Permit (122) CITY OF TIGARD ELECTRICAL PERMIT
14 -1- , COMMUNITY DEVELOPMENT Permit#: ELC2018-00743
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/13/2018
T[(;AR t7 g Parcel: 1S136DD05300
Jurisdiction: Tigard
Site address: 11850 SW 67TH AVE, STE#115
Project: Kronos Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Adding(2)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
2 crt Branch Circuits wo/Purchase 11/13/2018 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 11/13/2018 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 952-001-0090. You •y obtain a copy• the rules or direct questions to OUNC by calling 503.232.1987 or 00.332.2344.
/
Issued By: ‘ii i Permittee Signature:
„:7,44 --
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 Applicatio FOR OFFICE t SI. o y 1.1
Cl ofTigardtitAaFIVED Received
`J g Date/B : l iffrAtirig2
-..J=. 1_ 21EZEgial
111 13125 SW Hall Blvd.,Tigard,OR 97223N 0 V 1 3 2018 Plan Review
11 Phone: 503.718.2439 Date/B : A 1
�iIfI
Email: TigardBuildingPermits@Tigard y ,:.,., 10 Ready Date/By: H ee 'age 2 or
I I('A R I) Inspection Line: 503.639.4175 In u- v14
,t1g0['tfi:p�:#N Notified/Method: Supplemental Information
TYPE OF WORK t L �/1 PLAN REVIEW
❑New construction 0/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.
CATEG9RY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling Commercial/industrial 1:1Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
AddJob#: Job site address: /1 2s--0 s Cti1 .4....1.4* !*fir ❑100H ion of new motor load of system.
//v( 100HP or more. ❑«A„ «E„ «L2„«1.3»
City/State/ZIP: / 0 Six or more residential units. occupancy.
C!/ 0 Health-care facilities.
0 Recreational vehicle parks.
41160 s ldg./apt.#: 1 15 Project name: s Q c, , 't 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: FEE SCHEDULE
Description I 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'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
1"3ra/1(k l f(✓i}f I C* 1 Limited energy,multi-family
✓ residential(with above sq.ft.) 75.00 2
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:( ) 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 APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
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
Address: service or feeder fee,first t 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit i 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) 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: /I r?�,,,.1r!% E/p-4,i,,. ) ?j1* �.r Sign or outline lighting 67.84 2
C �J7Signal circuit(s)or limited-energy
Address:'Fa. Ts-,x 3 3 G panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: a 2 Each additional inspection over allowable in any of the above
fie, Additional inspection(1 hr min) 66.25/hr
Phone:($i 7 ) cu t ,. 6 50
Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: pc,o.c l/q E I )1 c Inspections for which no fee is
CCB Lic.: "� specifically listed('/�hr min) 90.00/hr
�l 1 (ilectrical Lic.: ' _34(le Suprv.Lic.: .� 3 *
`4�1 ELECTRICAL PERMIT FEES
Suprv.Electrician sign tore,required _moo,. Subtotal:
Print name:'' ",f*, "' r s4i/ Date: i 1//7 //g 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
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.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE sCi3EDULE
DeI
Fee for all residential systems combined: $75.00 Each Total
Qty.Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
n Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(Yz hr mint
COMMERCIAL WORK ONLY: tizetRiem, PERMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 10/26/2017
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11850 SW 67TH AVE STE 115, TIGARD,
OR, 97223
Record Type: Record ID:
Commercial - Electrical ELC2018-00743
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor