Permit CITY OF TIGARD ELECTRICAL PERMIT
s., COMMUNITY DEVELOPMENT Permit #: ELC2013 -00412
Date Issued: 07/31/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1 S126DC80001
Jurisdiction: Tigard
Site address: 9385 SW LOCUST ST
Project: Family Practice Clinic - Dr. Tanya Carter Subdivision: LOCUST OFFICE PARK CONDO Lot: 1
Project Description: (3) branch circuits for new medical clinic
Contractor: R C COSTELLO ELECTRICAL CONT INC Owner: TSE INVESTMENTS LLC
PO BOX 336 PO BOX 1754
AURORA, OR 97002 LAKE OSWEGO, OR 97035
PHONE: 503 - 982 -7400 PHONE:
FAX: 503 - 982 -7400
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 07/31/2013 $71.02
Specifics: Service or Feeder
1 ea Plan Review Electricial 07/31/2013 $17.76
Type of Use: COM 1 ea 12% State Surcharge - 07/31/2013 $8.52
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $97.30
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 • R 4 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.00.332.2344.
Issued By: r - 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 Applicati t FyCEIVED Fol oFFICF: USE ONLY
r C cs: CSC C C c C. C: L
City of Ti
Received
Tigard 1 _ t4ntit N o.!
g 2 3 9 ^ t Date/B : �_ . �•I DDO(//..2. 13125 S W Hall Blvd., Tigard, OR 9722�U �.. t U u 3
14
• T • •
Plan Review
0 �, p61er p ermit " • •
Phone: 503.718.2439 Fax: 503.598.1960 Date/B :
l' I G A R D Inspection Line: 503.639.4175 CITY OFTIGARD Date Ready/By: VIM 3aris: ® See Page 2 for
Internet: www.tigard- or.gov MIMING DIVISION � Notified/Method: 7 / Supplemental Information
TYPE OF WORK °'F- "7 em� : : . • - • • • PLf • +►N�• RE • •
P lease eclal that appl tsublhit II sets of pilaus s A /itQns checked below):
❑ New construction [ ch•l y
Addition /alteration replacement •. . • . ,,aa,, ..
Demolition ❑ Service or feeder 400 amps or more tJ�mlding over three stories.
❑ ❑ Other: where the available fault current ❑ Marinas and boatyards.
, C ATEG RY OF CONSTRUCTION ' . '' ex ee 10 D amps at 150 volts o r ❑Floating buildings.
• less to ground, or excee 44,0100 • .❑Commercial -use agricultural
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building amps:or all =her 4i1ati4s; :. • juitiings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire l p.. ; • • • • • • • '❑tnstlllation of 150 KVA or
JOB SITE INFORMATION AND LOCATION • ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "l 2 ", "I - ",
Job no.: Job site address:
q 3'85 S 1�.) 1 HP or more. occupancy.
V J OCU S I J ix or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Health - care facilities. ❑ Supply voltage for more than
r
El Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: 1) — ran U C(ar4r ❑ Service or feeder 600 amps or more.
y FEE SCHEDULE
Cross street/directions to job site: r�M I L . / A Q C d_t. � ,J C pperiptioo I Qty. I Fee. I Total I •
7 / � New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 7500 2
. • - DESCRIPTION OF WORK ' - (with above sq. ft.)
Limited energy, multi - family 75.00 2
re /Oca /� retO� -kG 6 residential (with above sq. ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation, alteration, and/or relocation
❑; OWNER . 200 amps or less 100.70 2 • . .. ❑ TENANT , '
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( )
relocation
200 amps or less 59.36 1
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, er panel • ' ❑ APPLICANT. I ❑ CONTACT PERSON,
A. Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit
B. Fee for branch circuits without
Contact name: service or feeder fee, first
t branch circuit 56.18 56 l $ 2
Address: Each add'I branch circuit Z 7.42 U. 8t1 2
3 )
City/ State/ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
Phone: ( ) I Fax: : ( ) dwelling, service and/or feeder
Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
N Business name: -R. Signal circuit(s) or limited-energy See
�. C, COS }t? I � � E 1 ee�r rcu co G rac T<t C it, panel, alteration, or extension. Page 2 2
t Address: ?O, "B X 33 6 J Each additional inspection over allowable in any of the above
Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: 11 ro rot 0 7 00 Z Investigation � (1 hr min) 66.25/ hr
Phone: (503) gg2.-1/. 0 3 I Fax: (563 ) X81. -1y0 I Industrial plant (l hr min) 78.18/hr
`r) Inspections for which no fee is
I CCB Lie.: g7L/o 2 I Electrical Lie.: 33L.jL/< I Suprv. Lic.: ,3g3l- /.,f s pecifically listed ('A hr min) 9000 / hr
( . E LECTRICAL PERMIT FEES .
4":) Suprv. Electrician signature, required:
n � (.7 Subtotal: ,J � 0 �
Print name: G or , C r Uncle I Date: f Z 3 u Plan review (25% of permit fee): j 1. -1.
I State surcharge (12% of permit fee): 13 . 51—
Authorized signature: TOTAL PERMIT FEE: ' 7 . a 5
This permit application expires if a permit is not obtained within l
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
11Building\ Permi ts\ELC_PennitApp_ELR_ERE.doc Rev 05 /21/2013 440 -4615T(11 /05 /COM/WEB