Permit 3 D Ae f7%1/J /aml7 aa(d-e0( / 6,11.41/, Ci>z /
l OF i ! GA R D ELECTRICAL PERMIT
° PERMIT #: ELC2007 - 00782
COMMUNITY DEVELOPMENT DATE ISSUED: 11/20/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S135BD-00300
SITE ADDRESS: 09735 SW SHADY LN ZONING: C -
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: TIGARD MEDICAL MALL
Project Description: Replace disconnect, (2) branch circuits, for roof top HVAC unit. 5/13/08 ADDED (1) branch circuit.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNALJPANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 2 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
HAZEL INTERNATIONAL, INC AND R C COSTELLO ELECTRICAL CONTRACTING
HIGASHIYAMA HIGHLANDS CO, LTD PO BOX 336
BY NORRIS + STEVENS REALTORS AURORA, OR 97202
PORTLAND, OR 97204
Phone: Contact #: PRI 503 - 982 - 7400
FAX 503 - 982 -7401
FEES
Description Date Amount Reg #: ELE 3 -344C
[ELPRMT] ELC Permit 11/20/200' $53.50 LIC 87402
[TAX] 8% State Surcharge 1 1/20/200' $4.28 SUP 39345
[ ELPRMT] ELC Permit 5/13/2008 $6.65
(additional fees not listed here) REQUIRED ITEMS AND REPORTS
Total $65.23
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 -0. 1 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued Permittee Signature:
Y �
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'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 OFFICE USE ONLY
City of Tigard P erm i t N o.: / /t% / E - 700A. 2 --
''a Received ,� DateBy: `/ 7 ' 13125 SW Hall Blvd., Tigard, OR 9' 23 ,- „- Plan Review
/3 /Q
' C Phone: 503.639.4171 Fax: 503.59849150 Date/By: Other Permit:
T I G A K D Inspection Line: 503.639 , Date Ready /By: orris: ® See Page 2 for
Internet: www.tigard - or.gov X1 ^ ` , I4ttified/Method: Supplemental Information
TYPE OF WOR•.. . PLAN REVIEW
❑ New construction dAddition /alteration% �ekalacement 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
❑ 1- and 2- family dwelling Commercial /industrial ❑ 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 ❑ Emergency system. larger separately derived system. A
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: 1 Job site address: 9 3 35 S 60 Sil 100HP or more. occupancy.
❑
a d � L >7 ❑ Six or more residential units. Recreational vehicle parks.
City/State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: I Project name: I i qa r d Medical PI a . If ❑ Service or feeder 600 amps or more.
J FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft)
75.00 2
/ ,I Limited energy, multi - family 75.00 2
re Con ne ( , T - akw n V t C , i f- residential (with above sq. ft.) _
Services or feeders installation, alteration, and/or relocatio
(Le kJ r G r 1 aeioi^ 0 IX 200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: �, Si ., W / ' /( Temporary services or feeders installation, alteration, and/or
/ relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 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, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, � 46.85 2
first branch circuit
Address: Each add] branch circuit / 6.65 G .65-2-
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
•
CONTRACTOR Sign or outline lighting 53.40 2
Business name: f? C C s 'e / � G f rim,( /� Signal circuit(s) or limited -
(� 7 .. ,, C ^ ( energy panel, alteration, or
Address: -- p Q E X 3 3 6 extension. Describe: Page 2 2
City /State /ZIP: /9v/ „c„ 0 e c r) o o Z Each additional inspection over allowable in any of the above
Phone: (S )) ) q g . r7Lf (J') I (SO 3) 1 222- - T'1 J Per inspection 62.50
Fax / Investigation per hour (1 hr min) 62.50
CCB Lic.: 9y I Electrical Lic.: 3 "34.1 y C 1 Suprv. Lic.: 3 ci 3y S. Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES _
Suprv. Electrician signature, required: /
( -- 1....._____ Subtotal: 6 . � S
Print name: ( S f e //,., Date: s l i s Jo Plan review (25% of permit fee):
l State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: - Lf
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.doc 05/23/06 440- 4615T(11 /05 /COM/WEB
-i , ah CITY OF TIGARD ELECTRICAL PERMIT
, �� PERMIT #: ELC2007 -00782
H COMMUNITY DEVELOPMENT DATE ISSUED: 11/20/2007
l'.1
IGARD' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 135BD -00300
SITE ADDRESS: 09735 SW SHADY LN ZONING: C -
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: TIGARD MEDICAL MALL
Project Description: Replace disconnect, (2) branch circuits, for roof top HVAC unit.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp: • PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
HAZEL INTERNATIONAL, INC AND R C COSTELLO ELECTRICAL CONTRACTING
HIGASHIYAMA HIGHLANDS CO, LTD PO BOX 336
BY NORRIS + STEVENS REALTORS AURORA, OR 97202
