Permit A, ‘. CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00385
IT'LL DEVELOPMENT SERVICES DATE ISSUED: 6/28/2004
13125 SW Hall Blvd.. Tioard, OR 97223 (503) 639 - 4171
PARCEL: 1 S136CD -00600
SITE ADDRESS: 08060 SW PFAFFLE ST 100
SUBDIVISION: SPRINT PCS WIRELESS MONOPOLE ZONING: C -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: 12 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/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 11 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:
CAMERON, KIRK (EEI SOLUTIONS) R C COSTELLO ELECTRICAL
5665 SW MEADOWS RD. ROGER COSTELLO
STE. 300 1439 SE 17TH LOOP
LAKE OSWEGO, OR 97035 CANBY, OR 97013
Phone: 503 - 221 -1121 Phone: 263 -2385 FAX
Reg #: 28B-8483 3834S
LIC 87402
FEES ELE 3 -344C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/28/2004 $120.00
[TAX] 8% State Surcharge 6/28/2004 $9.60 Rough -
Elect'l Final
Total $129.60
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 -800-33 - 44.
Issued By: Permit Signature:< -. C C--
7
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 639 -4175 by 7:OOpm for an inspection the next business day
i
4 ,, __r fa OOP _
Electrical Permit A n ' lion FOR OFFICE USE ONLY
� , Received Electrical /
R EC EI Date/By: W a # 0 I/ a Permit No.: al— WS
f Tigard Planning Av Sign
City 0 g Date/By: Permit No.:
13125 SW Hall Blvd. JUN 2 8 2004 Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503 -639 -4171 F adIT 50 $dRWt // � Post- Review Land Use
�" +�
Date/By: No.:
Internet: www.ci.tigard.o� t PI NG DIVISION w ■ op �r r�� Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 03 -639 -4175 ' -" . .J Name/Method: 1 c Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction I ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition /alteration/replacement f.2 Other: j . J ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling El/Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
_
The above are not applicable to temporary construction service.
Job site address: 1::;5O(ce) G LJ P- a- - (t FEE* SCHEDULE
Suite #: 100 Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: - Rna -}-1 -o n; g/1) Description Qty Fee (ea.) Total
New residential- single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
o 14 11 1000 sq. ft. or less 145.15 4
A Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: 1 Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
7 � Services or feeders - installation,
-
Rm i k C t rc.0 i + -Fvr re(IQ p+aG lef alteration or relocation:
200 amps or less 80.30 2
a n 01 I i e1 k fi /►l 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
IB ROPERTY OWNER TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: C O 1Vi Q r o V 1 r K Reconnect only 66.85 2
Address: S(p(oS 5 j Op el (jou, c pd. St,; t�O, Temporary services or feeders - installation,
alteration, or relocation:
City/State /Zip: i re OS W Q_) n 3 Q Q (703f 200 amps or less 66.85 1
Phone: 503 - 22.1- 11 Z I I ax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
❑ APPLICANT I ❑ CONTACT PERSON Branch circuits - new, alteration, or
Naive: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City/ State/Zip: B. Fee for branch circuits without purchase of / �r
`J p service or feeder fee, first branch circuit 1 46.85 `70.'t17 2
Phone: 1 Fax: Each additional branch circuit 11 6.65 7s IS 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
Business Name: W. e �f e' L EI e „ ( O , Description: or extension Page 2 2
W/ti�
Address: ?0. 112)(
OR Each additional inspection over the allowable in any of the above:
�Ot,
City/State /Zip: R O e 9100e.... Per inspection per hour (min. 1 hour) 62.50
PhOne:5Q3 -qgZ -'7Uov Fax :503- y82 - -- )1.4 0 / Investigation fee:
Other:
CCB Lic. #:87L/ p Z Lic. #: S -3 f G/(' Electrical Permit Fees*
Supervising electrician Subtotal $ / ,ZO. 00
si : ature re • uired: Plan Review (25% of Permit Fee) $
of
Print Name:'R (r �i .44 14 Lic. #: 3g3/4_f _ State Surcharge (8% Permit
TOTAL PERMIT FEE $ 12 q . 6 v
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set. by Tri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Petmit FormskElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information .
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems 575.00
Check Type of Work Involved:
Audio and Stereo Systems
O Burglar Alarm
❑ Garage Door Opener
❑ Heating, Ventilation and Air Conditioning System
L Vacuum Systems
▪ Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
O Audio and Stereo Systems
Boiler Controls
• Clock Systems
0 Data Telecommunication Installation
El Fire Alarm Installation
HVAC
❑ Instrumentation
E l Intercom and Paging Systems
O Landscape Irrigation Control
n Medical
El Nurse Calls
• Outdoor Landscape Lighting
❑ Protective Signaling
El Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
•
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection-Linei (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
nn / BUP
Received Date Re uested ' 1 (° AM PM BUP
Location . 61,e7 D Suite / C) MEC
Contact Person Ph ( ) 53 4 7 4 - -7A-80 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC ,,a74 0 V —d 43 (5'5
Footing
Foundation ELC
Access:
Ftg Drain ELR
•
Crawl Drain
Slab Inspection Notes: SIT A rAk
Post & Beam
Shear Anchors _
— Ext Sheath/Shear
Int.Sheath/Shear
Framing
Insulation 1 / r _ /� F Af �,
Drywall Nailing L F o/� /l�f�L�
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL •
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire larm
•
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SI Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Date nspecto
�� I
` / l (SM Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL