Permit . , CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00588
4, , 0 DEVELOPMENT SERVICES DATE ISSUED: 9/22/03
fill 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 - 4171
PARCEL: 25101 DC -00200
SITE ADDRESS: 13535 SW 72ND AVE 165
SUBDIVISION: 72ND AVE OFFICE BUILDING ZONING: C -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installion of (2) 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: 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 9/22/03 $53.50
[TAX] 8% State Tax 9/22/03 $4.28 Rough -
Electi 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: 4dik Permit Signature: q ----
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: 3 `/ S
Call 639 -4175 by 7:OOpm for an inspection the next business day
Electrical Per 't Application
CH VE Date receiveq o ?a o3 Permit no, :4 3 -- t s g
4 { ; I' r
�) j ..� �! City of igar Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, rd Date issued: By:-3) I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 CITY OF TIGARD Case file no.: Payment type:
Land use approval: BUILDING DIVISION
0 1 & 2 family dwelling or accessory Commercial/industrial 0 Multi - family enant improvement
0 New construction 0 Addition/alteration/replacement 0 Other: 0 Partial
3013 SITE INFORMATION
Job address: /3 1, I Subdivision:
S -72 N i� Bldg. no.: Suite no.: / (., Tax map /tax lot/account no.:
Lot: Block:
Project name: 1 Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Business name:, [„ e,os-f to Description Qty. (ea.) Total no. Imp
New residential - single or muhi- family per
Address t v
? 13)oX 33 dwellingunit . Includes attached garage. •
City: Avroro, I State:0 E I ZIP: g7O0 2 Seniceincluded:
Phone:q02 1 FaxR 32. 7L./ o / I E -mail: 1000 sq. ft. or less 4
CCB no.: 8 L/ a 'Elec. bus. hc. no: -3 4z/ C
Each ed energy, residential sq. ft or portion thereof
Limited energy, residential 2
Cit ' etro ic. no.: ? 9v Limited energy, non- residential 2
Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date C1/43i 03 Service and/or feeder 2
Sup. elect. name (print): 0 : ep ' I License no. SZ-/- - Services or feeders installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: 'State: 'ZIP: Over 1000 amps or volts 2
Phone: l Fax: 1E-mail: Reconnect only 1
Owner installation: The installation is being made on property 1 own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to htstallation, alteration, orrelocatioo:
200 amps or tens 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: 'State: 'ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 7 y8$6 2
Phone: Fax: E -mail: Each additional branch circuit:
G. Gti
PLAN REVIEW (Please check all that appl)) Misc. (Service or feeder not included):
O Service over 225 amps - commercial Cl Health -care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of 1&2 O Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* - 2
O Building over three stories O Feeders, 400 amps or more *Description:
O Occupant load over 99 persons CI Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan O Other. Per inspection 1 1_ 1 1
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ 5
O Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card number: / / within 180 days after it has been State surcharge (8%) $ • a
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
Cardholder signature Amount 440.4615 (6/00/COM)
Electrical Permit Fees: Limited Energy Fees: -
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed , (FOR ALL SYSTEMS)
Service included: Items ' Cost Total 4, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40. 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular ❑ Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2 Er Vacuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 -260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. n Audio and Stereo Systems
Branch Circuits ❑ Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit / $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 n Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ ❑ Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i:\dsts \forms\elc- fees.doc 10/09/00
CITY OF TIGARD 24 -Hour y - •
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / — a 7 AM PM BUP
Location / 3 3 suite / Co 3 MEC
Contact Person Ph ( ) 75'8 8 PLM
Contractor Ph ( ) SWR o�
BUILDING Tenant/Owner ELC 3-40 b F6
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 D 1 I C (� 3 0
Drywall Nailing
Firewall c c - 0 �� \�
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 Alarm
X Reinspection fee of .$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE ❑ Please call for - inspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA Date 0 Z" dlo Inspect Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection recor from th ob site.
PASS PART FAIL
CITY OF TIGARD 24- HouF ::..
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
q BUP
Received Date Requested ! ce AM PM BUP
Location /35 72 ^D Ave • Suite / 4p MEC
Contact Person CA" ) S Ph ( ) 5 4 — 6758 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner arip — 00 553
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam /� l
Shear Anchors
P /ilk co v W
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
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
UG/Slab
Low Voltage , ,�
a1Is1
`/ PART FAIL
El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE El Please call for reinspectio RE: Unable to inspect — no access
Fire Supply Line
ADA
/
Approach/Sidewalk Date ir <1...5 Inspector
PP
Other:
Final DO NOT REMOVE this inspection record f m the Job ite.
PASS PART FAIL