Permit i ii i ,, CITY OF TIGA ELECTRICAL PERMIT
1 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00198
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/15/2011
Parcel: 1 S126CA00500
Jurisdiction: Tigard
Site address: 9185 SW HALL BLVD
Project: U.S. Bank Subdivision: Lot: 0
Project Description: (2) branch circuits.
Contractor: COCHRAN INC Owner: U S BANK
'7550 SW TECH CENTER DR. #220 BY US BANK PROPERTIES
TIGARD, OR 97223 2800 EAST LAKE ST
MINNEAPOLIS, MN 55406
PHONE: 503 - 234 -6564 PHONE:
FAX: 503 - 238 -2098
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 04/15/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/15/2011 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through • : r • 2- 001 - 0090. You ma ob .: in a copy -„� Y`r direct questions to OUNC by calling 503.232.1987 or 1 332.2344. r'
Issued By: r "i/ _ --- Permittee Signature:
l
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
01 07:10:16 04-15-2011 1/2
Electrical Permit Application )4S) 1.0R orvicu: um.: ()Nil'
City of Tigard C.) e/By: r" Received .. ..--- 1
Dat ai 6 // 07 Permit No.:
" 13125 SW Hall Blvd., Tigard, OR
' II Phone: 503.639 4171 Fax: 503.5 60 \
1111
Other Permit:
l'IGARD ' 41, ... Plat o ey ev : Review
Plan R
Inspection Line: 503.639.4175 ) . ..kcSc,,, • pate Ready/By: ./nris: El See Page 2 for
Internet: www.tigard .C....1" .S.4 N''' Notified/Method: -.? ., tp Supplemental Information
'
i'':‘‘, ',' '';.;','..:: ; ';';,..:.:'.,': ...'..'; '''..' • ./:', ,,:::' - ::tii?.?.E . ..0t:W.O*C . , • :$.7 1 : - y•-'''3 * ;::::..' :.:1 :-1 ,.!: ,::::;,:. ; : j ',;,.,...' `y,:l:,', ..0
.,,,,,
0 New construction
Please check all that apply (submit I sets of plans w/items checked below):
dnddition/alteration/reent
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
64tidOfili OF CONSTRUCTION ,,,' I..: .Y ,':');::1: exceeds 10,000 amps at 150 volts or 0 Floating buildings.
- - ''' k ' ' ' ' ' ' '''''' ' -, ' '' ' '''' '' '' ' less to ground, or exceeds 14,000 ID Commercial-use agricultural
1:1 1- and 2-family dwelling Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder El Other: 0 Fire pump. 0 Installation of 75 KVA or
larger separately derived system.
JOB. SITE3NFORMATION:iwo't,ocATITI: . :' •.
. , . 0 Addition of new motor load of 0 "A", "E"."1-2", "1-3",
Job no.t6 t 0 0 ( Job site address. ?:;, 6U..) 4 4,,si, I 00HP or more.
Six or more residential units. occupancy.
Recreational vehicle parks.
City/State/ZIP: -1 4 0 c?..... -. . Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: 6. \ Ze....n—V--, 0 Service ur feeder 600 amps or more.
FEt 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 1
Tax map/parcel no.:
Limited energy, residential
75.
, '''''..• . . : .,, ' ' .. ' . .;:.. "iikSCRH7101 00 WORK ';.' • ' ,. :;;' ','. , . , (with above sq. ft.) 00 2 .
Limited energy, multi-family
VS0( t \ — 3OTS Au ete.. ce—c-escPka-c-C2 0 A residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
s 1 19 1 / 41 \ - C T ■S C (1../.__Lo..1't c■ 200 amps or less 100.70 2
,„,„ _,.. . , .., .
' • i ''. ,..;..1.;dr-11QPgRTY' OWNER ' ''''::' 7' ' . ' ': ."'.,; ; 0 7110ANT, . : . i...: . 201 amps 10 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: r , rq
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/Z1P:
relocation
Phone: ( ) — 1 Fax: ( ) 200 amps or less 59.36 i
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
Brandt circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
12," AP pLicANT ' '. '...''.'„'.:.•'::: ';'•:'•-',.,' .., PilisPi•I'. .*: .'''',.' az tee,
742 2
Business name: 4.o_me CkS C'Oeck ci-o--..r B. Fee for branch circuits without . --
=.-.'" - service or feeder fee, first 56.18 5 ki ,
Contact name: p v‘ B ( k ` 1/4.1 v\ branch circuit
Each add'I branch circuit ( 7.42 7 ,14 2
Address:
Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: 67.84 2
dwelling, service and/or feeder
Phone: 1! ) '2_c>5 t4 2.5 (\ Fax: : ( ) Reconnect only 67.84 2
ump or irrigation circle 67.84 2
E -mail: -mail:
' '
Sign or outline lighting 67.84 2
•. , • ', :. ' 'CONTR ' .
ACTOR '.,.. . ; .;, - ,': '. : • . ', ., ., : Signal circuit(s) or limited-energy
panel, alteration, or extension. Page 2 2
Business name: aA- ca
' Each additional inspection over allowable in any of the above .
Address: 7 5 50 3\ (e. . K tt22D
",11-C Additional inspection (I hr min) 66.25/ hr
Investigation (1 hr min)
City/State/ZIP: -- T766..c.k 0 R, 72 2_ 3
Industrial plant (I 66.25/ hr
hr min) 78.18/ hr
Phone: 503 )234— &a 6 4/ F ax: ()3 ) 7 3i — 2_098/ Inspections for which no fee is
90.00/ hr
specifically listed (Y: hr min) _
CCB Lie.: 7z j‘../a Electrical Lic.: 307546 e, Suprv. Lie.: 31_147 ',."'-' : ';'':':ELECTRICALIERMIT FEES". ' .-' .1 : •
Suprv. Electrician signature, required: \(3.
\ c.,
..k -
Plan review (25% of pei ' (C '(.1)°
Print name: ---k-c. Date: 4- (k ( State surcharge (12% of permit fee): 7, (e3
TOTAL PERMIT FEE:
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
1 : , Building;Pcrmils.ELC-PennitApp.doc 07 440-46157(1 1,05,COMWEB