Permit V'
- ,it'..‘'
in CITY OF TIGARD ELECTRICAL PERMIT
i
i 711 - 1 ."` ' COMMUNITY DEVELOPMENT Permit #: ELC2009 -00328
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/21/2009
Parcel: 1 S136CA01601
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Jurisdiction: Tigard
Site address: 11665 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Key Bank
Project Description: Install (1) 200 amp panel, and (38) branch circuits.
Owner: FEES
HALL, DONALD W & GRACE L & Quantity Description Date Amount
HALL, JOHN G ET AL, BY FIRST AMERICAN
REAL ESTATE TA, 8435 N STEMMONS 1 ea Services or Feeders - 200 08/21/2009 $80.30
amps or less
PHONE: 30 crt Branch Circuits w /Purchase 08/21/2009 $199.50
Service or Feeder
1 ea 12% State Surcharge - 08/21/2009 $33.58
Contractor: Electrical .
COCHRAN INC 8 crt Branch Circuits w /Purchase 08/21/2009 $53.20
626 SE MAIN ST Service or Feeder
PORTLAND, OR 97214 ' 0 ea 12% State Surcharge - 08/21/2009 $6.38
PHONE: 503 - 234 -6564 Electrical
FAX: 503 - 238 -2098
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $372.96
Required Items and Reports (Conditions)
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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: - � T Permittee Signature: O � ��L/CC9 -% /0/�
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 503.639.4176 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.
FROM COCHRAN — BROADWAY <THU)AUO 20 2009 11: 26/ST. 11: 2B /No. 7800000086 P 1
r`
Electrical Permit ApplicatioRECEIVED FOR OFFICE USE ONIA'
City of Tigard Received /� ,�
1, . De o f No. C10y 0(13a1
13125 SW Hall Blvd., Tigard, OR 97223 f
' G 2 0 2009 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
TI G n R D Inspection Line: 503.639.4175 .rV OF TIGARD Date Ready/By: hub: 0 See Page 2 for
Internet: www.tigardor.gov CI1 a Notified/Meth-ad: 77( Supplemental Information
- TYPE OF ING DIVISION
P LAN REVIEW ,
❑ New construction ❑ Addition/alteration/replacement Please check all that apply (submit a sets of plans wAtems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition
❑ Other: where the available fault current ❑ Marinas and boatyards.
. a set s of OF CONSTRUCTION exceeds 10,000 amps at (SO volts or 0 Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -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 SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition n
ddition of new motor load of ❑ "A ", "E" "1 -2" "I -3"
Job no.:la (.t -) LL'� I Job site address: 11Id.p C(� Z , 1 - t IP or more. occupancy.
IWy ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: �� G I ❑ Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 11.41 ` R30 titer ❑ Service or feeder 600 amps or more.
FEE SCHEDULE.
Cross street/directions to job site: ' Description I Qty. I Far I To I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. WV 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
. . DESCRIPTION OF WORK. (with above sq. ft.)
Bay) -� - r eA ' 'c�
Limited energy, (with above sqmulti-family 75.00 2
residential (wish above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less f 80.30 "V, 3 2
❑ PROPERTY OWNER • • • . . :. ❑ TENANT • .: • . . 201 amps to 400 amps r 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: ( ) I Fax: ( ) 200 amps or less 1 66.85 I I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
I
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 _ 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT • I ❑ CONTACT PERSON above service or feeder fee, ' 6.65 Z� ` 2
Business name: o��•e0/3$ Fee branch circuit iJ C�
B. Fee for branch circuits
without service or feeder fee,
Contact name: 46.85 2
efi n s Sejfn/ w,e_ first branch circuit
Address: a5,9 6 '�d 4t S 7, 5 7T /5) Each add'I branch circuit _ 6.65 _ 2
Miscellaneous (service or feeder not included)
��
City /State/ZIP: Co (,u 9 , /S E ach manufactured or modular
dular
u s D 13a� 90.90 2
/ dwelling, service and/or feeder
Phone: (r �' )
/ 7- vi / Fax :: 6/y y37-/30y Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
• CONTRACTOR . Signor outline lighting 53.40 2
Business name: r (( �' �1 Signal circuit(s) or limited -
x.�srM —�tnr r,1 ` �"J[�k IX U S(� (e L nergy panel, alteration, or
Address: 2 ( `'\N b-{-- extension. Describe: Page 2 2
City/State /ZIP: T�� NSA ck Cl 7 Z( 4 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (5 ' [. -(p5 ( Fax: (5(a,3) 3'' "" 2 • / Investigation per hour (1 hr min) 62.50
CCB Lic.: 7 C$ L.L VElectrical Lic.: 31 -9i SSuprv. Lic.:�3 L `C (V.c Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES _
Suprv. Electrician signature, required: Subtotal: 3 '3..5
Print name: \ ,� ate: Irr Plan review (25% of permit fee):
6 State surcharge (12% of permit fee): 311 fp
Authorized signature: TOTAL PERMIT FEE: 3-12... 1 (
Print name: Date: This permit application expires if • permit is not obtained within 180
days after It has been accepted as complete.
• Number of inspections allowed per pennit.
1''. BuitdingtPcrmitsrELC PermitApp. 05/27/06 440.461ST(IIPo5ICOMIWEB