Permit A- „ CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00002
��� DEVELOPMENT SERVICES DATE ISSUED: 1/2/03
�---' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S126BC-01506
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 520
SUBDIVISION: ZONING. C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of (6) branch circuits for TI.
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: 5 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:
PORTLAND OFFICE ASSOCIATES R C COSTELLO ELECTRICAL
BY TC PORTLAND, INC ROGER COSTELLO
8930 SW GEMINI DR 1439 SE 17TH LOOP
BEAVERTON, OR 97008 CANBY, OR 97013
Phone: Phone: 263 - 2385 FAX
Reg #: '"40-8483 3834S
LIC 87402
FEES ELE 3 -344C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 1/2/03 $80.10
[TAX] 8% State Tax 1/2/03 $6.40 Rough -in
Elect'I Final
Total $86.50
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 wil • - 44- : '4 accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for . e than 180 da . ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
fo in OAR 952 - 001 -00 a through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1 -:00- 332 -2344.
• /
Is ed By: f ; _� l l oi �1 ;� `I / Permit Signature: 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: �!�G DATE:
LICENSE NO: X95
Call 639 - 4175 by 7:00pm for an inspection the next business day
Electrical Permit Application .
A ll. late received: / ff p 5 ___ Permit no.: t r p,5 , p�0 �
`'',1'I _ _ r
City of Tigard Pruject/appl Bpi edata:
t J Address 13 SW H Blvd, 'Tigard. OR 97223 Date issued: ( ( Receiptn
city .
Phone. ;5031 639 - 4171
Fax. (503) 598 -196() Case file no.: Payment type:
Land use approval: —
CI I & 2 family dwelling or accessory O Commercial/industrial ❑ Multi- family Tenant improvement
O New construction ❑ Addition/alteration/replacement U Other: Cl Partial
Job address go? 0 to li )61r•1,i,t /,., g K// Bldg. no.: Suite no.:520 Tax matax lot/account no.:
Lot: ame :m��Q�i >� �r�CP.SS � i Bloch: 'Subdivision:
-_
Project n Description and location of work on premises: S f 4 - c e
.
Estimated date of conlpletion/inspecuoa.
Fee Max
Job no:
Description Qty. ! (ea.) Total no. tarp
Business narne:` ;.0. cs 4 e_ ijt; E)ec- - !rtc-A. ! _ .�' n "I' 1 ^(
New residential -single or maid- family per
Address: ,1 " " _ dwelling unit. Includes attached garage.
City: ,9or 0 - i\ , State.( 72 I ZIP: CI "700 2 - Seniceincluded:
�, ;000 sq. ft. or less _._ _t 4
Phone: 5O3- Nom?_ - )=; . ;;:; _I 't� 'q,51 + 91�- nt3►l: Bach additional 500 sq, ft. or portion thereof
CCB no.: A i r-1 i Elec. bus. lic. no: 3 - 3 NL! C " L � - -" —` 2 —'
,� , _ ---\ Limited energy, residential
City tetro�lt;. no) . Li ' — 4 _ L.irnited energy,non- residential ! 2 __--- -- r 7
/Z/ 3 / Each manufactured home or modular dwelling
� _
,� Service and/or feeder
natupcttir;ntg electrician (rcywre� Dat _ Services or feoders
Sup. elect. natitelynit : i. Pr 0 2,- (� t'f Liucriseno : 3r�3 alteration or relocation:
200 amps or less _ I _ 2
201 amps to 400 amps r 2
Name (print): 1, C C -i el ve -si M e 4 40t amps to 600 amps _ + -`_ 1 } — 2
Mailing address: I ' t1 5 Av , 4.____. 4.____. ) V O b0 amps to 1000 amps y- Thi I 2
City: >�� t „S , f•.? 1 -- i ; _ -- State: ('n ZIP: 0 Z_ Q Over 1000 amps or volts - 2
,— -- 1
Phone:3o, � . , 4 21 . , >0 - � i -c �� X 27- 25071 - mai l :
R econnect only
h ._ r.--- -- ---
Owner installation: Temporary services or feeders • he installation is being made on property I own installadon, alteration, orrelocattan:
which is not intended for ;ale. lease, rent, or exchange according to
200 amps or less �___ _ ''
ORS 447.455. 479. CIO, 701, 201 amps to 400 amps 2
Dat 40; to 600 am s 2
Owner's signature: _ _ - .-- "�
Branch circuits - new, alteration,
or extension per panel:
Name:
— A. A. Fee for branch circuits with pureh e .: ILL
Address: - service cr feeder fee, ,...ah branch circuit f ' • 11 .e 'T + �S 2
-- i State: I ZIP: B. Fee for branch circuits •v;:':out l:ur_h.se le 1 4. : � g - 2 1
City: _ of service or feeder fee, ills branch _ ir. :,.:t J
Phone: i Fax: Email:
4 Each
additional branch circuit
Misc. (Sen'ce or feeder not hit:hided); 2
Each pump or irrigation r.rc:e --
3 Service flyer 235 amp3•NtM,erci li t2 O H facility location E signor outline lighti• _ 2 1
� fam wells 2r) nu1 fisting of ; 6 J Hazardous g q r Si Signal circwt(s) of a I. (need rite :} ;} panel 1�
family dwelling U Building Duet 10,000 square feet four g 2
U System om er 530 volts a•: nai l' more residential units in one swcture alteration, or exteri:.or — • �l • , — _y_.__.: _ 1
• a Building over three sic. n., O Feeders. 400 amps or more •Descri • lion: __ .— _ _ -- -- - - -- -- - =
U Lk:cupar.t toil over 44 ; caso. :> U Manufactured structures or RV park Each additional inspection over the allowable In tut} of the abo,e:
Egre,r9 ' pun U Other _ --- -•-- - -- ins eciot• �_ __ I l + — S ^ 1 I
Submit . _ _ sets of plans with any of the above.
_ Pei_ nvestigationf ee ----_---
The above are HOE applicable to temporary construction service. Other
• t
—__ Permi fee .. $ r - -"-
'Not an jurisdicue accep cr
t t i nts
i .a• plea call juricdi:,lion for mom irtfonvcnonl Notice: This permit application Plan t f review (a[ %) �n
0 Visa .J Mas :eiCard I expires if a permit is not obtained State surcharge (8 %) •••• $
eitidit caid number _ __ . -_. —._ _-_- -�-- ..__. within l80 days after it has been
c accepte as complete. TOTAL $ —
• N:1;4 of car_r,a.hkr a, sh.. +n on ttwtn card $
Mnntmt 440.4615 (5/M'COM)
... CasdnalJtr atlrtatma i
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested rr AM PM BUP
Location 7 ' Or Q c S e ,LJ C c ireo d Suite , MEC
Contact Person Ph ( ) PLM
Contractor R. Ca CO.Sletto � Ph ( ) SWR
BUILDING Tenant/Owner ELC . 2an3 —�
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam .
Shear Anchors
Ext Sheath/Shear •
Int Sheath/Shear
Framing _
Insulation
Drywall Nailing
Fi rewal I
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam - / '
Under Slab Isar
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
PART FAIL Reinspection fee of $
required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. '
a Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date f t3 Inspector • • _, f� Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL