,. A.. i
Iran to ground, or exceeds 11,000 D Commercial agricultural
0 I- and 2-family dwelling Fa Commercial/industrial 0 Accessory building amps for all other installations. buildiegs,
0 Multi-family 0 Master builder 0 Other: CI fire pump. 0 Installation of 75 KVA or
0 Emergency system. larger separately derived system.
,. ,..4. , i
Job site address: i iiii 1.k...) UP &HI?
100HP or more, occupancy.
Job no.: D 5/131
0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: '11 ri a ra I 0 IR 0 Health-care facilities, 0 Supply voltage for morn than
13 I - ...r.
tiyteiro lefty D Hazardous locations. 600 volts nominal.
Project name:
Suite/bldg./apt, no.: ___ Service or feeder 600 amps or more.
atuV. ::', ::: : ' ': : FE SCOMYLE::: ':'
Cross street/directions to job site: D 5 ci -67 Description 1 Ow. I Fee_ 1 Toad •
Ncw residential single- or multi-famlly dwelling unit.
Includes attached garage.
Subdivision: . Lot no.: 1,000 sq. R. or less 168.54 1 4
Ea. add') 500 sq. R. or portion 33.92 1
Tax map/parcel no.:
Limited energy, residential
' : : : :. . Y • :' :!'::::!.'' . 55-1r 74fritION ' tik W6Ti:i (with above sq. IL) 75_00 2
Limited energy. multi-family
I-1V ACJ k) ?Sri d e-) residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or 1055 100.70 5 6 2
g r ko otr i;::oor a m . 5, , :::: : ,... .,.. .:, ‘,; 201 amps to 400 amps
133.56 1 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 1 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) I Fax: ( ) 20o amps or less 59,36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125,08 2
intended for sale, lease, rent, or cxchnnge, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
1:tranch circuits- new, alteration, or extension, per panel
Owner signature: Date: A. Pee for branch circuits with _
' ,',.."•• :: ';'1 MILMVICT6,611 .. T7'7. : El itON TA diltliMNIE above service or feeder fee I WA ,
742 ; • 2
eac branch circuit
Business name: B. Fees for branch circuits without
service or feeder fee, first
Contact name: .. branch circuit 56.18 , ALI 2
Each WI branch circuit q 7.42 51.n ' 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: 67.84 2
dwelling, service andlor feeder
Phone: ( ) I Fax : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E .... .
Sign or outline lighting 67.84 2
az‘:: ., .. , -:i:1000.40.0R :;. ::' r. ::: 7 !- 7 ,Mg:,:g :::::., : ' Signal circuit(s) or limired-energy _
,
Business name: 01 A. / t g ' panel, alteration, or extension. , 1 Page 2 2
r
A Each additional inspection over allowable hi any of the above
Address: 0 i P 4V,4 Additional inspection 0 hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City/State/ZIP: F an Industrial plant (1 hr min) 4 qa11-4- .... .. ,_
78.18/ hr
Phone: (51Z) aN .1 ... Fax: (r.
2J(4614-13 Inspections for which no fee is
90.00/ hr
specifically listed hr iniit. ., _._.
CCB Lie.: 1 2) .(2 %dr Electrical Lic.:fi , I Suprv. Lie.: 5 2130,5 ..• .,,..7:
o lui
S
Suprv. Electrician signature atotal: , required: '
p
L. — Plan review (25% of permit fee):
,
Print name: Z 0 c' < '1 vu ll • / A
r I I v . Date: .00 , . (
Slate surcharge (12% of permit fee): S, 15 _
TOTAL PERMIT FEE: 2 1 L 0
Authorized si . gnature:
This permit application expires it a permit is not obtained withi 180
days tifier ii has been accepted as complete.
Print name: Date:
* Number of inspections allowed per permit.
15BuildingTermiis\ELC-PermitApp doc 07/01/i0 440.4615TO 1/05/CONIAVER