Permit n CITY OF TIGARD ELECTRICAL PERMIT
71
I:'= COMMUNITY DEVELOPMENT Permit #: ELC2012-00705
T t GARD+ 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Date Issued: 12/13/2012
Parcel: 251018801400
Jurisdiction: Tigard
Site address: 12100 SW GARDEN PL, BLDG# 4
Project: Ricoh Subdivision: CROW PARK 217 Lot: 2
Project Description: (12) branch circuits to connect furniture
Contractor: COCHRAN INC Owner: WALTON CWOR PARK BC 8 LLC
7550 SW TECH CENTER DR #220 BY CTMT - WALTON RE TAX
TIGARD, OR 97223 4678 WORLD PARKWAY CIR
ST LOUIS, MO 63134
PHONE ' 503 - 234 -6564 PHONE
FAX 503 - 238 -2098
FEES
Quantity Description Date Amount
12 crt Branch Circuits wo /Purchase 12/13/2012 $137 80
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/13/2012 $16 54
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $154.34
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 2 01 -0090 You may obtain a js copy the rules or direct questions to OUNC by calling 503 232 1987 or 1.800 332 2344 ' I
Issued By: Permittee Signature: O y A 7 I n PUG4rO/l[
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.
0, RECEIVED 15:48:07 12- 12_2012 , /3
Electrical Permit Application colt 0141( 'L ( .ti1: ONLY
City of Tigard DEC 1 2 ' Rece q f 12 Dat ete y: ved 3 Permit No.: C, t' a 0070....5
0 7QS
n
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598. ell i OF TIG Date/By: Other Permit:
T 1 t; A It n w Inspection Line: 503.639.4175 �' a + Date Ready/By: orris: / H See Page 2 for
Internet: ww.tigard- or.gov BUILDING DIVISIO Notified/Method: 1 Sa Supplemental information
: - _ , - r < 1 . 1 # :OF., W, ,O)<t1C _ : -. ; I : .Y,1JrW.. ; ... ; .:•, .
❑ New construction Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
❑ Demolition ❑Other CD Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
' CAT O,Itif OF 'CONS'172UGT(O1V; ...1:'. - ' exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
El 1 - and 2- family dwellingCommerciaUndustrial 0 Accesso building less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
ry g amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. P ❑ Installation of 75 KVA or
B separately JOB SITE INFO RIyiATiON AND ❑ Emergency system. larger aratel derived system.
IACATiON:
❑ Addinon of new motor load of ❑ "A ", "E', "1 -2 ", "1 -3 ",
Job no.: 6t5y Job site address: 10/p 7 SGl) /�.�q) P/ 100HPormore. occupancy.
� CU ❑ Six or more residential units ❑ Recreational vehicle parks.
City /State/ZIP: / / .,i)_y /9re .� •' 3 ❑ Healthcare facilities. ['Supply voltage for more than
4! r / 7�� C /w !� ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: L� z . e !1 ['Service or feeder 600 amps or more.
Cross street/directions to job site: /� ...'t ., ...' 'I ?'' ";FEC' SGFIEDl;1f?E':- •_ _ • • ; .
Description I Qty. I Fm I Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: 1/ / / / ;fl Ave_ 2-17 Lot no.: 1,000 sq. R, or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. R.) 75.00 2
PP } /P„/J C ` � Rni) � A l / '!� n " � Limited energy, multi- family
75.00 2
� / 1!/ �•l (/ �/;�f� i residential (with above sq. IL)
/,I(/ I 511
1 Services or feeders installation, alteration, and /or relocation
(i, 4.1/g/'11.11‘ ) 200 amps or less 100.70 2
❑ PROPERTY .OWNER ' • I '0 ei' 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 I
Owner installation: This installation is being made on property 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 168.54 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT 'I : ONTACP• PERSON above service or feeder fee, 7.42
t
,� (- L each branch circuit 2
Business name: � M - S C.1h - \ `t `C _ 13. Fee for branch circuits without
J` C �ZK service or feeder fee, first Q
Contact name: L /1 emPI) ip branch circuit i 56.18 6/_ 2
PI) dd'I
Each Eac a branch circuit 7.42 5 f /0�
Address: ( 2
Miscellaneous (service or feeder not included)
2ity/State/ZIP: Each manufactured or modular 67 84 2
dwelling, service and/or feeder
'hone:603)6 Z - 736 Fax: : (9/t 2,c0 (7/7/0 S Reconnect only 67.84 2
F• 1.&0/14 t t�^� (� Pump or irrigation circle 67.84 2
l� c lY1 ) at' ' 0 f) m Signor outline lighting 67.84 2
CONTRACTOR
(' �,, Signal circuit(s) or limited- energy
3usinessname: �--�C�k( can _ _ panel, alteration, or extension. Paget 2
1 0 �� I � t v � _ • Each additional inspection over allowable in any of the above
kddress: 5 5 `1 Ce..('t *22D Additional inspection (I hr min) 6625/ hr i
;ity/State/ZIP: ` fl 4, . (al OK 9 72 Z Investigation (1 hr min) 66.25/h
/ Industrial plant (I hr min) 78.18/ hr
'hone: 9-7/ age/e4/ Fax: (97/ �7 /tit► V_ Z / _ 8 Inspections for which no (CO is 90,00 / hr
< �b� T (� r� specifically listed (h hr min)
L
:CB Lic.: 7 Z ' a Electrical Lic.: C , Suprv. Lic.: 3L-147 / 5 : "'1,"._,t`;;f':r%' tir:CfRiCAL:RERIC11T'EEESP;.:,
um. Electrician signature, required: \C.3.\-' \s Subtotal: • `37F �d
� _ Plan review (25% of permit fee):
lint name: f n , K ^ Date: /0.---/0 '10, State surcharge (12% of permit fee): / ' a�3
,uthorized signature: lw TOT
explrws AL if PERMIT a FEE not ootaln `
Th is permit application permit is ed wi
• Number of thin 180
tint name: Lai On - ! ca m•, t_1 Date: /z — /Z_ , inspections allowed per permit. as complete
girding •Ptr,ttilsELC- PennitApp.doe 07411.10 440.4615T(I lb5't'OM,WEB / � ' L 37
01 15:48:37 12 -12 -2012 2/3
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
No licenses are required. Licenses are required
for all other installations
Build ing‘Pamits\ELC- PermitApp.doe 07/01/10