Permit CITY OF TIGARD ELECTRICAL PERMIT
IN 1 +, COMMUNITY DEVELOPMENT Permit# ELC2011 -00601
Date Issued 10/26/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 715 2439 Parcel 2S101 DA00104
Jurisdiction TIGARD
Site address 13333 SW 68TH PKWY, STE# 220
Project ACS Subdivision YARNS ACRES Lot 9
Project Description (2) branch circuits in data room on main reception floor
Contractor COCHRAN INC Owner TRIANGLE POINTE LLC
7550 SW TECH CENTER DR #220 901 NE GLISAN ST, #100
TIGARD, OR 97223 PORTLAND, OR 97232
PHONE 503 - 234 -6564 PHONE
FAX 503- 238 -2098
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 10/26/2011 $63 60
Specifics. Service or Feeder
1 ea 12% State Surcharge - 10/26/2011 57 63
Type of Use COM Electrical
Class of Work ALT
Type of Const
Occupancy Grp:
Total $71 23
Required Items and Reports (Conditions)
This permit issued Cu. - t to the re• ulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All walk will
be done accordance with - • • • •ed • an This permit will expire if work is not started within 180 days of i once, or if work is suspended for more the 180
days • TENTION Oregon I- • regain u to follow the rules adopted by the Oregon Utility • • cation Center Those r les are set ,forth in OAR
952 -001 0010 thr'ugh OAR 952 • • 0090 %1• ay obtain a copy of e rules or direct questions to OUNC - -- �•r232 1987 or 1 800 332 '344
Ii ( :�T� 7 /,
Issue. By ' ! Perm ittee Sig 4 � I/ � " et "t
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 INSTAL TION ONLY,
SIGNATURE OF SUPR ELEC' `v / / ti-0 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 11 18.09 10 -24 -2011 1 /2
Electrical Permit Application RECEI\ FOR USE ONI.Y
mil City of Tigard 1 Recef, /0 ��� Permit No fI/ �/
Dat Re „]
1 3125 SW Hall Bivd, Tigard, OR 97223 OC 24 I l� tcRsview
Phone 503 639 4171 Fax 503 598 1960 D Other Peron
Date Ready/By K'c See Page 2 for
TI GA RD Inspection Line 503 639 4175
Internet www tigard -oi gov CITY OF TIG„ i iedimetiiod Supplemental Information
Please cheek all that apply (Submit of winces checked below)
❑ New construction Addition /alteration /replacement
❑ Senate or feeder 400 amps or more 0 Building over three stories
Demolition Other
where the available fault current ❑ Marinas and boatyards
- ' ' - . `CATEGORY OF CONTR
SUCTION r, ,; :' c , „' :..ii exceeds 10.000 amps at 150 volts or 0 Floating buildings
less l0 ground. or exceeds 14,000 0 Commercial -use agricultural
iii I , and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other mtallaaons buildings
El Multi-family ❑ Master builder ❑Other, 0 fire pump O Installation of 75 KVA or
'
_ ❑Emergency system larger separately derives!5ysteln
- , JOB SITE INFORMATION , AND LOCATION
/ a' ❑ Addmon0fiuw molar load of ❑ "A " "B "•'1- 2 - "7 -3
V r / Job no. L -`,' `\ Job site addiess ` 33'3 5(.3 � e'6 l'- " p{� gy I00HP occupancy
/' a•' ❑ Six or more reaidenual units ❑ Recreational vehicle parks
City/State/ZIP c s 0 0 7 zZ ❑ Healthcare facilities C Supply voltage for m ore than
G� ❑ Hazardous locations 600 volts nominal
Suite/bldg /apt no , ,fi g Project name Is n O Servvx or fccaer 6% amps or more
_ 'FEE SCHEDULE ,
Cross street/directions to job site`(4, - Per . 0 , nuanpiwn nry J ice Total I
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision Lot no 1,000 sq ft or less 16854 4
Ea add'1500sq fl orponion 33 92 1
Tax map /parcel no Limited ever -
gy, residential 75 00 2
„ „ DESCRIPTION OF WORK (with above sq R)
1 r I Limited energy, multi- family
L \ \a�f\ \ r 31(Q l - ( CA *LOD J'q „k �\ �tv/ 0 }S icsidentlal (with above sq ft) 7500 I 2
\ Services or feeders Installation, alteration, and/or relocation
v\
\ 4 -c - 'T \JV\ 200 amps or less 10070 2
' ''' 0 PROPERTY OWNER; - „ KI TENANT 201 amps to 400 amps 133 56 2
Name -`�
401 amps to 600 amps 200 34 2
- 601 amps to 1,000 amps 30104 2
Address Over 1,000 amps or volts 552 26 2
City/State/ZIP Temporary services or feeders installation, alteration, and /or
_ relocation
Phone ( ) _I Fax ( ) 200 amps or less 5936 1
Owner Installation. This installation is being made on ptoperty that I own which is not 201 amps to 400 amps 125 08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701 401 amps to 599 amps I 166 Sa 12
Branch circuits - new, alteration, or extension, per panel
Owner signature. Date A, Fee for branch circuits with
, ,-. 0, APrLtCANT ' a ' I ' "- ' III PERSON above service or feeder fee 742 2
C^ � y., each branch circuit
)t-r
Business name -M� cLS C1(1 c B Tee for branch circuits without
service or feeder fee, first l 56 Is s(e,( 2
Contact name branch circuit
Address Each add'( branch circuit \ 742 `4 t , i 2... 2
Miscellaneous (service or feeder not included)
City/State/ZIP Each mana£actured or modular 6784 2
dwelling, service and/or feeder
Phone ( ) Fax ( ) Reconnect only 6784 2
Pump or irrigation circle 67 84 2
E - mail:
' ' ' ••COJVTRACTOR Sign or outline lighting 6784 2
n - Signal circun(s) or limned - eneigy
Business name
et
Business panel, alteration, or extension Paget I
— s_ 1 Each additional inspection over allowable in any of the above
Address — 1550 ,S 4 (eck . , ,Ac #7 2_0 Additional inspection (I hi min) _ 66 25/ lir
City /State/ZIP 'zCLr OR. 972_ Z3 Investigation (I hr min) 6625/hr
(I•\ Industrial plant (I hr mm) 7818 /hr
1, /Phone 502 -- Lo5 <( Fax'( ) ��` - 2-09r Inspections for which no fee is 9000 /hr
p specifically listed ('6 hr mm)
CCB Lie 11Z5�4 Electrical Lie' 751.6 Supry Lic 31 11 1751 'ELECTRI,CAL' FEES'
Subtotal
Supry Electrician signature, required Plan review pennn fee)
K
Print name P.r\Y1e.�-1Y\ K I Date ,,,c,(2..“.„\ 0 State suicharge (12% of pennit fee) `7,(
' \ TOTAL PERMIT FEE '3
Au[laorized signature This permit application expires if a permit is not obtained l thi in n 1 80
days after It has been accepted as complete
Print name Date • Number of inspections allowed per permit
I'fsnlding Penults £LP- PcnTtApp doe 07 44046151711 '0$QOMWEa