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Permit y n CITY OF TIGARD ELECTRICAL PERMIT : 1 $ COMMUNITY DEVELOPMENT Permit #: ELC2012 -00617 T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/29/2012 Parcel: 2S 113AB00300 Jurisdiction: Tigard Site address: 16037 SW UPPER BOONES FERRY RD 110 Project: Professional Practices Subdivision: FANNO CREEK ACRE TRACTS Lot: 38 Project Description: (3) branch circuits for TI Contractor: R C COSTELLO ELECTRICAL CONT INC Owner: OREGON STATE BAR, THE PO BOX 336 16037 SW UPPER BOONES FERRY RD AURORA, OR 97002 TIGARD, OR 97224 PHONE: 503 - 431 -6313 HONE: 503 - 982 -7400 FAX: 503 - 982 -7400 FEES Quantity Description Date Amount 3 crt Branch Circuits wo /Purchase 10/29/2012 $71.02 Specifics: Service or Feeder 1 ea 12% State Surcharge - 10/29/2012 $8.52 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $79.54 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 ac • • - • 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. ATT. •TION: Oregon =w r -• -s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -r' 10 throu• OAR 952-01 -009 may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 32.2344. Issue By: 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' y^ � / Date: /0 /09 �i LICENSE NO. ( 3 - 7 5 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 FOR ()1 1 I.: I Sl: O\I.1 City of Tigard Received 71 City DateB /O ` . d i Permit No.: f� jla—� /7 • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ■ Phone: 503.718.2439 Fax: 503.598.1960 Date/13 : Other Permit: f I n It D Inspection Line: 503.639.4175 Date Ready/By: its: El See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information E OF WORK PLAN REVIEW ❑ New construction 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 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 ❑ l- and 2- family dwelling Ur ❑ 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 El Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "l -2 , "l -3 ", I OOHP or more. occupancy. Job no.: Job site address: (c (, ' La 0 Six or more residential units. 0 Recreational vehicle parks. City/State /ZIP: `t . ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. uite/bldg. /apt. no 1 r Project name: O , ❑ Service or feeder 600 amps or more FEE 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 7500 2 DESCRIPTION OF WORK (with above sq. ft.) � Limited energy, multi - family 75.00 2 L t rf i 'r, i . 7;, 7.^E,'';', I v .. , - . J j , o residential (with above sq. ft.) 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 2 401 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: /State /ZIP: Temporary services or feeders installation, alteration, and/or ty relocation Phone: ( ) Fax: ( ) 200 amps or less 5936 I 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 am intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 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 56.18 . rg 2 Contact name: branch circuit Each add'I branch circuit' 7.42 /5 _ 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 circuit(s) or limited -energy Business name: panel, alteration, or extension. Page 2 2 ° ®o � �� 6: � i 'r� Each additional inspection over allowable in any of the above Address:`, je :?,'t• Additional inspection (1 hr min) 66.25/ hr _ Investigation (I hr min) 66.25/ hr City/State /ZIP: a¢ c%, „-e i �e) ou:., Industrial plant (1 hr min) 78.18/ hr Phone: ( _> :9 - ,i';% Fax: ( ) L��z_ q I nspections for which no fee is , $03 ®/ 90.00/ hr specifically listed (%: hr min) CCB Lic.:8() 1102.. Electrical Lic.: 1- 3 Suprv. Lic.: g34 _ s ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: s ubtotal: � r . 2 e-e a r � Plan review (25% of perm fee): Print name: o3er. C a�,¢ � V Date:,0 12 ; / �t State surcharge (12 %of permit fee): I.52, TOTAL PERMIT FEE: 79 . Sy 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 \Permits\ELC- PermitApp.doc 07/01/10 440-4615T(11/05/COM/WEB