Permit CITY OF TIGARD ELECTRICAL PERMIT
' * . ' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00172
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/06/2011
Parcel: 1 S136CD02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Project: Costco Subdivision: Lot: 0
Project Description: Electrical for new produce cooler.
Contractor: COCHRAN INC Owner: COSTCO WHOLESALE CORPORATION
7550 SW TECH CENTER DR. #220 PROPERTY TAX DEPT 111
TIGARD, OR 97223 999 LAKE DR
ISSAQUAH, WA 98027
PHONE: 503 - 234 -6564 PHONE:
FAX: 503 - 238 -2098
FEES
Quantity Description Date Amount
8 crt Branch Circuits wo /Purchase 04/06/2011 $108.12
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/06/2011 $12.97
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $121.09
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 • • - - - - 001 -0090. You ma • • . ••• • • - ru - • • irect questions to OUNC by calling 503. R? 1987 or 1.800.332.2344.
f
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 the next available inspection date.
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.
01 07:29:41 04-04-2011 1/2
Electrical Permit Application . uoR (nuic 1 I si. 0 N I \
City of Tigard Receiv
Date/B : LW e Alr ill 2Mu r Permit No.: •••-••7 .4 (..)(
. ° 13125 SW Hall Blvd., Tigard, OR 97223 Pta Review
: Ig Phone: 503.639.4171 Fax: 503.598.1960 Date/By:
III
Other Permit:
inspection Line: 503.6394175 Date Ready/By: Jurist 0 See Page 2 for
TI GA RD
Internet: www.tigard Notified/Method 7 Supplemental Information
7 .;.7;Y : pg. : :OF,,:** ..'":,:,::.: ,:' : ... "': '' ',: :::::':.,.. ' ...I . .1; ,-,,,':-..., '.. i.gylEw', ,s ,,.. , .,_ ,:•.. .. ' '
0 New construction *Addition/alteration/replacement
Please check all that apply (submit / sets of plans w/items checked below):
/
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current CI Marinas and boatyards.
''' '' ''. • CATEGORY OF coksiliucilow,..;' ..‘,', .'-=',. i' ' .,,,-:: -;,'',' exceeds 10,000 amps at 150 volts or 0 Floating buildings.
• • • ' ' ' ' ' ' less to ground, or exceeds 14,000 0 Commercial agricultural
0 1- and 2-family dwelling Commercial/industrial 0 Accessory building amps for alt other installations. buildings.
0 Multi-family Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
• • - • • • . .• , , . . ,.. , . 0 Emergency system, larger separately derived system.
. . .401 stit..INFos LocAriorl, . , . .. .. . 0 Addition of new motor load of
Job no.: L1 \I Job site address:7 5 50 5c.,,_.) D4 vlAnAr■ gi- I ODHP or more.
Six or more residential units. 0 occupancy.
Recreational vehicle parks.
0 Health-care facilities. 0 Supply voltage for more than
City/State/ZIP: ` 4 .- 0 ?... S722- 3 0 Hazardous locations. 600 volts nominal.
Suite/bldg/apt, no.: Project name: Co .. c 0 D Service or feeder 600 amps or more.
• 2 ' •‘ ', , '. ''..' '2'•: ' ' Setwoigg 2 ; ..':•,, ,,,, ..
to site:
Cross street/directions job
Description 1QtY• I Fee. I Total I .
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 . I
Tax map/parcel no.:
Limited energy, residential
75.00 2
,' 2' : ' .• , ' :: DESCRIPTION OF WORK . ; .. - ', • : , (with above sq. ft.)
Limited energy, multi-family
k.
C - 3 0 cS .--(4,,- residential (with above sq. ff.) 75.00 2
Services or feeders installationolteration, and/or relocation
v .rr.)._)C-R... C--... CN 4 e ■P 1 200 amps or less 100.70 2
0 PROPERTY - OWNER.. :: ,'" < '' : .' . , '. :., 0 Tgi■l*NT, • . • .• - : . : : , 7 201 amps to 400 amps 133.56 2
Name
401 amps to 600 amps 200.34 2
' C 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 strips 168.54 2
Branch circuits- new, alteration, or extension, i er panel
Owner signature: Date: A. Fee for branch circuits with
. , , , .. . . ,. . , . .
, .• . ,•• ••• 0. APPLICANT ' ; ' :.:l , ,. :1;1 ,coNTt■cir -rp,t.$01%, ...•., ? e b s raz i b c : j or cu f i e t eder fee,
742 2
Business name: G•r me C.k Cr-'k'( \- d--0,-- B. Fee for branch circuits without i
service or feeder fee, first
1 56.18 5- ( 9 ` 2
Contact name: branch circuit
Each add'I branch circuit
"7 7.42 s k ( (At( 2
Address:
Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: 67.84 2
- dwelling, service and/or feeder
Phone: ( )
1 : ( ) Reconnect only 67.84 2
Pump or irrigation circle _ 67.84 2
E
. Sign or outline lighting 67.84 2
Signal circuit(s) or limited-energy
Business name: ('5')r\ c\ can panel, alteration, or extension. Page 2 2
*,, r\c...
. Each additional inspection over allowable in any of the above
, t -
Address: - 1550 5 \i‘i ( e_ C - .4 A --- #2,20 Additional inspection (I hr mm) 66.25/ hr
" Investigation (I hr min) 66.25/ hr
City/State/Z1P: -- ( - 7 6 6., 0 OK Q 72 2._
. Industrial plant (1 hr mm) 78. I 8/ hr
Phone: 503 ) 2 ii„562y* Fax: (; ) .2_3g- 2_09 ?' Inspections for which no fee is
90.00/ hr
specifically listed (Vu hr mm)
CCB Lic.: 7z $42 Electrical Lic.: 17546 ell Suprv. Lic.: 341475 ', " r; FEES''' •
Suprv. Electrician signature, required: - t ta
Plan review (25% of pe ' 12--
13.2'
rt
Print name: 0 „Ai, Kce\--0 Date: k-k t qk ■ k State surcharge (12% of pennit fee):
_
TOTAL PERMIT FEE: \ 2. 3
Authorized signature:
This permit application expires if a permit is not obtained within 180
Pr11t name D days after it has been accepted as complete.
ate: 1 :
, Number of inspections allowed per permit.
1: Penn its■ELC-Perm it A pp.doc 07'01'10 440-4615T(11,05,COMMES