Permit CITY OF TIGARD ELECTRICAL PERMIT
° • COMMUNITY DEVELOPMENT Permit p: ELC2012 -00443
T t C A:Ik D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/25/2012
Parcel: 1S 136 DD05300
Jurisdiction: Tigard
•
Site address: 11850 SW 67TH AVE, STE# 140
Project: Broad River Expansion Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: (7) branch circuits for TI
Contractor: R C COSTELLO ELECTRICAL CONT INC Owner: PNWP LLC #2
PO BOX 336 PNWP LLC
AURORA, OR 97002 6600 SW 105TH AVE #175
BEAVERTON, OR 97008
PHONE: 503 - 982 -7400 PHONE:
FAX: 503 - 982 -7400
FEES
Quantity Description Date Amount
7 crt Branch Circuits wo /Purchase 07/25/2012 $100.70
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/25/2012 $12.08
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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: Oreg n 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 OA 5 001 -0 0. You may bbtai a cop of the rules or direct questions to OUNC by calling 503.232.198 . 0.332.2344.
Issued By: Permittee Signature: C
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 Application1 . J�r D l ()I( ()1 FICI. 1 S1. ()NI.)
City of Tigard ��44•• � � 8 4761 S r Permit NoEL P f ,Z.. 0 uhf
le 13125 SW Hall Blvd., Tigard, OR 97223 J U L 5 2 012 Plan Review Other Pernik • �� �.�a�
Phone: 503.718.2439 Fax: 503.598.1960 D : ernik[
r I(..', n It D Inspection Line: 503.639.4175 Date Ready/By: orris: ® See Page 2 for
Internet: www.tigard -or.gov Ri CIT OFTIG/ �D Notified/Method: Tt cp Supplemental Information
TYPE OF (INO DIVISION PLAN REVIEW
❑ New construction ® 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 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 of new motor load of ❑ "A ", E", "l -2 ", "I -3 ",
Job no.: Job site address: / / 95Q S I or more. occupancy.
W r)-t
❑ Six x o or r more residential units. ❑ R Recreational vehicle parks.
City/State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
ite Idg. /apt. no.: 1140 Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Dmcription I Qty. I 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
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: _ Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
- 8 rU Inc, k 0 1 f c.t, 'i+ c 43 r T L residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER 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 amps or less 59.36
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 ex tension, per 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: B. Fee for branch circuits without
service or feeder fee, first / 56.18 56.18 2
Contact name: branch circuit
Each add'I branch circuit ) 7.42 yy, 52. 2
Address: Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or. modular 67 84 2
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 C C. I �r 1 panel alteration, or extension. Page 2 2
COS O �'let4 r ica 1 CoodrCtG'�jrl Each additional inspection over allowable in any of the above
Address:p0 lox 33(, Additional inspection (1 hr min) .66.25/ hr
Investigation (l hr min) 66.25/ hr
City/State/ZIP: Au 0I ll -I 0002 Industrial plant (1 hr min) 78.18/ lrr
Phone: ( 3) gla • r1/40( • Fax: (spa qg q y0 1 Inspections for which no fee is 90.00 / hr
specifically listed (%] hr min)
/CCB Lic.: 817y02_ I E)2ctrical Lic.: 3. yc `5upry . Lic.: .93/. S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 7 ` i ' � 101 {3 Subtotal: / O O . — 1 D
d� Plan review (25% of permit fee):
Print name: Mme -. C � IL, Date: '7 /ZS f JZ State surcharge (12% of permit fee): /z, 06) ` � TOTAL PERMIT FEE: / / 2 .7 if 5(
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
I:\ Building \Permits\ELC.PermitApp.doc 07/01 /10 440- 4615T(l1 /05 /COM/WEB A. " D-