Permit CITY OF TIGARD ELECTRICAL PERMIT
� n
gip- COMMUNITY DEVELOPMENT Permit #: ELC2009-00504
1GA 13125 SW Hall Blvd , Tigard OR 97223 503.639 4171
Date Issued: 09/29/2009
Parcel: 1S136CD02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Subdivision: Lot: 0
Project: Costco
Project Description: (2) branch circuits
Owner: FEES
COSTCO WHOLESALE CORPORATION Quantity Description Date Amount
PROPERTY TAX DEPT 111, 999 LAKE DR
ISSAQUAH, WA 98027 2 crt Branch Circuits 09/29/2009 $53.50
wo /Purchase Service or
PHONE Feeder
1 ea 12% State Surcharge - 09/29/2009 $6 42
Electrical
Contractor:
AC & E ELECTRIC
3535 DEL WEBB AVE #100
SALEM, OR 97303
PHONE: 503 - 363 -2301
FAX 503 - 363 -2302
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59 92
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 -0 1 -010 You may obtain a copy of the rules or direct questions to OUNC by calling 503 246 6699 or 1 800 332 2344
Issued By: 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 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.
El Permit Applic . � FOR OFFICE USE ONLY �
•. ° of Tigard C p Date/By / / � � Penult o C GC .2oa9 o i
- 13125 SW Hall Blvd , Tigard, OR NP�t3 2009 Plan Review
Phone. 503 639 4171 Fax 503 598.1960 Date /By Other Permit / 7O7. -op/3?
TIGARD Inspection Line 503.639 4175 CITY OF TIGARD Date Ready /By 1 ® See Page 2 for
• Internet' www tigard- or.gov BUILDING DIVISION+ Notified/Method / /9 Supplemental Information
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Please check all that apply (submit 2 sets of plans w/items checked below)
El New construction ® Addition/alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards
;: ' / L CA T E , CORY ` Cp rn N : exceeds 10,000 amps at 150 volts or Floating buildings
�' `° "' ° "` (z � ' " °` " " "' ' �'' ' � 4.-!- ' " "" °�` 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
,, ,,;, -. . , «,:,, 3 .., , . m ,,,,
,v ; , , ; ;•; g,, ,,,R ..,Y ❑ Emergency system larger separately derived system
.• r B SIT I1YF AN L OC - , ` % := Addition of new motor -
.. „.. ,._. , , .a ,� •,ice „�.. ..,. a�xxia.. ,aoa �. .� �„ � ,.>�` .. -..,Y �` ❑ d e otor load of ❑ .. ., .. . I.3 -,
Job no.: Job site address: artmouth Ave 1ooHP or more occupancy
D
❑ Six or more residential units ❑ Recreational vehicle parks
City /State /ZIP: Tigard, OR / 8:. ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite /bldg. /apt. no.: Project name: Costco tire center entry ❑ Service or feeder 600 amps or more
•
Cross street /directions to job site: ' Description FE.E°-SCtI Qiy. I , Fee. ,•'• ' .- � I
Descri tion - Fee. Total
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 75 00 2
3; : ; - impESCRIPT,ION.;''OFWORK • • , (with above sq ft )
Limited energy, multi- family 75.00 2
re- routed a conduit to allow remodel of the tire center entry residential (with above sq ft )
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
.M ;:, .:" <.'P1t. frEfITy R ;pax=�-�: ,u t . •,
O WNS, �.` ..� TENANTn;; ° "' 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: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66 85 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
_'T ' ARPJ CANT- i "' fee,
:.a .. ,,s, ❑- GQNTAf •PER - . , 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, 1 46 85 46 85 2
first branch circuit
Address: Each add'I branch circuit 1 6.65 6 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
z "`'z` '1 :, ° `' '`' >?: <"`�" "```- /" / ::_ ` Sign or outline lighting ,, -,>: „ _„ , , , �r����;- , ., . . 'CUNTRA�TOR� , , ... ,� �,y • -s °:.. , , g g g 53 40 2
Business name: AC &E Electric Signal circuit(s) or limited -
energy panel, alteration, or
Address: 3535 Del Webb Ave extension Describe. Page 2 2
City /State /ZIP: Salem, OR Each additional inspection over allowable in any of the above
Per inspection 62 50
Phone: (503) 363.2301 F • (503) 363.2302
/ Investigation per hour (1 hr nun) 62 50
CCB Lic.: 591 =/ Electrical Lic.: 2 - ' Suprv. Lic.: 5387S Industrial plant per hour 73.75
41RICA `- PERMIT FEES`: ' "' `'` 9
Suprv. Electrician signature, required: I "�$-- Subtotal: 53 50
Print name: Carl Duncan Date: 9/28/09
Plan review (25% of permit fee)
State surcharge (12% of permit fee): 6 42
Authorized signature: TOTAL PERMIT FEE 59 92 L
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
1 \Building Termas\ELC- PermitApp doc 05/23/06 440- 4615T(11 /05 /COM/WEB
OCT. 30.2009 1;49PN1 5036455357 c<N0.6994Dev 1/4:
Bunning 1 lvision
—/ ° . "' 13125: SW Hall Blvd.
