Permit CITY OF TIGARD
PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELC2008 00448
DATE ISSUED: 8/6/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 136DD - 05300
SITE ADDRESS: 11850 SW 67TH AVE 100 ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT : 013 JURISDICTION: TIG
PROJECT: TIGARD TRIANGLE COMMONS
Project Description: Installing (6) branch circuits.
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/0 SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 5 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:
LARSON, IRVING L/JENNIE E TRS RC COSTELLO ELECTRICAL CONTRATING
BY JUDY L STROJNY PO BOX 336
555 CHESTERTOWN ST AURORA, OR 97002
GAITHERSBURG, MD 20878
Phone: Contact #: PRI 503 - 982 -7400
FAX 503 - 982 -7401
FEES
Description Date Amount Reg #: ELE 3344C
[ELPRMT] ELC Permit 8/6/2008 $80.10 LIC 87402
[TAX] 12% State Surchar 8/6/2008 $9.61 SUP 3934S
Total $$9.71 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. - • stain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
VP
Issued By: r ::��— 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'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.
�- v f . f
Electrical Permit Application ®q ~ 4 � t� Lv FOR OFFICE'USE ONL a
,n , ' : ece - • C of Tigard r D. : .g._ Permit No.: G G te- -4 1 it
'
Ph one: 50 3 . 639 . 4171 F ax: 503.598.1960
. q 13125 SW Hall Blvd., Tigard, OR 97223 , •
g
0 O't Plan Review Other Permit:
`, Date/By:
Inspection Line: 503.639.4175 AUG ' 5 2�
TIGARD ;ca Ready/By: lur See Page 2 for
Internet: www.tigard - or.gov � q t etho i • Supplemental Information
ail •
E OF - WORK _ � . (± � � - , . • PLAN REVIEW.
❑ New construction Addition /alteration /I® 73 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 Y OF CONS • - exceeds 0 000 amps at 150 volts or Floating b
- 10,000 Its o g uildings.
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
. ❑ Emergency system. larger separately derived system.
• JOB SITE INFORMATION AND LOCATION . • • . ❑ Addition of new motor load of ❑ "A ", "E ", ` I -2 ", "1 -3 ",
Job no.: Job site address: / / 850 S (,v ( 7 -(11 Vn IOOo or more residential R occupancy.
❑ Six or more residential units. ❑Recreational vehicle parks.
City/State /ZIP: I iqq rc., o R 0 112 2 7 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
S
- ui� bldg. /apt. no.: / 0 0 Project name: J 7 1 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE' . :.'
Cross street/directions to job site: TT cso7I f c er .t� e
ri ,, ,n � - Description 1 Qtr. 1 F«• 1 Tow 1 "
1/ '7 Yf 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
.. DESC RII'TION OF WORK • • • (with above sq. ft.)
Tt tit n Limited energy, multi - family 75.00 2
/3C il e /, c „ t • 4 S � r • re ete +n L L S residential (with above sq. ft.)
r Services or feeders installation, alteration, and/or relocation
C4 /1 a re sW 1'+ C L, ) i 1 hi i k 7 / 200 amps or less 80.30 2
❑ PROPERTY OWNER' -- .. • • • .❑ 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: 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 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, 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, .- .• . • . ❑ CONTACT PERSON er fee, 6.65 2
abo ve service or feed ee
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, )
Contact name:
first branch circuit 46.85 %, 76
Address: Each add'I branch circuit 5 6.65 3
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: / a Co'.s -i2 / 1, Signal panel, or limited -
energy panel, alteration, or
Address: PO, 13 o)( 33 b extension. Describe: Page 2 2
City/State /ZIP: 0 u ro ,.- o T 9 9 Ov L Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( 50)) 992-9z-10o Fax: (S o)) oi 62_ • L / J / Investigation per hour (I hr min) 62.50
CCB Lic.: S 990 Z. Electrical Lic.: 3 -3�� Suprv. Lic.: - 3c1 5 s Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: W(' ! Subtotal:/ (v
Print name: i z z . ( C 5+1 11 Date: 6 (� t6
-) Plan review (25% of permit fee): State surcharge (12% of permit fee): l /
Authorized si nature: TOTAL PERMIT FEE:
a
g This permit application expires if a permit is not obtained witti 't80
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
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL 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:
COMMERME 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
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2008 -00448
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/6/2008
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 s': °'I ..
INSPECTION WORKSHEET FOR DATE: 9110/2008 TIME: 7:00AM PAGE: 3
SITE ADDRESS: 11850 SW 67TH AVE 100 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 013 TYPE OF USE:
PROJECT NAME: TIGARD TRIANGLE COMMONS
DESCRIPTION: Installing (6) branch circuits.
OWNER: LARSON, IRVING L /JENNIE E TRS, PHONE #:
CONTRACTOR: RC COSTELLO ELECTRICAL CONTRATING PHONE #: 503 -982 -7400
Inspection Request Scheduled For: Date: 9/10/2008 Pour Time:
Code # Inspection Description Confirm # Contact # N
199 Electrical final \ 075328 -01 501312 -3876 \ Y'
Corrections/Comments/Instructions:
\,(\
\ \
I/ \
_A PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �' N Li Date: 9[ Phone #: (503) 718- YK
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2008.00448
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 016/2008
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 ....':� I ...
INSPECTION WORKSHEET FOR DATE: 8/22/2008 TIME: 7:01AM PAGE: 11
SITE ADDRESS: 11850 SW 67TH AVE 100 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 013 TYPE OF USE:
PROJECT NAME: TIGARD TRIANGLE COMMONS
DESCRIPTION: Installing (6) branch circuits.
OWNER: LARSON, IRVING LIJENNIE E TRS, PHONE #:
CONTRACTOR: RC COSTELLO ELECTRICAL CONTRATING PHONE #: 503-982 -7400
Inspection Request Scheduled For: Date: 8122/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 Ceiling cover 074544 -0i\ 503 - 5047214 N
\ )
Corrections/Comments/Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: , N O21 Lam! Date: l' 7 1- ' 14 Phone #: (503) 718- Zi l i t
CITY OF TIGARD --
BUILDING DIVISION , , PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: /6 /2 0(18 O(?r148
8
Phone: (503) 639 -4171 ICI /5l200t3
Inspection Requests (24 Hrs.): (503) 639 -4175 ...' � —
INSPECTION WORKSHEET FOR DATE: 8/7/2008 TIME: 7:01AM PAGE: 20
SITE ADDRESS: 11850 SW 67TH AVE 100
CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT # 013 TYPE OF USE:
PROJECT NAME: TIGARD TRIANGLE COMMONS
DESCRIPTION: Installing (6) branch circuits.
OWNER: LAI SON, IRVING LJJENNIE E TRS, PHONE #:
CONTRACTOR: RC COSTELLO ELECTRICAL CONTRATING PHONE #. 503 -382 -7400
Inspection Request Scheduled For: Date: Pour Time:
8/7/2008
Code # . Inspection Description Confirm # Contact # Message
126 Wall cover 073886 -01 503- 6046758 N
Corrections /Comments /Instructions: \ .
f t N% n waLL ) 0 - it,\ C.b\I . _
n PASS 0 PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
1 I FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ' • 1 "" Date: '$ 1' Phone #: (503) 718- 016