30KVA dry type transformer (480 X 120/208)
Can it be located above a suspended accessible ceiling (say in a medical office building)?
Can it be located above this ceiling if the ceiling space is a return air plenum?

NEC 2008 450.13(B) says, generally for this size and type, you can. The plenum space question is not addressed.

300.22 (c)(2) should be read, and then I suggest you speak to the local AHJ for his/her interp. Under 50 KVA is no issue, BUT...the air handling ceiling needs to be addressed. Also, you may want to have a cut sheet for the exact xfr you intend to install.

I think this is probably legal, depending on the transformer but it might be a questionable design choice. If that transformer smokes it will share the joy with the rest of the building pretty fast, at least that HVAC zone anyway.

If the Life Safety System ( Fire Alarm ) is up to snuff a duct detector is going to shut things down well enough in time.

Not quite the same set-up...

But I rigged a 45kVA XFRMR, dry-type, above a grid to give isolated power to data loads. Upon the detection of fire, within this space only, a shunt-trip killed total power - with a time delay of seconds so that the data state could be frozen/ preserved. Subsequently the dry fire system would be flooded into the now unpowered space.

So the question of plenum return air really would seem to be a life safety question not to be answered within our Code.