Permit CITY OF TIGARD ELECTRICAL PERMIT
`�'! COMMUNITY DEVELOPMENT Permit #: ELC2011 -00485
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/01/2011
TI�rARD g Parcel: 1 S136DA00101
Jurisdiction: Tigard
Site address: 11410 SW 68TH PKWY
Project: PERS Subdivision: PERS SITE Lot:
Project Description: Electrical for clean agent fire suppression system and standby power.
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 - 200 09/01/2011 $100.70
Specifics: amps or less
1 ea Services or Feeders - 201 to 09/01/2011 $133.56
Type of Use: 400 amps
Class of Work: 2 ea Services or Feeders - 401 to 09/01/2011 $400.68
600 amps
Type of Const: 36 crt Branch Circuits w /Purchase 09/01/2011 $267.12
Occupancy Grp: Service or Feeder
1 ea 12% State Surcharge - 09/01/2011 $108.25
Electrical
1 ea Plan Review Electricial 09/01/2011 $225.52
Total $1,235.83
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 may obt - - _ _ , es or direct questions to OUNC by calling 503 2.1987 or 0 32.2344.
Issued By: 411 _ 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
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 -e, .
FOR OFFICE USE ONLY - •
‘
City of Tigard
OS) c Received
" 13125 SW Hall Blvd., Tigard, Tigard OR 97
111 .. ° P 1.1 Date/B :
wc ..4101 . 1) *Ian iB Rev . iew la r , 0 . 11 ..1 Mil i ti 1 c it II Permit No.: r:FtC , I — . i gi o
Other Permit: C
' ...1 ' I
•
' • 7, . Phone: 503.718.2439 Fax: 503.598.1960 \Y> / • 1 .5, •
Inspection Line: 503.639.4175 ,. ...N ate :
fa
-
TIGARD (2) \ D ate Ready/By: Juris: 10 See Page 2 for
Internet: www.tigard-or.gov 45v Notified/Method: . 7 Supplemental Information
' . 06
' -
0 New construction deAddition/alterationacement Please check all that apply (submit 2 sets of plans w/items checked below):
AS [' Building over three stories.
0 Demolition 0 w here or feeder 400 amps or more Other: here the available fault current 0 Marinas and boatyards.
': ::''„',' ,.,, ,.:*. ,:•,, ,„ f 00,t6.0)Vi( CpNsTRpepo ,N, -, ,: :: .. „;-,,_ , :_.,- :t 4 i':,1 exceeds 10,000 amps at 150 volts or 0 Floating buildings .
less to ground, or exceeds 14,000 0 Commercial-use agricultural
D 1- and 2-family dwelling OCommercial/industrial 0 Accessory building amps for all other installations. buildings.
1=I Multi-family El Master builder D Other: 0 Fire pump. 0 Installation of 75 KVA or
: -7.,--, -- — - --.----, -- ---,,,---- - , ., _ .__-.---,-- , , . „ „, ,-;;;;; 0 Emergency system, larger separately derived system.
:-.- • , - ', ,,." '‘' ''' ' : . ;` KOAPPI"I : .. , : i y - i , ,_ , ., D Addition of new motor load of
Job no.: 0 5"70 0 Job site address: 1 1 Li ( b 5 IA) OStri y ,, 100HP or more.
0 Six or more residential units. 0 occupancy.
Recreational vehicle parks.
City/State/ZIP: Ti o p.,. , Health-care facilities. 0 Supply voltage for more than
..„-i O
c ject name: f [de 1 ' D Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: - 1/4) Service or feeder 600 amps or more.
- - - ,.„ :FEE' '8 CITEDKLE,:i.:! -...: e , 2 i 4,
Cross street/directions to job site: Description . I QW• 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. addl 500 sq. ft. or portion 33.92 1
Tax map/parcel no.:
Limited energy, residential
75.00 2
,p oFyvo,RN - - . , ,. ,,,, . __ • .!, (with above sq. ft)
Limited energy, multi,family
e /-
3 tc k,J .i, , 0 (..0 c,,,„,..t f": -e._ -Si. i pp teC.S (i A up -3 ',lie
residential (with above sq. ft.) 75.00 2
i_.___—"
Services or feeders installation, alteration, and/or relocation
I - t2 j o c / 200 amps or less 1 100.70 tO0 ‘ 10 2
SC '
',- ' 110PEitTV'CIWIctii ;'' ' '-- ' • ' ' ' - - - E TENANTr .-'..' % . . - 201 amps to 400 amps - I 133.56 13 3 ,._, 2
401 amps to 600 amps - 2_ 200.34 4 0 0 b----- 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP:
relocation
Phone: ( ) Fax: ( ) 200 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
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
,.._ 1 2.
above service or feeder , 6
,, , • . - , _ . ' • . is ?APPLICANT' : , - ' ' • ' - ''' iii ' CONT'Aer.PERSCIN, • , " fee 3 742
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first
56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E
Sign or outline lighting 67.84 2
T 7.7 7 'i;..'7?4,7,65Sirititi . o - 57+ ! ::'W.17. '9
'...77•Tic77:^; t'''','" . . . .
- , --, .,..,, , .0, • v - ,..- - - ,,.. ::::!:- ',...,..--, -. - ----,:._ ;..:1:i....,.4....r.BiLtn, Signal circuit(s) orlimited-energy
panel alteration, or extension. Page 2
Business name: AA C CP., E( ecT1 CO
( Each , additional inspection over allowable in any of the above 2
Address: 2.6 (Li ,E_ 771% Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: p rt -f 4 ad aa-e a, 7 '7 2( y Industrial plant (1 hr min) 78.18/ hr
Phone: ( 563) 13 i 0. 5 zi , Fax: (_S ) 13 11 CVO 3 Inspections for which no fee is
specifically listed (Y2 hr mm) 90.00/ hr
CCB Lie.: 11 g 2 i 7 Electrical Lie.: 2 -2 Suprv. Lie.: .3 C r•-• -.) D 5 ''.„1: ..„7:7,:•:':attiffileAlt,:lfEfilatify 7,,E'li:-
-6
, Subtotal:
Suprv. Electrician signature, required: -- . _ ..
Platt review (25% of permit
71
Print name: . il 'M . 5 , ,-,1 Date: i 2.4 i it State surcharge (12% of permit fee):
TOTAL PERMIT FEE: -e -
Authorized signature:
This permit application expires if a permit is not obtaMe. . 8
days after it has been accepted as complets . -- 5
Print name: Date:
* Number of inspections allowed per permit.
....„,
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