Permit (123) CITY OF TIGARD.$ ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2018-00742
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/13/2018
TIC. It[� 9 Parcel: 1 S136DD05300
Jurisdiction: Tigard
Site address: 11850 SW 67TH AVE, STE#105
Project: Kronos Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Adding(3)branch circuits for TI.
Contractor: R C COSTELLO ELECTRICAL CONT INC Owner: PNWP LLC#2
PO BOX 336 PNWP LLC
AURORA, OR 97002 6600 SW 105TH AVE#175
BEAVERTON, OR 97008
PHONE: 503-982-7400 PHONE:
_ FAX: 503-982-7400
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 11/13/2018 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 11/13/2018 $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 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 OAR 001-00 . You �i�obt/ain a cop f the rules or 'ect questions to OUNC by calling 503.232.1987•r 1.800.332.2344.
Issued By: -ail' ✓li/ 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.
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.
FrIVED
Electrical Permit Applicatio r�i E FOR OFFI( E I.SE()NEI
City of Tigard Nov 1 3 2Q18 Received
Date/B : N 2I
II ® 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review /
Phone: 503.718.2439 Fax: 503.598.1tppj CiF T I ARD Date/B : 4t, I !/tgi
Inspection Line: 503.639.4175 BUILDING DIVISION ReadyDateBy: iiiiillill ® See Page or
T I G A R D Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
0 New construction ED/Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION, exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling I: Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family
0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE, INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: //8 50 34 j q j ..h 1lie 10011P or more.
City/State/ZIP: //_ ❑Six or more residential units. occupancy.
(f7 7 I l El Health-care facilities. El Recreational vehicle parks.
#II ldg./apt.#: /0 s Project name: K ro 60 S 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEES SCHEDULE
Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
L (with above sq.ft.) 75.00 2
�€ c-7/+'r (et/ 7 a ` e ( 3, Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2 ,
❑ PROPERTY OWNER 1 0 'I'I NANI' ; Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A3'PLICANT A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first 1 56.18 2
Address: branch circuit
City/State/ZIP: Each add'l branch circuit 11, 7.42 _ : 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:-s O ,s- e,//o £4,,H(8(rx / 644, r7+r•-,. Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy 0 See Page 2 2
Address: '%� EOE .336 panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Ci
ty f944,-.0(„ „t O+` q�OV Z-- Additional inspection(1 hr min) 66.25/hr
Phone:( 3)501_ r)se, Fax:( ) Investigation(1 hr min) 90.00/hr
( Industrial plant(1 hr min) 78.18/hr
Email:rC y I{L el.�_a)I (.O i ,.yi Inspections for which no fee is
CCB Lie.: 917Li0Z. .1.\ 3-3L, C Suprv. 3G3Lt S specifically listed(%hr min) 90 00/hr
` }electrical Lic.: Lic.:
``\ ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: ;52 Subtotal: t"
Print name:'52-!' C code i 6a Date: ii l/3// 2-1 J ❑Plan Review Required(25%of permit fee):
l State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
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.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB