Permit CITY OF TIGARD ELECTRICAL PERMIT
NI 3 . COMMUNITY DEVELOPMENT Permit #: ELC2013 -00135
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/25/2013
Parcel: 25101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 410
Project: Spec Space Subdivision: VARNS ACRES Lot: 9
Project Description: (2) branch circuits for receptacle
Contractor: R C COSTELLO ELECTRICAL CONT INC Owner: GK TRIANGLE CORPORATE PARK III L
PO BOX 336 BY THOMSON REUTERS INC
AURORA, OR 97002 ATTN: MEGAN DOWLING
PO BOX 130174
CARLSBAD, CA 92013
PHONE: 503 - 982 -7400 PHONE:
FAX: 503 - 982 -7400
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 02/25/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/25/2013 $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: Orego 1 -w 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 • 2 r01 -0090 You may ob in a copy of he rules or direct questions to OUNC by calling 503.232.1987 332.2344.
Issued By: `' Permittee Signature: CI
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.
Electrical Permit Application RECEIVED I:OH (),:r,(:,... (isl :ONLY
RECEIVED v �I
City of Tigard Received DaDate/B : 3...s- 3...s— Permit No.: C /3 - 35'
II • 13125 SW Hall Blvd., Tigard, OR 97223 FEB 2 5 013 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 2 Date/B : Other Permit: , ` / /3 ' We/
I' I G n R 17 Inspection Line: 503.639 Date Ready/By: Ins RI See Page 2 for
Internet: www.tigard or.gov CITY OFTIGARD Notified/Method: 62 Supplemental Information
BUILDING DIVISION
TYPE OF WORK PLAN REVIEW
❑ New construction Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION " - . ' exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling giCommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION
CI Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 - "I - ",
/ -n ,} ,/' _ ` IOOHP or more. occupancy.
Job no.: Job site address: 13 2.2. l S t(J CJ r h tN. ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
ui /bldg. /apt. no.: („4 Ili Project name: . p ,� `P' IO ❑ ice or feeder 600 amps or more.
( FEE SCHEDULE
Cross street/directions to job site: Description I Qtr. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1 ,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
{+ � Limited energy, multi - family 7500 2
- 6 f qn G y, CI fr. -G r r Pee p Ott/ residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
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
ty 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 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, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT • ' I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first I 56.18 2
Contact name: branch circuit
Each add'I branch circuit I 7.42 2
Address: Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
1 CONTRACTTOR / Signal circuit(s) or limited -energy
Business name: ' C C OSTA U G I �Q / tGA / t Ail rmc '�1 �1 1 panel, alteration, or extension. Page 2 2
/ Each additional inspection over allowable in any of the above
Address: -p ja� - Additional inspection (1 hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City/State /ZIP: A Ir arcs 0 - R q r _ Industrial plant (1 hr min) 78.18/ hr
Phone: Fax: C� Inspections for which no fee is
Phone: ( So)) g2 - - ] �( (503) 9 D z- �U specifically listed (%: hr min) 90.00 / hr
CCB Lic.: l idZ Electrical Lic.: . 3 3L Suprv. Lic.: 3 3 L� r� ELECTRICAL PERMIT FEES -
Suprv. Electrician signature, required: o Subtotal:
/.4 Plan review (25% of permit fee):
Print name: "R 2,. r /' U -t e l lO Date: Z ( I12 S / I -) State surcharge (12% of permit fee):
Authorized signature: • TOTAL PERMIT FEE: 1 1 -
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number o inspections allowed per permit.
1.\Building\Permits\ELC- PermitApp.doc 07/01/10 440-4615T(II/05 /COM/WEB
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13221 SW 68TH PKWY 410, TIGARD, OR, 97223
Commercial - Electrical
125 Wall cover
02/26/2013 00:00
ELC2013-00135
PASS
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13221 SW 68TH PKWY 410, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
04/02/2013 00:00
ELC2013-00135
PASS - No C of O
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13221 SW 68TH PKWY 410, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
03/19/2013 00:00
ELC2013-00135
FAIL
Fresh tile No access
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13221 SW 68TH PKWY 410, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
04/02/2013 00:00
ELC2013-00135
PASS - No C of O
Violation Summary:
Inspector Contractor