Permit CITY OF TIGARD ELECTRICAL PERMIT
11111 = ',-.- COMMUNITY DEVELOPMENT Permit #: ELC2012 -00100
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/15/2012
Parcel: 2S112DC01400
Jurisdiction: Tigard
Site address: 15865 SW 74TH AVE 115
Project: Spec Space Subdivision: FANNO CREEK ACRE TRACTS Lot: 4
Project Description: (1) feeder and (6) branch circuits.
Contractor: RC COSTELLO ELECTRICAL CONT INC Owner: JDS LLC
PO BOX 336 CRITERION CREEKVIEW LLC
AURORA, OR 97002 ATTN JAMES A MEYER
PO BOX 6525
BEAVERTON, OR 97007
PHONE: 503 - 982 -7400 PHONE:
FAX: 503 - 982 -7400
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 02/15/2012 $100.70
Specifics: amps or less
6 crt Branch Circuits w /Purchase 02/15/2012 $44.52
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 02/15/2012 $17 43
Electrical
Type of Const:
Occupancy Grp:
Total $162.65
Required Items and Reports (Conditions)
This permit i ssued subje o the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done i• accordance with ap• •ve• • .ns. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. A TENTION: Oregon law s -quires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 0010 throug OAR 952 -0s1 -dYo . m_y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1 32.2344.
J Issue By: ' // / `.� /0 Permittee Signature X - �- ��
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' (t_----7/ 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 ,+ 'jam
IN City of Tigard �� � Date/By: t9 ��7 � Permit No.:
. c � C � "� , / �_U ct io Li
• q 13125 SW Hall Blvd., Tigard, 0 G Plan Review
- Phone: 503.718.2439 Fax: I9 0 �'L Date/By: Other Permit.
T I G A R D- Inspection Line: 503.639.4175 $ v+ Date Ready/By: Inds ® See Paget for
Internet: www.tigard- or.gov . < >, C: Notified/Method Supplemental Information
' TYPE OF WORK G ... v-- PLAN REVIEW .
❑ New con Addition /alt ?tom` t , l ment Please check all that apply (submit 2 sets of plans w /items checked below):
0 ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition I=I Other: �� where the available fault current ❑ Marinas and boatyards.
CATEG9RY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
•
L _, VJ / 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
0 Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
' .1 /� 100HP or more. occupancy.
Job no.: Job site address: /5865 5 lea 994 k R VE, ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite ldg. /apt. no.: I 15 Project name: creel( v1Q.V 14 ❑ Service or feeder 600 amps ormore.
FEE SCHEDULE
Cross street/directions to job site: Soot ee Description I Qty. I Fee. I Total l "
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'l 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.)
LL Limited energy, multi- family 75.00 2
4e de l' e 1,"-a 4e- A airce., S residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 100.70 /). 7e 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: ( ) 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 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
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 / 7.42 144-1 2
each branch circuit �D
Business name:
H. Fee for branch circuits without
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)
Clt /State /ZIP: Each manufactured or modular 67.84 2
y 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 circuit(s) or limited- energy
Business name: C Cos-le //a eJe ?hG Panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: ' 0. - B ox 3 3 6 Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: / r U r- C.A. 0 R q-7002- Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18 / hr
Phone: (50 3) 982 - "7 L.11OV Fax: (503) 982- 171101 Inspections for which no fee is 90.00/hr
•
specifically listed (%Y hr min)
CCB Lic.: 8,-/ 4 02 Electrical Lic.: -3 - 11jN C Suprv. Lic.: ..37341'51 ELECTRICAL `PERMIT FEES
Subtotal: i[/S /
Suprv. Electrician signature, required: . a.
Plan review (25% of permit fee):
Print,name: - R 05 er. C° Ca s -1. t 1 Date: 2//3 �Z State surcharge (12% of permit fee): / ' Y ?
` TOTAL PERMIT FEE: r 1, a.696
, (p 5'
Authorized 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.
L\ Building \ Permits \ELC- PennitApp.doc 07/01 /10 440- 4615T(11/05/COM /WEB