PORTLAND, OR 97204
Phone: Contact #: PRI 503 - 982 - 7400
FAX 503 - 982 -7401
FEES
Description Date Amount Reg #: ELE 3 -344C
[ELPRMTI ELC Permit 11/20/200' $53.50 LIC 87402
'TAXI 8% State Surcharge 11/20/200' $4.28 SUP 3934S
Total $57.78 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
o'
Issued By: / / . • Permittee Signature: Q!i r9/P C',1-/ /OA./
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'N: DA/ 4 / 77c"7 DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
°Nov 19 2007 9:42AM HP LASERJET FAX p,1
•
Electlrie d Permit Aapli E1VED t� 1 ur. err "rlc r I rtir fiat
� Ci of Ti and R0CE1`�e // /s / 7 i %� mrr per N n.. c '
g o - 'o 9 Fa_
�-, 131 SW Hell Blvd., Tigard, OR 440I1 1 r 1 2 001 Plan Rcvitw � . J
Other Pamir: ' p /
Phone. 503,639.4171 Fax: 503.598.1960 oaisIny:
; , t g g , inspeetson Line: 503.639 4 lIktithri DIVISION 175 CITY OF rIGARD DarcReadyiFy: iutir � ® See Page tier
Internet: www.li and of ov ' Nob 6cd/Mahod. % � � Snppttmeaasd nfortaelloa
of woilat . 0
® New construction Addition /Operation /neplacemeni Pleats check all clot. apply (submit acre of plans whitens cheacedTtolow)
O Sen+ee or feeder 400 amtr m more CI Bud din ova Ores nowise.
❑ DenKlitiOr ❑ Other: • where the aysilshle (cull euncnr Q Mcrinas and boatyard.
- .CA11C, 00' CONMIUCTION_ .- eaceode IC, 000 amps at 150 wlh or o florMmthuldingt
Imp m roiled, at snood.' 14,000 0 Commaeial•uae naricvla
❑ 1 and 2•fatltily dwelling Commercial /industrial ❑ Accessory building tmpa fat 00 Dian initnllalions. hnil4ingt
❑ Multi- family ❑ Master builder ❑ Other: ❑ fire pump 01notallnioa of 75 KVA ow
. .. 0Emerar•ity sysrem. larger aeownteiyderived syrtem.
- .: STT
JOB WE 'INFORMATION' AND 1A717
CAoir D Addition of now morn land of [] "A" '•p" '•I.2" "I -1"
Job no. !ob Site address: q 1 - S S .S C heYA L r1 P 001-.7 or :note. Pompey, ❑ ask n, mare rosidennsl sans. ❑ Re( rewiring! vehicle parks.
City /Statc /Z.1P77 0 1 0 ❑ Nsaltb•cr.e heil■r:a.. 0 Supply wlsa for mare than
0l4izndoue locations. 600 will nominal.
Su ite/bldg./apt. no.; Pmject "e71.134.1.61 m ) t . GA } jy) ( to Service or road= 600 amps or misc. .
Ina r FEE SCHEDULE
Cross strtxt/dirtection9 to job site oar • re. Pm Toad •
New residential single- or ntullidemily dwelling unit.
Includes ett*ched g rage,
Subdivision: l Lot no.: 1.000 sq. R. or Ins 145.15 1
Tax map /parcel no.: Ea. odd' 1 500 sq. R. or portion 33.40 1
Limited energy, r idcnciel 75 DO 2
DZSCR1YTYON OF WORK `: (w;m above ,q. n.1
n J ` Limited energy, multi - family -
e,t)iIACR oIIL (soft ALL 4 ' 4 r rod -4-op ) . _ residential (cairnabove sq. n.) 75.00 2
1 Services or feeders inatalladonosItcratiaa, eiNor relouldon
U n i + 200 amps or Ic99 80.30 .- 2
PROPERTY OWNER ❑ TENANT 201 gimps to 400 stops 106.85 2
Name: 401 amps to 60D amps 160.60 2
601 amps to ' .000 amps 240.64 2
Address; Over 1,1100 amps or volts 454 65 2
Cily/State/ZIP; Temporary serv1c i or feeders Insbdletlon. slier don, endlor
relotation
Phone: ( ) I Fax: ( ) 200 amps or Ic;a 1 66.85 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange. according to ORS 447, 449.610. end 701, 401 amps to 599 amps 133.75 2
Owner signature: Date: Breach circuits- new, elrerarion, oreiIenalon, er peed
A Fee for brooch circuity with
. • 0 APPLICANT ❑• CONTACT FUSON • -- above service or feeder fcc. 6 65 1
cock branch circuit
Business name:
H: Fcc for branch cimuily
....Mow service or feeder rec. 1 ,/ r ,
Contact name: first branch circuit Y i 46 it s " 2
Address: Each add'1 branch circuit 1 f 6.65 f 2
Misecllaneoue (service or feeder ern loci tided)
City /StatcIZIP: Each manufactured or modular
Phone: ( ) Fox: '' ( dwelling, service and /or Nader 90.90 2
Reeonned only 66. R5 2
E-mail: Pump or irrigation circle 53,40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business none: -7?, 0. Cos ` f !V E/ec ih(.�i I '� n �,. 74 Signal pane). a or limited -
energy panel. al reralipn, or
.Address: 'o vac 3 1, 3 ealens . Dcccrihc: Page 2 2
/j i I
City /State /•Z1P: 171 1x ,,, r ,,, 0 q ii U a [sell additional iatapeetion ever allowable in any of the above
Per
Phone: (503 ) 9$2 r� Co O Fax: (6o3) 0182- r7L'U Investigation 62.50
gasi0n per hour (1 hr min) 61.50
CCB Lie.: 89go2. Electrical Lic.. 3.) 4 lI f( • Suprv. Lie.: 39.31 -+ -S Industrial plant per hour 73.75 i
ELECTRICAL PERMIT. FEES`
5uprv. Electrician signature, required ( 1_09e/O ______ Subtotal! , • _
3. 50
Print name: Wc� L Cos-te �J Date: i 1 11 j 0 r ,
Plan review (25 h of permn fee):
V suit surcharge (R% fee); i -4, 22,
Authorized signature: TOTAL PPRM1T PPE: 5 ? $
This *snail applicaaoo expires 1f a pta'mlr 1s sal obtained within 160
Print name: Dace:
days after it has assn aeeepoerl OP ramie*.
