Permit t �.
„
14 a CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00314
TIGARD 13125 SW HaII.Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/24/2009
Parcel: 2S110DCO2300
Jurisdiction: Tigard
Site address: 11555 SW DURHAM RDA -4
Subdivision: Lot: 0
Project: Oregon Music Academy
Project Description: 7 branch circuits
Owner: FEES
HIP WILLOWBROOK LLC Quantity Description Date Amount
BY TAX DEPARTMENT, PO BOX 2708
PORTLAND, OR 97208 7 crt Branch Circuits 06/24/2009 $86 75
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/24/2009 $10.41
Electrical
Contractor:
R C COSTELLO ELECTRICAL CONTRACTING
INC
PO BOX 336
PHONE: 503- 982 -7400
FAX: 503 - 982 -7400
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $97.16
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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800 332.2344.
Issued By: !' ✓ Permittee Signature: .S&L A (gyp •
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 an inspection that business day.
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.
Jun 23 2009 8:50AM HP LI t1 i p.2
Electrical Permit Application JUN 2 3 2009 FOR OFFICE USE ONLY
City of Tigard Dale/B�d 3 /
Pe mil No. 2 O� -
13125 SW Hall Blvd„ Tigard, OR 97223 CITY OF TIGARD Plan Re+;ew
■ , Phone: 503 639.4171 Fax: 503 598 1' r 1 Onte Other Permit:
P' Ins ection Line: 503 639,4175 ILDING DIVISIO j Date Ready/By mail. Rf See Page 2 for
TC ° D ' . p
Internet: w'Ww.tigard- or,gov Notified/Method. Supplemental Information
O F WORK . PLAN FtEYIl W'' :? `? : :; :
• Please _heck all that apply (submit 2 sets of plans w /items checked below):
❑ New construction Addition /alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building ever three stories
❑ Demolition ❑ Other. where the available fault current 0 Marinas and boatyards,
- CATEGORY OF CONSTRUCTION exceeds 1!1,000 amps at 150 volts or ❑ Floating buildings.
less to gi mind_ or exceeds 14,000 ❑ Cnmmexial -use agricultural
❑ 1 - and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations- buildings
❑ Multi - family ,] Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
• JOB ,SrTE INFORMATION AND. LOCATION a stem, larger separately acme system.'
❑ Emergency sy d s st
❑ Addition f new momt load :if ❑ A , E I -2 ', 1 3 ,
*w 100HP or more occupancy
Job no.: Job site address: I I L Sc� r � ❑S ix or more residential un iis. ❑ Recreational vehicle perks
City /State /ZiP: O Healt`i -care facilities, ❑ Supply voltage for more than •
❑ Hazardous locations- 400 volts nominal.
wi Id a t. no.: / I Project name, ! ❑ Service or feeder 400 amps or more.
�`! FEE SCREDULT': >i; :: ° :.` :;.. :
Cross street /directions to job site Description I Qty. I Fee. 1 Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no : 1,000 sq. ft.pr less 145.15 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
AESCRIPTION OF WORK ' (with above sq. ft.)
I.imitzd energy, multi- fami'v 75.00 2
13 ecoi , Pt C.f ta`,Sd i4S Tor (ea* ._ ! residential (welt above sq R.)
Services or feeders installation and/or relocation
0 VI 01 1coh tNeitir
i ,. ". . 200 amps or less 80.30 2
. 't,;;,z :3i .[f . TY OWNER • ,. : �t , TENA_ NT ` -`. ' : ,., . :.. :,.y ;' 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240 60 2
Address: Over 1.000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation _
Phone: ( ) Fax: ( ) 200 amps or less 66 85 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 .._... 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133 75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits is -ith
'❑ :.APPLICANT,i'r' : ' • ❑ CONTACT PER above service or feeder fee,
each branch circuit 6.65 2
Business name: B Fez for branch circuits
Contact name:
without service or feeder fee / 46 85 .$ 2
first branch circuit
Address: Each add - 1 branch circuit J G 6.65 3 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
90.90 2
-- dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66. _ 85 2
E -mail: Pump or irrigation circle 53.40 _ 2
• '• CONTRACTOR Sign 'or outline lighting 53.40 2
Signal :ircuit(s) or limited -
Business narne:-R e. cos-ij [ 1 _ Q f I C ,) -i.. crie uric! alteration or
c� 1 _ G /ifra d9 . !� t - ) gY p
Address :pU 13, Us /'?�
extension. Descr Page 2 2
City/State /ZIP: RururOX OR G` 10°1 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( S43) .182. r ) Fax: (5o3) cis 2.- C) 40 ! Investigation per hour (1 hr min) 62.50
CCB Lie.: 8 Electrical Lic.: 3-34140 Supry Lic.• 3c 3L . 5 Industrial plant per hour 73,75
J ELECTRICAL PERMIT., FEES ' _ u ,,:_,_
. Suprv. Electrician signature. required.. -
on : Y�a . E . :, Subtotal: � /4
� Plan review (25% of permit fee):
Print name: 'o5 C 1 ,01 ) vie Date'6 / '/
f State surcharge r 12 %of permit fee): IC . 4
Authorized signature', TOTAL PERMIT FEE: 7 $4.
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted at complete.
• Number of inspections allowed per permit.
P.\ BuildingWermie \ELC- Permi.App,Joc 0103)00
440-46157(11/0/C0/v1/WEB