Permit n CITY OF TIGARD ELECTRICAL PERMIT
a ` ' COMMUNITY DEVELOPMENT Permit #: ELC2012 -00709
T [ Gr1:RD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Date Issued: 12/13/2012
. _ -. Parcel: 2S115AB01900
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY G2
Project: Foot Solutions Subdivision: 1994 -028 PARTITION PLAT Lot: 2
Project Description: (1) branch circuit for exit sign
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
1 crt Branch Circuits wo /Purchase 12/13/2012 $56 18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/13/2012 $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 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 / 9 2 0 01 -0 09 You may obbbttain copy of the rules or direct questions to OUNC by calling 503 232 1987 332 2344
Issued By: 5 d �+ (� —lit�t 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 RE rs E Iv FOR OFFICE USE ONLY
Received
City of Tigard Date/By Permit No Blvd.,
ll 13125 S W Hall 503.718.2439 Tigard, OR 97223 DEC 1 3 2012 Plan Review @ , � ap ( ' �S
Phone. 503.718.2439 Fax: 503.598.1960 Date/By Other PermiC P (0 S p
T I G A R D Inspection Line: 503.639 4175 � Date Ready/By Juris H See Page 2 for
Internet www.tigard - or.gov CITY TT OF 1 T IGARD Notified/Method. 11 t. Supplemental information
'YPE OF W -OtNG DIVISION PLAN REVIEW
❑ New construction L }'Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below)
❑ Service or feeder 400 amps or more ❑ Building over three stones
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings
L � J , / / less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
ID 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 denved system
❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ",
Job no.: Job site address: 4" 2 0 0 S (,V 4 C I �' ` )4�t -1 100HP or more occupancy
V t ❑ Six or more residential units ❑ Recreational vehicle parks
City /State /ZIP: ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
j i bld /a t. no.: nn Project name: 4 C El Service or feeder 600 amps or more
ui g• P V � Pro J tai `1 SJ � V ��+4 f
FEE SCHEDULE
Cross street/directions to job site: Description I Otv. I Fee. I
I Total
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 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft) 75.00 2
j� Limited energy, multi - family 75 00 2
/ ern ie L, Cot • -IC /` LY I ) I c 0 residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
f C r jt , 200 amps or less 100 70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133 56 2
401 amps to 600 amps 200 34 2
Name:
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 I 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 ❑ CONTACT PERSON above service or feeder fee 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first I 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 irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67 84 2
CONTRACTOR Signal circun(s) or limited- energy
Business name: ( Cos-71-e 110 panel, alteration, or extension Page 2 2
Each additional inspection over allowable in any of the above
Address: l — 0 so, X 73 4 Additional inspection (1 hr min) 66 25/ hr
investigation (1 hr min) 66 25/ hr
City /State /ZIP: film) e 0 N, 02. q-- a)z- industnal plant (I hr mm) 78 18/ hr
Phone: ( ?) q 8 Z boo Fax: (5.57) q SL- / (I Inspections for which no fee is 90 00/ hr
specifically listed C: hr min)
CCB Lic.: $l 14V L Electrical Lic.: 3- '1t1C Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician si! atur , ( uired: �� ,i�/ / � Subtotal:
e C...� Plan review (25% of permit fee).
Print name: "Z ( ti, Date: ( z 1 l `i ) I � State surcharge (12% of permit fee).
J ( /!( - D TOTAL PERMIT FEE: ( _5?-,-
AUthOilZed signature: 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
I \Building\Permus\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:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
El Burglar Alarm
El Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
El Vacuum Systems*
El Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
•
El Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
I \Buddmg\Permtis\ELC- PermftApp doe 07/01/10