Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00504
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/13/2011
Parcel: 1 S126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 450
Project: River City Travel Subdivision: Lot:
Project Description: (4) branch circuits for receptacles
Contractor: RC COSTELLO ELECTRICAL CONTRATING Owner: WISCO REAL ESTATE EQUITY FUND I
PO BOX 336 1501 SW TAYLOR ST STE 100
AURORA, OR 97002 PORTLAND, OR 97205
PHONE 503 - 982 -7400 PHONE:
FAX: 503 - 982 -7401
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 09/13/2011 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 09/13/2011 $9.41
Type of Use: Electrical
Class of Work:
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 acc• _ - - , ith approved plans This permit wit expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days ATT ION Oregon law - quires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 - 001 -01 0 through OAR 952 •.! -0091 You may obtain a copy of the rules or direct questions to OUNC by calling 3 232 1987 or 00 332 2344
Issued : / 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' ..„1„0,00110" 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
City of Tigard 'SOMA
Date/B ' ^ ' ^ ���0 �
Permit No � 1.{_ 2 D a
111 . ° 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review a
Phone 503.718.2439 Fax 503.598.1960 Date /B Other Permit bu pAO p9. //— €40/69
T 1 G A R D Inspection Line 503.639.4175 Date Ready /By furls ® See Page 2 for
Internet: www.ttgard- or.gov Notified/Method Supplemental information
YPE OF WORK PLAN REVIEW
❑ New construction L J 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 CommerciaUindustrial ❑ 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:( 20 S Id Wash i n)4. on -S2 U 100HP or more occupancy
❑
❑ Six or more residential units Recreational vehicle parks
City /State /ZIP: ❑ Health-care facilities ❑ Supply voltage for more than
t ❑ Hazardous locations 600 volts nominal
` S te/b dg./apt. no.: Li 5 Project name: (! C r - � i at u e l ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site Description I Qty. 1 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
Tax map /parcel no.: Ea add'l 500 sq ft or portion 33 92 1
Limited energy, residential 75 00 2
DESCRIPTION OF WORK (with above sq ft )
r p Limited energy, multi - family
D ram ( 1 rc U t I' S - -t7 Ce d. C (1 residential (with above sq ft ) 75 00 2
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
401 amps to 600 amps 200 34 2
Name:
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 I
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 amps 168 54 2
Branch circuits – new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with
❑ APPLICANT ❑ 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 1 56 18 5 2
Contact name:
branch circuit
Each add'I branch circuit 3 7 42 . 2„/ Aer 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67 84 2
City /State /ZIP: dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67 84 2
Pump or irrigation circle 67 84 2
E - mail:
Sign or outline lighting 67 84 2
CONTRACTOR Signal circuit(s) or limited energy
Business name: C ( 4'e I 1 panel, alteration, or extension Page 2 2
Each additional inspection over allowable in any of the above
Address:` 0, ! / (J o x J 3 .6 Additional inspection (i hr mm) 66 25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP:
r 0 r,,, 0 r Industrial plant (1 hr min) 78.18/ hr
Phone: (C)') (/ QZ 1 l t)iJ Fax: (5o)) qiZ — ? / inspections for which no fee is 90 00/ hr
specifically listed (% hr min)
CCB Lic.: v)/-4 oz Electrical Lie.: 3.. 3 ti 1 Suprv. Lie.: 3c1 ) ti l ELECTRICAL PERMIT FEES
Subtotal: `� g . 4
Suprv. Electrician signature, required: �C / '` Plan review (25% of permit fee). —
Print name: f .. C . I G Date: c J ) / (, State surcharge (12% of permit fee): 9. it/
J ( TOTAL PERMIT FEE: g ?, 16
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.
N umber of inspections allowed per permit
I \Building\Permits\ELC- PenmtApp 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*
H Burglar Alarm
H 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
H Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
H Fire Alarm Installation
H HVAC
H Instrumentation
H Intercom and Paging Systems
H Landscape Irrigation Control*
n Medical
❑ Nurse Calls
H Outdoor Landscape Lighting*
H Protective Signaling
n Other
Total number of commercial systems:
*No. licenses are required. Licenses are required
for all other installations
1 \Building\Permits\ELC- Perm¢App doe 07/01/10