Permit CITY OF TIGARD ELECTRICAL PERMIT
- ! COMMUNITY DEVELOPMENT Permit #: ELC2011 -00473
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/24/2011
Parcel: 1 S136CD01000
Jurisdiction: Tigard
Site address: 11745 SW PACIFIC HWY
Project: Cash and Carry Subdivision: Lot:
Project Description: (4) branch circuits for new walk -in cooler.
Contractor: COCHRAN INC Owner: MONAGHAN FARMS, INC
7550 SW TECH CENTER DR. #220 14120 EAST EVANS AVE
TIGARD, OR 97223 AURORA, CO 80014
PHONE: 503 - 234 -6564 PHONE.
FAX: 503 - 238 -2098
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 08/24/2011 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 08/24/2011 $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 accordant • roved 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 requir s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 throycOAR 952 -001- . Yo y obtain a copy of the rules or direct questions to OUNC by calling 503.2 .1987 or 1.800.332.2344.
Issued By: _ 1 ' \� Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own we' - ' not intended for sale, lease or rent. ,
OWNER'S SIGNATURE !.
AZ. / ` 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.
01 16:15:16 08 -23 -2011 1 /2
Electrical Permit Application - %'■\
�'' Permit No.: L`�t�
City of Tigard . �® R. Received p � t 2
q c} c r y Date /B Q r w 1/ / 7 �3
I . 13125 SW Hall Blvd., Tigard, OR'972 3� yae o G� Plan Review
Phone: 503.639.4171 Fax; '503.590 �,..0.k.3"
Date Ready /By: �`�� Date /By: Other Permit: Heap` / -005 �7
TI G A It [7 Inspection Line: 503.639.4175 y Cj ��J • 0 See Page 2 for
p �'C
Notified/Method: Supplemental Information
v
7 1' i'�
o 'wa r °
Internet: wwwugat or.go OF •WO�� •,, . ,._' . , ; � PLAN %R;E
El New construction Addition /alteration /replacement
Please check an that apply (submit 2 sets of plans w /items checked below):
0 Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
1 ' CATEGORY OF CON . ° 4 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 Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder 0 Other: ❑ Fire pump. ❑ Installation of 75 KVA or
nergency system. larger separately derived system.
'' JOB INFORMATION AND'LOCATION '; Additiouofnewmotorioadof Q "A^ E" "i -2" '1 -3"
Job site address: 1 `� r� Q 100HP or more. occupancy.
Job n0.:
��� \ l •�`� r ❑ Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: 3c ,, ,r - � 0 Ip ---1 7 2.,_i I ❑ Healthcare facilities. ❑ Supply voltage for more than
Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: C� k �„..,�
� ❑ Service or feeder 600 amps or more.
':• i
Cross street/directions to job site: 0 e� 22 7 4,,_ Description l Qty. I Fee. 1 T otal l `
_\
` New residential single- or multi - family dwelling unit.
2-. c_ r'vv s J ' ‘ ` Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less 168.54 4
Tax map /parcel no.:
Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential
DESCRIPTION :OF WORK (with above sq. ft.) 75.00 2
t L I Limited energy, multi-family 75.00 2
43 0 C1 1 ^ 33 � \ Q-_� \c Cc-` '4e ,1' k.s3 a�� '� residential (with above sq. 0.)
t t Services or feeders installation, alteration, and /or relocation
(N- C 6 A \ e , 200 amps or Tess 100.70 2
0 PROPERTY OWNER I ; ., ENANT ,. 201 mnps to 400 amps 133.56 2
Name: C c� Co_ f j
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 7 P: 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 amp 168.54 2
Branch circuits- new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
r o •IPPLICANT I 0 CONTACT PERSON a b ove serv or fe f ee , 7.42 2
each branch c
Business name: j0-Me.. a Cos∎*( ., i i-,�V ` -- B. Fee for branch circuits without
service or feeder fee, first 56.18 . , I 2
Contact name: branch circuit
Each add'I branch circuit `, 7.42 22 , 2..(s 2
Address: Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular 67 84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.8 2
E -mail:
Pump or irrigation circle 67.84 2
•' ,.. ,. CONTRACTOR ` Sign Signal outline lighting 67.84 2 • mi
1 1
' , . l circuits) or limited-energy
Business name `` c can `t' _ _ panel, alteration, or extension. Page 2 2
�� Each additional inspection over allowable in any of the above
Address: v( 550 51/41,1 e.ch C_e_n_K #�� B Additional inspection (I hr min) 66.25/hr
City /State /ZIP: ' T & 0R. q 7� 2_ Investigation (1 hrrnin 66.25/ hr
{� industrial plant (1 hr min) 78.18/ hr
Phone: 503) 2_34__ &'56'/ Fax: ( )3 ) 238' - Z p 9 g' inspections for which no fee is 90.00 / hr
;L "i � specifically listed CA hr min)
CCB Lie.: — 7 Z Z / Electrical Lie.:375L4, Suprv. Lie.: 3-�' 3
•'' t •';' ELECI'RICw,PERItiIIT' FEES . ;"
S ubtotal
Suprv. Electrician signature, required: - 746' k 9
V �"" \ �� Plan review (25% of permit fee)
Print name: \<P (..\'Z l Y, k Date: ' Z' j t t State surcharge (12% of pennit fee): 9 , L{ (1 - /
TOTAL PERMIT FEE: r~'
Authorizedsignature: � ,� �•
This' permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete,
Print name: Date: * Number of inspections allowed per permit.
1! Pcrinits•ELC- PermitApp.doc 07/01,10 440- 4615T111•05,COMFWEB