Permit (148) CITY OF TIGARD ELECTRICAL PERMIT
'11
I ' ' COMMUNITY DEVELOPMENT Permit#: ELC2019-00297
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/06/2019
T I c;r11;,p9 Parcel: 2S113AB00300
Jurisdiction: Tigard
Site address: 16037 SW UPPER BOONES FERRY RD 300
Project: Oregon State Bar Subdivision: FANNO CREEK ACRE TRACTS Lot: 38
Project Description: Adding(3)branch circuits for recaps and lighter.
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: 503-982-7400 PHONE:
FAX: 503-982-7400
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 05/06/2019 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 05/06/2019 $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 -001-0090. You m obtain a copy of the rules or direct questions to OUNC by calling 503.232.1 00.332.2344.
Issued By: .,4°.... 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.
Electrical Permit Applicattt:,'' ''' .''. ,.;-,7 ri ..-,,R OFFICE': I SE 0\1.1
_ . • . ,,.
City of TigardReceived 41011 M11,
: ArVfMrAir 41 .411.41 - 411 V
71 q 13125 SW Hall Blvd.,Tigard,OR 97Date/B/gY 0 ':: 2019 Plan Review
: I Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
Inspection Line: 503.639.4175 ' I Ready Date/By: Juris: 0 See Page 2 for
TIGARD, Internet: www.tigard-or.gov ,.._ , 'M Notified/Method: Supplemental Information
TV-Pk OF FWORK ' . .... , , , .,, ,., ,1,,AN:RV-:VIEW
O New construction Lg Addition/alteration/replacement Please check all that apply(submit a sets of plans w/items checked):
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.
CATIRY OF CONSTRUCTIMN : ' exceeds 10,000 amps at 150 volts or 0 Floating buildings.
O 1-and 2-family dwelling Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
D Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
4013 SITE INFORMATION AND LOCATION . . E Emergency
system, larger
load of lsary:teermseparately derived
Job#: Job site address: 1‘ 0 3 r7 So j Ur.Basalts ce:r4e1 100FIP or more.
) 0 Six or more residential units. occupancy.
City/State/ZIP: ID Health-care facilities. 0 Recreational vehicle parks.
arseldg./apt.#: 30 0 Project name: 0, q, -3 0 Hazardous locations. 1:1 Supply voltage for more than
CI Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: ' TEE SCHEDULE
Description 1 Qty. I Each I Total I *
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'l 500 sq.ft.or portion 33.92 I
DESC/01410N4OP*Olkt. 1 '- ' '-;," Limited energy,residential
75.00 2
t (with above sq.ft.)
-13 ra 6 c.-In c rcv)4.1 -kl r recelos C I i,ki fr Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER . ', -, -._ , 0 TENANT. ' . 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 i
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
Branch circuits-new,alteration,or extension,per panel
CONTACT PERSON=,,, ' _ 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 I 56.18 54, la 2
Address: branch circuit
City/State/ZIP: Each add'I branch circuit 2. 7.42 //./ r39 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
67.84 2
Business name: R,C, Code.ho Cie,...4.e.,,, I c3.,,,..fr, 3-, , Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address:po, -50,4 31() panel,alteration,or extension. 0 See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP: /ii,co cc% 0 re q 7 o o Te- Additional inspection(1 hr mm ) 66.25/hr
Phone:(503) of-g (015 8 Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:rc,c,sie IL,e.1e .(Doh:0 ,c-0 0'1 Inspections for which no fee is
CCB Lie.: E37/40 z Electrical Lie.:3LI-LI L-I c Suprv.Lie.: 3q 34 $ sI7c,.,IficallY listedt0 hrnm) - 90.00/hr
IcAZCIIICAL PERMIT FEES
Suprv.Electrician signature,required: 67 ....r,„,.....s,- ' 'Subtotal: -7 1 0
....„4 .....
Print name: 7: ,r3jee- C Date:S1C 1 / q El Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 8 53
Authorized signature: TOTAL PERMIT FEE: -7 q .
This permit application expires if a permit is not obtained within 180
Piirit narm. Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\BuildingWermits\ETC PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T01/05/COM/WEB