Permit n CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2013 -00131
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/21/2013
Parcel: 1S 136DA00100
Jurisdiction: Tigard
Site address: 11308 SW 68TH PKWY
Project: Comcast Tech Ops West Subdivision: PFAFFLE PLAZA CONDO Lot: 2
Project Description: Temporary service for construction trailer
Contractor: COCHRAN INC Owner: BENENSON 68TH PARKWAY KEY LLC, T
7550 SW TECH CENTER DR #220 BY PROVIDENCE HEALTH SYSTEM
TIGARD, OR 97223 ATTN• PROPERTY MANAGEMENT
1235 NE 47TH STE 160
PORTLAND, OR 97213
PHONE 503 - 234 -6564 PHONE:
FAX 503 - 238 -2098
FEES
Quantity Description Date Amount
1 ea Temp Services or Feeders - 02/21/2013 $59.36
Specifics: 200 amps or less
1 ea 12% State Surcharge - 02/21/2013 $7 12
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $66 48
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 ordance h 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 AT NTION Orego - • quires you to follow the rules adopted by the Oregon Utility Notificat • . Center Those rules are set forth in OAR
952 -001 010 through OAR • - 001 -00 r ou may obtain a cony of the rules or direct questions to OUNC b e r or 1 800.332 234' ,
Issu By: Permittee Sig d''J '_(
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.
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Electrical Permit Applicatn CEINTED FOR 01.11C1.: I SF: ONLY
City of Tigard Received ? /4/ /� ��
Datd6 (/� / > 3 1'" Permit No.: E(Z�.Q / 3 DO /3I
?,' ° 13125 SW Hall Blvd., Tigard, OR 97 3Q 14 2013 Plan Review
B Phone: 503.639.4171 Fax: 503.598!196W Date/By: Other Permit: 6 u P2 01 3." evo7- y
Tit; A RI) Inspection Line: 503.639.4175 Date Ready /By: Avis: RI See Page 2 for
Internet: www.tigatd- or.gov CITYOFTIGARD Notified/Method: Supplementallnformation
.. .' *pt altiaING DIVISION
❑Newconstruction ❑Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
/ � O /
t/ � Del %ee � ❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition Other C where th e available fault current
� ,,. ❑ Marinas and boatyards
•CATF F COIV'I'RUCT
SII)N„ - , . exceeds 10,000 amps at ISO volts or ❑ Floating buildings.
El I - and 2 family dwelling �iCommercial /industrial ID Accessory buildin • amps slot other installations. ❑ Comm g cial - use agricultural
} u r y g amps for all other instalhtions, buildings.
❑ Multi - family Master builder ❑Other: ❑ Fire pump. 0 Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION
❑ Addition of new motor load of ❑ "A ", "E•, "1 -2 ". "1-3", 1"�s
Job no.,4'Oo t "J 7 Job site address: // , 9 , 05) zA /2,,,i,„.,,,,,, T r,� 0011P or more.
[] S oe ion e/
Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: '776,4 ne_ 6)-7,z.-A,- ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal
Suite/bldg. /apt. no.: Project name: 1 i2/e " ❑ Service or feeder 600 amps or more. (Ai
1, -•FEk. SCHEDULE .
Cross street/directions to job site: 5b0 e e "t 1 _ ` /, % 7.- Description `j1' ;f I Q tr. I Fee. l I Total i
t 1 /� New residential single- or multi - family dwelling unit
N- f /fJmlex, sC-T _ Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less r 168.54 4
Tax map/parcel no.: Ea add'I 500 sq. ft. or portion 33.92 i
Limited energy, residential 0Q
DESCRIPTION OF WORK (with above sq. R.) 75.00 2 \ •
{, I� �/'} Limited energy, multi - family
.0e930.5- ,,& ?3 7C/ --Z residential (with above sq. ft 75.00
.) 2
//J/ i' /� r� f y� Services or feeders installation, alteration, and /or relocation
(JM4 ei 1 77� TO /. re I� �ie4ie_ /2 - 200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ `i'ENANT 201 amps to400 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 /StateJZiP: Temporary services or feeders installation, alteration, and/or .
relocation
Phone: ( ) Fax: ( ) 200 amps or less i 59.36 ,. , 34 I
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 125 pg 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 1 68.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
0. APPLICANT " 'R. CONTACT PEitSON above service or feeder fee
each branch circuit 7.42 2
Business name: 5�me, C
service or feeder fee, first
� � B. Fee for branch circuits without
Contact name: 9 ,4 h ,e/ branch circuit 56.18 2
Address:
Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular 67.84
dwelling, service and/or feeder 2
Phone: 'O3 7y/ -1 z Fax: ( ) Reconnect only 67.84 2
�
E- mail: !! CC ((�� Pump or irrigation circle 67.84 2
L1 rrxxe h c' e oe h er n I 4c_, e_e) m Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy •
panel, alteration, or extension. Page 2 2
Business name:
A--,` Each additional inspection over allowable in any of the above
4ddress: '1 5 `{ ∎1 eeh Cen. l' *220 Additional inspection (I hr min) 66.25/ hr
7.ity /State/ZiP: ( 2l 02 9 72 z_
Investigation (] hr min) 66.25/hr
�
� r[ Industrial plant (I hr min) 78.18/ hr
'hone: �� C.
91/ , 7 z _va. Fax: q7/ i`,, /6" Inspections for which no fee is
:CB Lic.: Z pecifically listed ('/s hr min) 90.00 / hr
Electrical Lic.: ic.:.F7 .F754/t p j L4 L4.' 5 '',r ? i n;:` ,: MEOTi;[CAL;• : I'Ei NIIVF1EES
iuprv, Electrician signature, required: �� Subtotal:. 4 ��
Plan review (25% of permit fee):
'rint name: KP ,n • - .le Date: ,'_ j / — rmit / State surcharge (12% of pe fee): 41 ` / z
/ TOTAL PERMIT FEE 7 e
wth orized signature: / / � Q � ,
This permit application expires if a permit is not obtained thin 180
tint name: D ate: 7 days after it has been accepted as complete
vi o C _ /lQG t} !� J T (/ 1 " Number of inspections allowed per permit.
ueldingiPcmries•ELC -Pmni p.doc 07101.10 440446157(11'05'COMAYEB
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for 22 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
;ystem
(SEE OAR 918 309 - 0000)
heck 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
3uild'bI P mitsWELC- PamitApp.doc 07/01/10