Permit x n
CITY OF TIGARD ELECTRICAL PERMIT
11 111 is COMMUNITY DEVELOPMENT ` Permit #: ELC2012 -00547
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/19/2012
— Parcel: 2S115BA02500
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY S
Project: Spec Space Subdivision: 2004 -015 PARTITION PLAT Lot: 1
Project Description: Relocate (2) panels & (2) branch circuits. 10/2/12, reprinted to correct suite address from S2 to S.
Contractor: R C COSTELLO ELECTRICAL CONT INC Owner: SN PROPERTIES PARTNERSHIP
PO BOX 336 1121 SW SALMON ST
AURORA, OR 97002 PORTLAND, OR 97205
PHONE: 503 - 982 -7400 PHONE:
FAX: 503 - 982 -7400
FEES
Quantity Description Date Amount
2 ea Services or Feeders - 200 09/19/2012 $201.40
Specifics: amps or less
2 crt Branch Circuits w /Purchase 09/19/2012 $14.84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 09/19/2012 $25.95
Electrical
Type of Const:
Occupancy Grp:
Total $242.19
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 r ance i 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 law requires 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 95 0 . You may obtain a copy of the rules or direct questions to OUNC b 2.1987 or 1%800.332.2344.
Issued y: ( Permittee Sig .4
4
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.
CITY OF TIGARD ELECTRICAL PERMIT
. COMMUNITY DEVELOPMENT Permit# ELC2012 -00547
Date Issued 09/19/2012
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 2S1156A02500
Jurisdiction Tigard
Site address 16200 SW PACIFIC HWY S
Project Spec Space Subdivision 2004 -015 PARTITION PLAT Lot 1
Project Description Relocate (2) panels & (2) branch circuits
Contractor R C COSTELLO ELECTRICAL CONT INC Owner SN PROPERTIES PARTNERSHIP
PO BOX 336 1121 SW SALMON ST
AURORA, OR 97002 PORTLAND, OR 97205
PHONE 503 - 982 -7400 PHONE
FAX 503 - 982 -7400
FEES
Quantity Description Date Amount
2 ea Services or Feeders - 200 09/19/2012 $201 40
Specifics: amps or less
2 crt Branch Circuits w /Purchase 09/19/2012 $14 84
Type of Use SF Service or Feeder
Class of Work ALT 1 ea 12% State Surcharge - 09/19/2012 $25 95
Electrical
Type of Const -
Occupancy Grp
Total $242 19
Required Items and Reports (Conditions)
This per Yisissued • • ct to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will
be d e in accordance with "prove. plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
da ATTENTION Oregon la -quires' • • to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
9 2- 001 -0010 t ough OAR 952-0A-0090 •u m obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 32 2344
Issued By � l� 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 Application FOR OFFICE USE ONLY
City of Tigard Received / irlAwI Permit No �Leaoi� —GY�S�
13125 SW Hall Blvd , Tigard, OR 97223 Plan Review / ' �^ ���
Phone 503 718 2439 Fax 503 598 1960 Date/By Other Permit , 1.4 a`a
TI G A R D Inspection Line 503 639 4175 Date Ready/By Juns H1 See Page 2 for
Internet www tigard - gov Notified/Method Supplemental Information
T YPE OF WORK PLAN REVIEW
❑ New construction (` Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below)
❑ Demolition ❑Other ❑ Service or feeder 400 amps or more ❑ Building over three stones
where the available fault current ❑ Marinas and boatyards
CATEGQRY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings
' J 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 ", "1 -2 ", "l -3 ",
Job no Job site address s� ' , IOOHP or more occupancy
��� �� �{'�I I � 1� � � ❑ Six or more residential amts ❑ Recreational vehicle parks
City/State /ZIP ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suit f ldg /apt no 5 Project name e ❑ Service or feeder 600 amps or more
Job site FEE SCHEDULE
Cross street/directions to
J 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 les 168 54 4
Tax map /parcel no Ea add'I 500 sq ft or portion 33 92 I
Limited energy, residential 75 00 2
DESCRIPTION OF WORK (with above sq ft )
Limited energy, multi - family
re /oCQ i CPA �j, f o ( ikc1 . /r"C - residential (with above sq ft )
75 00 2
\_ Services or feeders installation, alteration, and/or relocation
200 amps or less 2 100 70 POW 2
❑ PROPERTY OWNER ❑ 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 I
201 amps to 400 amps 125 08 2
Owner installation: This installation is being made on property that 1 own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701 401 amps to 599 amps 168 54 2
Branch circuits— new, alteration, or extension, per panel
Owner signature Date A Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 2. 7 42 2
each branch circuit
Business name B Fee for branch circuits iv,thoat
service or feeder fee, first 56 18 2
Contact name branch circuit
Each add'I branch circuit 7 42 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 imgation circle 67 84 2
E - mail
Sign or outline lighting 67 84 2
CONTRACTOR / ,/ Signal clrcuit(s) or limited-energy
Business name R C e4s- /I° L /PG //,Cn- / e ,vnTri panel, alteration, or extension Paget 2
J Each additional inspection over allowable in any of the above
Addressor, � 1 - 6, Additional inspection (I hr min) 66 25/ hr
City/State /ZIP /Y _ Investigation (I hr min) 66 25/ hr
AI r-G oe q n / Cb ? Industrial plant (1 hr min) 78 18/ hr
Phone (45j 9 _ ? y4 p Fax (5 ,3 3 42.2 - r) / Inspections for which no fee 1s 90 00/ hr
/ specifically listed (%2 hr min)
CCB Lic 91/,/ Electrical Lic �7 Supry Lic 3 3ti. 5 ELECTRICAL PERMIT FEES
Supry Electtrici r an signature, required ..-.7.......,„,,__— Subtotal At • 7
�� ` Plan review (25% of permit fee) F6
Print name 11 e p ( ', // Date j/ i q fl 1 State surcharge (12% of permit fee) / t/. 87
TOTAL PERMIT FEE , /
Authorized signature ��
This permit application expires if a permit is not obtainea within 10
Print name Date • days after it has been accepted as complete.
Number of inspections allowed per permit
1 \BuildingWermits\ELC- PermitApp doe 07/01/10 440 -4615T(I I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
r'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
E l Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems
*No licenses are required. Licenses are required
for all other installations
1 \Buddmg\Permus\ELC- PermitApp doc 07/01/10