Permit CITY OF TIGARD ELECTRICAL PERMIT
III I COMMUNITY DEVELOPMENT Permit #: ELC2011 -00117
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/01/2011
Parcel: 1S126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 200
Project: DQ of the Pacific NW Subdivision: Lot: 0
Project Description: (1) branch circuit for receptacles.
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: 503 - 294 -0400
FAX: 503 - 982 -7400
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 03/01/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/01/2011 $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
952- 001 -0010 through • . • - k i01- 0090 Y. a • • - in a copy • - r -s o •• - ct questions to OUNC by calling 503.232.1987 or .332.2344.
09
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Issued By: � — •SM11•••■• _ Permittee Signature: -
t _ 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 4V° FOR OFFICE USE ONLY
City of Tigard "°d _
M • 13125 SW Hall Blvd., Tigard, OR 972 �� + \� ,�•
8� 0 Review
Phone: 503.718.2439 Fax: 503.598. , Date/B:
O ther Permit: 2 .. i
T I G A R D Inspection Line: 503.639 s a Ready/By: ® Page for
Internet: www.tigard or.gov 4 P � c ∎' • tified/Method: Supplemental Information
YPE OF WORK , G V � PLAN REVIEW
El New construction ( Addition/alteration/re cat 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.
It less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
El 1- and 2- family dwelling Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family El 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 ", "1 -3 ",
Job no.: Job site address: cl 02 C) S W (, 11 54 6 self Six xHP or more. occupancy.
❑
1 J Z J " ❑ Si or more residential units. Recreational vehicle parks.
City /State/ZIP: ❑ Health-care facilities. ❑ Supply voltage for more than
�+ ❑ Hazardous locations. 600 volts nominal.
Suit Idg. /apt. no.: ) Project name:'? q 0 T ki LJ ❑ Service or feeder 600 amps or more.
job site: Description FEE SCHEDULE
Cross street/directions to
] I Qty. I Fee. 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
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 I
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
I — (� 1- Limited energy, multi- family 75.00 2
V('A n C 1, C t (c., i - -4-�t -- ree.e ,tL1c-- residential (with above sq. ft.)
r Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ 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 1
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
each branch circuit
Business name: B. Fee for branch circuits without /
service or feeder fee, first l 56.18 I 2
Contact name: branch circuit L
Each add'l 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: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
1 CONTRACTOR // Signal circuit(s) or limited- energy
Business name:' C Cos+e 11, E Vl C rr co ( (,:, 1 panel, alteration, or extension. Page 2 2
YLZ7 Each additional inspection over allowable in any of the above
Address: p„). A. 3.3 4 Additional inspection (1 hr min) 66.25/ hr
City / State/ZIP: Q n-',�/ _ Investigation (1 hr min) 66.25/ hr
t ita f OrA, 4 t i) `- Industrial plant (1 hr min) 78.18/ hr
Phone: (S))) Ole I Fax: ( p ) - O ,■ - — SO t Inspections for which no fee is 90.00 / hr
specifically listed (V2 hr min)
CCB Lic.: t 2, Electrical Lic.: 1.. c Suprv. Lic.: 3g3Ti 7 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: t� cJ Subtotal: .---- , i
Plan review (25% of permit fee):
Print name:-T2 C Sc /_ Date: Q l l / f �' State surcharge (12% of permit fee): f Dr
Authorized signature: ��" �/� /+ t TOTAL PERMIT FEE: 9, } -,
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Num o inspections allowed per permit.
I: lBui lding\Pamits\ELC- PermitApp.doc 07 /01/10 440.4615T(11/05/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:
n Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n 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
n Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 07/01/10