Permit CITY OF TIGARD ELECTRICAL PERMIT
Is COMMUNITY DEVELOPMENT Permit #: ELC2012 -00187
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/03/2012
Parcel: 1 S126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 400
Project: Renasis Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: (3) branch circuits for TI
Contractor: RC COSTELLO ELECTRICAL CONT INC 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 -7400
FEES
Quantity Description Date Amount
3 crt Branch'Circuits wo /Purchase 04 /03/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/03/2012 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
•
Occupancy Grp:
Total $79.54
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 -0 - 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 .800.332.2344.
Issued By: 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 Fo R ( w r i t ] : I s 1.:(1\1.1
City of Received and Ti R H C�i I, D Rec / �
Tigard
9'l�l3' Rec eiv 7 � � � Permit No. A ( /�% 7
• 13125 SW Hall Blvd., Tigard, OR Plan Review
iii III Phone: 503.718.2439 Fax: 503.598.1960 D : Other Permrtigad /.2 - D0Q,5 - '
. 1 . 1'. A RD Inspection Line: 503.639.4175 APR 3 2012 Date Ready/By: fa See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
TYPE OF kilauF TI { N
GARD tit PLAN REVIEW
❑ New construction N td
[( Additio i •=91 bi 1 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.
❑ 1 - 2 dwelling Commercial/industrial less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
y g ❑ 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: �-r kin �a 10OHP or more. occupancy. 0 20 s (1�J kin G 11 i Y7rj*i a! . • ❑ Six or more residential units. ❑ Recreational vehicle parks.
/
City/State/ZIP: � L ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
V " r Idg./apt. no.: L/00 I Project name: A EAT / 9-_s- / ...s- ❑ Service or feeder 600 amps or more.
job site: Description FEE SCHEDULE
Cross street/directions to
J f Qty. I Fen 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. add'1500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
- 8 f A /t(; I c i rCy if r - r (V f) -F e Ie S residential (with above sq. ft.)
1 1 a f Services or feeders installation, alteration, and/or relocation
re S W ; 4c Li 1 i o "I t Jel -ure. r 200 amps or less 100.70 2
❑ PROPERTY OWNER v I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 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 /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 snips 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 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, r panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: _ - ' . s B. Fee for branch circuits without
service or feeder fee, first / 56.18 �o 8 2
Contact name: branch circuit
Each add'l branch circuit Z, 7.42 / N . 8 4 _ 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: R R. C . Co Ste Ho O L l ec+r I ca I C f 4 � p alteration, or extension. _ Page 2 2
//-- Each additional inspection over allowable in any of the above
Address: po. "' x 33 to Additional inspection (1 hr min) I 66.25/ hr
/ r U Y. 0 ,,.. 0 R r] '1 0 0 Z
Investigation p ( I min) 66.25/ hr
City/State /ZIP: A l
- 1 Industrial plant (1 hr min) 78.18 / hr
Phone: (603/ 982. 1 /,! ®Q I Fax: (5 q82 .. ri L. , Inspections for which no fee is 90.00 /hr
/ specifically listed (V2 hr min)
CCB Lic.: $r/ 4 O Z Electrical Lic.: 3 - 3 EPIC 'uprv. Lic.: 39,3LJ..s. ✓ ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required? 6 Subtotal: r] I . 0 Z
P ' — Plan review (2 of permit fee):
Print name: R4 9 e _ r — C COS -le ' I O Date: Li/3 / /Z State surcharge (12% of permit fee): 8.1
Authorized signature: TOTAL PERMIT FEE: ? 9 .
This permit application expires if a permit is not obtained withi
Print name: Date: • days after it has been accepted as complete.
Number of inspections allowed per permit.
1:\ Buildin ¢Permits\ELC- PamitApp.doc 07/01/10 4404615T(11/05 /COM/WEB