Permit r• CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00644
DEVELOPMENT SERVICES DATE ISSUED: 9/1/2005
5' 'I I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S110DC - 02300
SITE ADDRESS: 11545 SW DURHAM RD B - 6 ZONING: C - G
SUBDIVISION: WILLOWBROOK BUSINESS PARK LOT: JURISDICTION: TIG
Project Description: (5) 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: 4 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:
HARSCH INVESTMENTS R C COSTELLO ELECTRICAL
1121 SW SALMON ST ROGER COSTELLO
PORTLAND, OR 97205 1439 SE 17TH LOOP
CANBY, OR 97013
Phone: Phone: 263 -2385 FAX
266 -8483
FEES Reg #: SUP 3834S
Description Date Amount LIE 87402
• ELE 3 -344C
[ELPRMT] ELC Permit 9/1/2005 $73.45
[TAX] 8% State Surcharge 9/1/2005 $5.88 REQUIRED ITEMS AND REPORTS
Total $79.33
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: 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.
Electrical Permit Application Foil OFFICE USE ONLY
City of Tigard Received . PennitNo.: �
C yy
Date/By. 1 C/ ) M
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
A Phone : 503.639.4171 Fax: 503.598.1960 ,p iy. I4 , Date /By Other Permit:
Inspection Line: 503.639.4175 " -' f Date Ready/By: H See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: ININ Supplemental information
T YPE OF WORK • PLAN REVIEW
❑ New construction Er Addition/alteration /replacement Please check all that apply:
❑ Demolition 12 Other:
ID Service over 225 amps, comm'l 0 Hazardous location
0 Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
' . - ' , . CAT OE CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling Lldto e ei 1/industrial ❑ Accessory building 0 System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑ Other ❑Building over three stories ❑Feeders, 400 amps or more
, ❑Occupant load over 99 persons 0 Manufactured structures or
• ,., ' , JOB SITE .INFORMATION AND 'LOCATION ❑EgressAighting plan RV park
Job no.: Job - site address: ! / ! 0 Health-care facility ❑Other:
1 5 { � j 1' lH' � fN n' 1 Submit 2 sets of plans with any of the above.
City / State/ZIP: S .Qtr (n :C7 The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: Project name: / FEE* SCHEDULE
Description J Qty. I Fee, Total I ""
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
,
DESCRIPTION OF WORK Each Limited manufact or modular non - residential 75.00 2
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
• 200 amps or less 80.30 2
❑ PROPERTY OWNER JD TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 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 I 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 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
' 7 ❑ APPLICANT ❑ CONTACT PERSON- A. Fee for branch circuits with ,
- service or feeder fee, each 6.65 2
• Business name: branch circuit .
Contact name: B. Fee for branch circuits
without service or feeder fee,
each branch circuit 46.85 G�6 °? 2
Address: Each add'I branch circuit 6.65 2‘ , d 11 2
City /State/ZIP: Miscellaneous (service or feeder n6t included)
• Phone: ( ) • F; : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited- '
. ,- CONTRACTOR - energy panel, alteration, or
,. C• W S 4e f extension. Describe: Page 2 2
Business name:
Address: {� 12 0-.../ 3 3 CO Each additional inspection over allowable in any of the above
1 o Per inspection 62.50
City /State /ZIP: At / ro r.o () 12 G boo Z. Investigation per hour (1 hr min) 62.50
S2 - 7Ll0 / Industrial plant per hour 73.75 •
Phone: (50 3 ) ci 52 . -7 6/00 Fax: ( 503 c
ELECTRICAL PE RMIT FEES *'
CCB Lie.: r1-102—. Electrical Lie.: 33 y y C Suprv. Lie.: 3 9 3 dt s Subtotal 7 , j ,
Suprv. Electrician signature, required: ( Plan review (25% of permit fee)
•
Print name: t e 0, s ke 1 Date: State surcharge (8% of permit fee)
l 1 TOTAL PERMIT FEE 71 ‘3.37 ' Authorized signs re: ,. This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
' is \Building\Pernits \ELC- PennitApp doc 12/03 440-4615T(10/02/COM /WEB ,
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RE�SIDENTIALWORKONLY:;� � -_ � �'�
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:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
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
is \Building \Permits \ELC- PermitApp.doc 04/03
CJTY TIGARD *.
BUILDING DIVISION PERMIT #: ELC2005- 00644
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/1/3005
Phone: (503) 639 -4171 oo��4U��ii�� �I l
..
Inspection Requests (24 Hrs.): (503) 639 -4175 ,, °__..
INSPECTION WORKSHEET FOR DATE: 9/W2005 TIME: 7:09AM PAGE: 15
SITE ADDRESS: 11546 SW b RHAM RD B - 6 CLASS OF WORK:
SUBDIVISION: WLLOWBRO( BUSINESS PARK LOT #: TYPE OF USE:
PROJECT NAME: SPEC SPACE
. DESCRIPTION: (5) branch circuits.
OWNER: HARSCH INVESTMENT, PHONE #:
CONTRACTOR: R C COSTELLO ELECTRI ► AL PHONE #: 263 FAX
Inspection Request Scheduled For: Date: 9/8/2005 Pour Time:
Code # Inspection Description C• ifirm # Contact # Message
i
199 Electrical final ;16 86-$1 503 -504 -6758 Y .
Corrections /Comments /Instructions: • R / I) =.�
L r7/2-. ',� � 7, ° � Di
•
•
j --------- PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1 60 Date 1(`�f Phone #: (503) 718- 2
I
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