• Number of inepoetions allowed porpermil.
r ;ratdlengukmrbwflt•►melrepp,dne asga/aa 444 1.46 l,~r1 1 I I0 /CVMFWED
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other: _
COMMERCIAL WORK .ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \ Building \Permits\ELC- PermitApp.doc 03/23/06
Community Development
Request for Permit Action
TIGARD
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard - or.gov
FROM: ❑ Owner • ❑ Applicant ❑ Contractor P City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
• Ci /State /Zip:
00 ), itep Phone No.:
PLEASE TAKE ACTI N FOR THE ITEM(S) CHECKED (✓):
$f CA PERMIT APPLICATION.
❑ FUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: ZOog- t>o 7 4140,441Z--- 2 714
Site Address or Parcel #: 973 5 I10 Z.,
Project Name:
Subdivision Name: Lot #:
EXPLANATION: 624/ 7471-1-7' 17L l t Gil 4. 7 wif7'1
yW Wry /y2.Q /1 � •��
Signature: Date:
j�
Print Name: S
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80 %'° of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fcc for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
s ; FOR :OFFICE USE ONLI'. ,v. x
Rte to S s Admin: Date B Rte to Bldt Admin: Date // O B 7(via
Refund Processed: Date /✓® B MI Invoice Processed: Date B
Permit Canceled: Date ! 06' B r;jfiral Parcel Tat Added: Date B
Recei.t # Date Method Amount $
l: \Buil ding \Forms \RegPermitAction.doc Rev 07 /26/07
CITY OF TIGARD
ti
1
BUILDING DIVISION "' ' PERMIT #: EL C2007-00782
2007 007132 1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/20/2007
Phone: (503) 639 -4171 �
Inspection Requests (24 Hrs.): (503) 639 - 4175 i "' IL EXPERED
INSPECTION WORKSHEET FOR DATE: 802008 TIME: 7:00AM PAGE: 19
SITE ADDRESS: 09735 Sw SHADY LN CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD MEDICAL MALL
DESCRIPTION: Replace disconnect, (2) branch circuits, for roof top HVAC unit. 5/13/00 ADDED (1) branch circuit.
OWNER: HAZEL INTERNATIONAL, INC AND, PHONE #:
CONTRACTOR: R C COSTEL.LO ELECTRICAL CONTRACTING PHONE #: 503
.
Inspection Request Scheduled For: Date: 8/8!2008 Pour Time: I
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 073962 -05 503 - 422 -1991
o-
Corrections /Comments /Instructions: VAi1 ( I
tI UAM
C7) eA4 tw •� cZ�o► — Co to N ® Lam -
U
r ®- a‘4. 30 c.Wit is 1 o .
I
a 'PR4:=1v-t ttel(ko.0 l*uL414.4'grii* ;a. c,L3 1- 0 kLupe,
v L I td.6 ,
6) G QI`) C F3a( L p± &bcPb \
G -Rflul.1.0 wt ire. .
1) Q (ko . NCz li ..1,`, L .. ., ' AEI a IA+aHR defects noted
- on thi eport shall be corrected and
an inspection request made within 20
"\ 1- 5-T • c SN i ' .
calendar days per OAR 918 - 271 -0030
ti -13- N No IF Ls 40 gi• '\3.1
PASS ❑ PARTIAL APPROVAL ❑ CANCEL Ill NO ACCESS
k__�• CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: CrThr n v V3 1 -6 Date: '/) % v Phone #: (503) 718 - tMb.