Permit 11111 n CITY OF TIGARD ELECTRICAL PERMIT
a.: COMMUNITY DEVELOPMENT Permit #: ELC2010 -00642
.TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/12/2010
Parcel: 1S126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 460
Project: Bjorklund & Montplasir Subdivision: Lot: 0
Project Description: (4) branch circuits for lights and outlets
Contractor: RC COSTELLO ELECTRICAL CONT INC Owner: WISCO REAL ESTATE EQUITY
PO BOX 336 FUND I LTD PARTNERSHIP
AURORA, OR 97002 BY WYSE INVESTMENT SRVS CO
1501 SW TAYLOR ST STE #100
PORTLAND, OR 97205
PHONE: 503 - 982 -7400 PHONE:
FAX: 503 - 982 -7400
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 11/12/2010 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/12/2010 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 O. - 952 - 001 -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 • , 00.332.2344.
Issued By: OF - - - 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.
CaII 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.
1 } r N,
ElEetigiil -Permit Application -- FOR OFFICE I'si: ONLY
li
City Of Tigard RE Received / �, � �GC 1w/O /
Date/B [� �2 �Q Permit No.' vY/ --, —
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503. v EIVED
12 20 Dateiv Other Permit:
f 1 ( ;\ I(1) Inspection Line: 503.639.4175 w V Date Ready /By: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
TYPE O W :MNG DIVISION PLAN REVIEW ..
❑ New construction [Addition /alteration /replacement Please check all that apply (submit a sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: 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 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: Job site address: q ]]�� (A (, .) `` IOOHP or more. occupancy.
2 lJ i f 11 nGx�n ❑Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: S c7 V0� f e G (/1 J ❑ Health -care facilities. ❑ Supply voltage for more than
L y II ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 1Z- k i mOnT� I�1 ❑ Service or feeder 600 amps or more.
job site: FEE SCHEDULE
Cross street/directions to
-I Description I Qty. 1 Fee Total
New residential single- or multi - family dwelling unit.
Includes attached garage. _ _
1
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
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family 75 00 2
— 6(191n no IN C I (-C V i {-S -Cr ( I .Gle r residential (with above sq. ft.) _
I Services or feeders installation, alteration, and/or relocation
a n A / + / 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
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation
Phone: ( ) F ax: ( ) 200 amps or less 59.36
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps I25.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
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, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56.18 2
Contact name: branch circuit
Each add'I branch circuit '5 7.42 C
Address: Miscellaneous (service or feeder not included)
CI /State /ZIP: Each manufactured or modular
67.84 12
ty dwelling, service and/or feeder _ L_
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 circuit(s) or limited- energy
Business name: R L �l e II IA i I c -fr t c4-) C_un4� -{- 4 S
panel, alteration, or extension. Page 2 2
/ Each additional inspection over allowable in any of the abov
Address: P. O - 13 X 33 t - Additional inspection (I hr min) 66.25/ hr
/� Investigation (1 hr min) 66.25/ hr
City/State /ZIP: T/V ray O ? Gt 7 o O ' Industrial plant (1 hr min) 78.18/ hr
Phone: ( 3) cm Q o Fax: (54/ ) q $Z 1 l'fd t Inspections for which no fee is 90.00 / hr
specifically listed (Y: hr min)
CCB Lie.: S Yd Z F gt �� �l / iical Lic.: 3 - 3 1 -4 Supry . Lic.: 3q 7 zi / / 5 ELECTRICAL PERMIT FEES
Suprv. Electrician signatur ,
! required: t'0/ S ubtotal: � s� .
��+` Plan review (25% of permit fee): //
Print name: -R . C CS -(P II, Date: / // I L' / J State surcharge (12% of permit fee): l , yI
TOTAL PERMIT FEE: x' ,p5
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
I. \nuilding''crmits \EI.C- PermitApp doc 07/01/10 440- 4615T(1 I /05 /COM/WEB