• 1 LC A11Y3 Tigard, OR 97223
503.639 -4171
Walter "Chip" Barnett TV Direct 503.718.2644
K�.,E /OVPELDER Building Inspector II rax 503.624.3681
Bdph People. Right solutions. winter @egeor1- or,gov TDD 503.684.2772
Web wow Tigard or-gov
eh?, - _ 6(
Date: October 27, 2009 a..14 1/0 —
Project No: 106431
COSTCO WHOLESALE ie. .
c/o IVlulvarinyG2 Architecture
1110 112 Avenue NE, Suite 500
Bellevue, Washington 98004
Attention: Mr. Jan Hromada -- Project Manager RECEIVED
Subject: Final •Special Inspection Report NOV 0 3 2009
Costco Wholesale Warehouse #111
Tire Sales Entry Remodel CITY OF TIGARD
7850 SW Dartmouth Street BUILDING DIVISION
Tigard, Oregon 97223
MulvannyG2 Architecture Project No. #95- 1840 -14
Dear Mr. Hromada:
This final special inspection report has been prepared to document that Kleinfelder's
field professionals have performed special inspection and materials testing services on
the following elements of the work as required by the project plans, specifications, and
International Building Code (IBC) requirements at the above referenced address:
. Proprietary Anchor (Epoxy and Mechanical);
• Reinforced Concrete;
. Structural Steel ( Welding and High Strength Bolts ); and
• Structural Masonry;
Kleinfelder's ICC certified special inspectors and testing professionals conducted the
above listed inspections and testing services between September 18 and 25, 2009.
Based upon our inspector's personal observations of these items and written reports
regarding this work, it is our professional opinion that the above inspected work was
performed, to the best of our knowledge, in accordance with the approved plans,
L:1 2009 1Projects11064311POR91. Page 1 of 3 October 27, 2009
2009 KleInfelder
9200 SW Nimbus Avenue, Suite A BeavQdon, Oregon 97008 _ 503 -644 -9447 503 -643 -1905 fax
ONLY THE CLIENT OR ITS DESIGNATED REPRESENTATIVES MAY USE THIS DOCUMENT AND
ONLY FOR THE SPECIFIC PROJECT FOR WHICH THIS REPORT WAS PREPARED.
OCT, 30. 2009 1:49PM 5036455357 N0. 6994 P. 2/4
specification, and the applicable workmanship provisions of the International Building
Code.
Test results or special inspections and observations reported are those existing at the
time of our services and may not be the same or comparable at other times. As our
client, please recognize that construction monitoring is a technique employed to reduce
risk of problems arising during construction, Provision of construction monitoring by
Kleinfelder personnel is not insurance, nor does it guarantee construction of any type.
Even with diligent monitoring, some construction defects may have been missed. In all
cases, the contractor shall retain sole responsibility for the deficiencies or omissions,
regardless of when they are found. We do not undertake the guarantee of construction
or production of a completed project conforming to the project plans and specifications.
This work was performed in a manner consistent with that level of care and skill
ordinarily exercised by other members of Klelnfelder's profession practicing in the same
locality, under similar conditions and at the date the services are provided Our
conclusions, opinions, and recommendations are based on a limited number of
observations and data. it Is possible that conditions could vary between or beyond the
data evaluated. Kleinfelder makes no other representation, guarantee or warranty,
express or implied, regarding the services, communication (oral or written), report,
opinion, or instrument of service provided.
The work performed was based on project information provided by Client. If Client does
not retain Kleinfelder to review any plans and specifications, including any revisions or
modifications to the plans and .specifications, Kleinfelder assumes no responsibility for
the suitability of our recommendations. In addition, if there are any changes in the field
to the plans and specifications, Client must obtain written approval from Kleinfeider's
engineer that such changes do not affect our recommendations. Failure to do so will
vitiate Kleinfelder's recommendations.
L: 120091Projeets11064311PQR9L074 .doe Page 2 of 3 October 27, 2009
2009 Kleinfelder
9200 SW Nimbus Avenue, Suit A : Beaverton, Oregon 97008 503 -844 -9447 503 -043 -1905 fax
ONLY THE CLIENT OR ITS DESIGNATED REPRESENTATIVES MAY USE THIS DOCUMENT AND
ONLY FOR THE SPECIFIC PROJECT FOR WHICH THIS REPORT WAS PREPARED
OCT, 30. 2009 1:49PM 5036455357 NO. 6994 P. 3/4
We trust that this report meets your needs at this time. If you have any question
regarding our professional services or require additional information, please contact our
office at (503) 644 -9447,
Respectfully submitted,
KLEINFELDER WEST, INC.
Stacie Steel'
Materials Group Manager
cc: Dan Kemnitz - Robinson Construction
Andy Franks Kleinfelder Client Service Manager
L; 12009 \ProJects1106431 \POR9L074.doc Page 3 o 3 October 27, 2009
® 2009 Kleinfelder
0200 SW Nimbus Avenue, Suite A •) Beaverton, Oregon 97008 503- 644 -9447 503- 643 -1905 fax
ONLY THE CLIENT OR ITS DESIGNATED" REPRESENTATIVES MAY USE THIS DOCUMENT AND
ONLY FOR THE SPECIFIC PROJECT FOR WHICH THIS REPORT WAS PREPARED.