Permit -CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00523
i DEVELOPMENT SERVICES DATE ISSUED: 8/21/03
`�'� ..� I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 25101 DC -00200
SITE ADDRESS: 13535 SW 72ND AVE 100
SUBDIVISION: 72ND AVE OFFICE BUILDING ZONING: C -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: Tenant Improvement
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: SIGNAUPANEL:
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:
PACIFIC NW PROPERTIES LTD PTNSHP RC COSTELLO
9665 SW ALLEN BLVD STE 115 PO BOX 336
BEAVERTON, OR 97005 AURORA, OR 97202
Phone: Phone: 503 - 982 - 7400
Reg #: LIC 87402
ELE 3 -344C
FEES SUP 3934S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/21/03 $53.50
[TAX] 8% State Tax 8/21/03 $4,28 Elect'I Final
Total $57.78
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.
/
Issued By: Permit 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: / i /0 3
LICENSE NO: 3q 3 ti- 5
Call 639 -4175 by 7:OOpm for an inspection the next business day
• ." FOR OF}10E USE ONLY
Electrical Permit Application Received Electrical
Date/B : i 1 2 d 3 11 ,! //I Permit No.: ' ,/. , _ it ,S.
City of Ti and Planning Approval / Sign
ty g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
//a�r�Alp ( Date/By:
Case No.:
Internet: www.ci.tigard.or.us ■ � el Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 _" I Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Plea se check all that apply)
['New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY OF CO TRUCTION 1 & 2 family dwellings four or more residential units in
ill & 2- Family dwelling [ C ommercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant Toad 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: S l3s SW n (,l Ai V Q, ll J Q, FEE* SCHEDULE
Suite #: /do 1 B1d_. /Apt. #: / Number of inspections per permit allowed
Project Name i f c - T c S i ° • , Hi 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:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: 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
L Services or feeders - installation,
. j ranc i1 C 1 rC v I l'S " CR. r rtee f-4-AL le S alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
APPLICANT ❑ CONTACT PERSON 401 to 600 amps 133.75 2
❑ Branch circuits - new, alteration, or
Name: 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 ' I
service or feeder fee, first branch circuit 1 46.85 1 -6 5 2
Phone: I Fax: Each additional branch circuit j 6.65 ,go,(. 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: J t- I P.G T 1 f,,,- Description:
Signal circuit(s) or a limited energy panel,
I Io L or extension Page 2 2
^ Bus i ness Name: T5 t O i's -I e Descripti onn:
Address: - PO 3oA 33 �o
n f7 � Each additional inspection over the allowable in an of the above:
n
City /State /Zip: u ro co. U 2 vl ? 007_ Per inspection per hour (min. 1 hour) 62.50
Phone: qq2- 7'-100 Fax: c g Z - 7LIo) Investigation fee:
CCB Lic. #:F37 CIO Z Lic. #: S -3L-11-1 Other:
1 C Electrical Permit Fees*
Supervising electrician Subtotal $ -51, co
Signature required: Plan Review (25% of Permit Fee) $
Print_Name: y¢,- ' 5-4 e I 0 Lic. #: VI S4 S State Surcharge (8% of Permit Fee) $ q. ZS?
TOTAL PERMIT FEE $ 5 '7B
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\Permit Forms\ElcPermitApp.doc 01/03
•
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
O Burglar Alarm
Garage Door Opener
• Heating, Ventilation and Air Conditioning System
El Vacuum Systems
0 Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
Boiler Controls
O Clock Systems
❑ Data Telecommunication Installation
•
❑ Fire Alarm Installation
HVAC
Instrumentation
Intercom and Paging Systems
❑ Landscape Irrigation Control
0 Medical
0 Nurse Calls
El Outdoor Landscape Lighting
0 Protective Signaling
in 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 Lines:(503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested q 9' AM PM BUP
Location / _3,C 36 - 7,,z Suite lei MEC
Contact Person ( ratio Ph ( ) 3 Z '/r to 7 s' PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 3 " DU, Xc2.3
Footing
Foundation \A ELC
' Access: -
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: \• - SIT
Post & Beam V\ RAY) ‘1\i " 1
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling ,
Roof / p
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
F1 : arm
in • Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
. •ART FAIL
SIT 0 Please call f•r rein pection RE: ❑ Unable to inspect — no access
Fire Supply Line
Approach/Sidewalk Date Inspector ro Ext
Other:
Final DO NOT REMOVE this inspection record m t j site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspectiontinlsa (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
c1 BUP
Received Date Requested f s AM PM BUP
Location r 3 5 3-s 7a /)'l Suite 1 6 0 MEC
Contact Person Ph ( q PLM
Contractor Ph ( SWR
BUILDING Tenant/Owner c-a_ ELC 3 - oo Sa 3
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing lJ n�
Firewall / %/ �/�
Fire Sprinkler ' 1
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL -
PLUMBING
Post & Beam V 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 4 / �� FF
Low Voltage �v U
Fire Alarm
i"" l Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date c.5 ) 3 Inspe or mo =d //✓ 9 Ext
Other:
Final DO NOT REMOVE this inspection record f om the Jo : site.
PASS PART FAIL
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