Permit •
• V CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00600
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/22/2012
Parcel: 1S136CD02200
• Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Project: Costco Subdivision: PALMER ACRES Lot: 1 -3, PLL
Project Description: (2) branch circuits for pharmacy remodel
•
Contractor: ADK ELECTRIC, INC. Owner: COSTCO WHOLESALE CORPORATION
9000 NE 90TH STREET PROPERTY TAX DEPT 111
VANCOUVER, WA 98662 999 LAKE DR
ISSAQUAH, WA 98027
PHONE: 360 - 546 -5155 PHONE:
FAX: 360 - 576 -6975
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 10/22/2012 $63.60 .
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/22/2012 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of, issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503 2.1987 or 1.800.332.2344.
Issued By: - ' 441-At." Permittee Signature.
OWNER INSTALLATION ONLY
•
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
(•: SIGNATURE OF SUPR. ELEC' • , - ;;I Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
•
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
• Approved plans are required on the job site at the time of each inspection.
Oct. 19. 2012 12:42PM REgENEf) - No. 2017 P. 2
Electrical rermit Appl FOR OF'FIC'E USE ON L1'
City of Tigard Received f�C o?
`, g D � 2�1 Dg : D APR -1M Permit No.: �4 -� .//
N i - 13125 SW Hall Blvd., 'Tigard. 0 23 Plan Review
Phone: 503.7182439 Fax: 5Q , Q$, } t' �� Date/B : Other Permit: PAP/A- p /ate DD l9
r i c ; A :c C, Internet: Line: 503.639.417'' �jjj l Date Ready/By: l uis See Page 2 for
p� DIVISION
Inteet: www.tgard.or.go t 'i D G° Notified/Method: Supplemental Information
Va ,1� , -1F.'- %:' il kY �(C !,� ' t _ Tt /J b 1 �
'�. M :' I ' - , '.'ai ., A,�} '.,
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❑ New construction ® Addition/alteration/replacement Plcaae check all that apply (submit 2 sets of plans w /items checked below):
El Demolition ❑ Other: where the ❑ available a fault current ❑ Building over three stories.
, o , 1:1 M Marinas and boatyards.
- • '1_ -- , 1 GORY OF', •C i ,, ., . `' 4 o - 7 .:.. exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
' . ' less to groW+d, Or exceeds 14,000 ❑ Commeraral -use agricultural
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
w, r a l ❑ Emer Addit on of s ste m.
c a 1P�Y i INFORMAT[ ' ri" 1��? �` + e Y Y larger separately derived system.
--- 8,, , `'•: , ❑ if new motor load of 1=1"A", °'E" "1-2", "1-3"
Job no.: CM12025 Job site address: 7850 SW Dartmouth Street IooHPOr oec tion
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97223 ❑ Healthcare aciities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: Costco Pharmacy Tigard OR ❑ Service or feeder 600 amps or more. • `y i•!C•.:
FEE ,:3Cfi. 01 ' ' '. : y .
Cross street/directions to job site: Hwy 217 to 99W. Head north and take the cacti •tloa .E •
first right onto SW Dartmouth St. Turn right into Costco parking lot. New residential single- or multi - family dwelling unit.
8 g P g Includes attached garage.
Subdivision: I Lot no,: 1,000 sq. R. or less 168.54 4
Tax map /parcel no.: La. add'l 500 sq. ft, or portion 33.92 1
TV e . Limited energy, residential
;i' �% DESRI 1)! :%.-5.-44'...7.,',16.,..- (with above sq. ft.) 75.00 2
:. ;., r ry
Modify 2 circuits Limited energy, multi- family
75 .00 2
y residential (with above sq. R,)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100,70 2
t v P) RTY OVI4+7 ~ } .; ❑ TEN a 201 amps to 400 amps 13156 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeder installation, alteration, and /or
City /State/Z1P: relocation
Phone: ( ) I Fax: ( ) 200 amps or less 1 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits— new, alteration, or extension, er panel
Owner signature: Date: A. Fee for branch circuits with
r: AP - a n �+, - t, . �h .�_ r ` ,, : '+� '''44 - ` ° 8bove service or feeder fee
1-5 • ® ''p4`�' � ' CONTA 1 , each branch circu 7.32 2
Business name: ADK Electric, Inc. B. Fee for branch circuits without
service or Contact name: Kaylee Simonson branch c rc ui t der fee, first 1 5618 56.18 2
Each add'I branch circuit 1 7.42 7.42 2
Address: 9000 NE 90"' Street Miscellaneous (service or feeder not included)
City/State/ZIP: Vancouver, WA 98662 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (360) 546 -5155 Fax: : (360) 576 -6975 Reconnect only 67.84 2
E -mail kaylees@adkelectricine.eom Pump or irrigation circle 67.83 2
_� >' v 14 - d _L - ^ r: - • n � ,, ,, Sign or outline lighting 67.84 2
k ;; r A % s'n Signal circuit(s) or limited -energy
Business name: ADK Electric, Inc. panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 9000 NE 90 Street Additional inspection (1 hr min) 66,25/ hr
City /State /ZIP; Vancouver, WA 98662 Investigation (1 hr min) 6625/ hr
Industrial plant (1 hr min) 78,18/hr
Phone: (360) 546 -5155 Fax: (360) 576 -6975 Inspections for which no foe is 90.001 hr
specificall listed (%: hr min
CCB Lic.: 148882 4111 Electrical Lic.: 37 -934C /Il u rv. Lic.: 4853s job 1l ,: , ;',.'.;,- °' . ELECTRICAL_=;11x_ ` - >
t_
�, Subtotal: 63.60
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: Alan Kangas Date: 10/19/12 State surcharge (12% of permit fee); 7.63
TOTAL PERMIT FEE: 71.23 lq /
Authorized si 404) This permit application expires Ira permit is not obtained within 180
Print name: Alan Kangas Date: 10/19/12 days after It has been accepted as complete.
• Number of inspections allowed per permit.
1:\ 8uildlnehmlastEl.C- PermaADp'aoc 07/01/10 440.461 ST( I1/as /COMAVSg
Oct. 19. 2012 12 : 41 PM No. 2017 P. 1
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ELECTRIC
Fax Transmittal Form
Date: I !i f I2
To: Pff r I4r)i
Company: , ell it I Fax #:(5751)598- I /lab
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9000 NE 90Th ST, VANCOUVER, WA 98662
(360) 546 -5155 • (360) 5766975
WA: ADKBL1 *992K2 • OR CCB #: 148882
AN EQUAL OPPORTUNITY EMPLOYER