Permit CITY OF TIGARD ELECTRICAL PERMIT
s COMMUNITY DEVELOPMENT Permit#: ELC2014-00321
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/12/2014
T[c;;�A.C1 Parcel: 2S 110DCO2300
Jurisdiction: Tigard
Site address: 11555 SW DURHAM RD A-3
Project: Willowbrook Subdivision: 1998-128 PARTITION PLAT Lot: 1
Project Description: (1)branch circuit for code corrections
Contractor: R C COSTELLO ELECTRICAL CONT INC Owner: HIP WILLOWBROOK LLC
PO BOX 336 BY HARSCH INVESTMENT CORP
AURORA, OR 97002 PO BOX 2708
PORTLAND,OR 97208
PHONE: 503-982-7400 PHONE:
FAX: 503-982-7400
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 06/12/2014 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 06/12/2014 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 a rd nce • 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. ATT TION: Oregon :w re• - you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0 10 through OAR 952-0• 1090. `do - ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 332.2344.
Issued y: ��� _ 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' J� Date: 6//,216/
LICENSE NO. /� pl4 3 t 5
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 Ec F a FOR OFFICE USE O\I \
� P rot No.:
t 'City of Tigard
1 eo 3�
• 13125 SW Hall Blvd.,Tigard,OR 97223 ++)) Plan Review '
a Phone: 503.718.2439 Fax: 503.598.19 N 1 2 2, Date/13 Other Permit:
TRIARP
Inspection Line: 503.639.4175 Date Ready/By: Jens ® See Page 2 for
Internet: www.tigard-or.gov CITY Of-IlliAllb Notified/Method: Supplemental Information
)YPE OF gtopw,rf1fl4Ono PLAN REVIEW
❑New construction Ei'Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
ion Other:
El Service or feeder 400 amps or more El Building over three stories.
❑ Demolit
❑ 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 150 KVA or
JOB SITE INFORMATION AND LOCATION
El Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","I-2","I-3",
r' l r" r lOOHP or more. occupancy.
Job no.: Job site address: /1 `; 5 to 1:),,d ,
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: Aga r ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: 17 .3 Project name: w t ILA," -E ❑Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description 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'I 500 sq.ft.or portion 33.92 I
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
(,,yLk Gay' A 1 J✓) f residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER I
1 ❑ TENANT 200 amps or less 100.70 2
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
relocation
Phone:( ) Fax:( ) -
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,per panel
❑ APPLICANT 1 ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
Business name:
each branch circuit 7.42 2
B.Fee for branch circuits without
Contact name: service or feeder fee,first
/ /
branch circuit
/ 56.18 5 2
Address: Each add'I branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:( ) 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
Business name:R c ( ,.,5.1&l(V E CA I C1 r I,. Signal circuit(s)or limited-energy See
C05-1 a �►T panel,alteration,or extension. Page 2 2
Address: -r�0 - u 3.3 6P Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:
iii// & Investigation(I hr mm) 66.25/hr
Phone:(%J)q82.--. `)Liao Fax:(5 ) 392 -7140 i Industrial plant(1 hr min) 78.18/hr
— Inspections for which no fee is
90.00/hr
CCB Lie.: 9,747a Electrical Lie.: T _ 3 LILic Suprv. Lie.: 3143q S _ specifically listed('IA hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required:
Subtotal: tj 6 , t t5
1 Plan review(25%of permit fee):
Print name:T�^� �� S 110 Date: �( � o
�.J ! State surcharge(12%of permit fee): 40.7 tt
Authorized signature: TOTAL PERMIT FEE: (I), ,(7 2-
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
- • Number of inspections allowed per permit.
1.\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 05/21/2013 440-4615T(I l/05/COM/WEB