Permit CITY OF TIGARD ELECTRICAL PERMIT
1111- - COMMUNITY DEVELOPMENT Permit#: ELC2014-00638
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/10/2014
Parcel: 2S112DA00800
Jurisdiction: TIGARD
Site address: 15115 SW SEQUOIA PKWY 200
Project: Sumner College Subdivision: PACIFIC CORPORATE CENTER Lot: 2
Project Description: Branch circuits for TI
Contractor: R C COSTELLO ELECTRICAL CONT INC Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 336 ATTN: N PIVEN
AURORA, OR 97002 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-982-7400 PHONE.
FAX: 503-982-7400
FEES
Quantity Description Date Amount
21 crt Branch Circuits wo/Purchase 11/10/2014 $204.58
Specifics: Service or Feeder
1 ea 12%State Surcharge- 11/10/2014 $24.55
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $229.13
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 throughh OAR 95 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19 00.332.2344.
Issued By: �lY 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.
Electrical Permit Application FOR OFFI( F- FSF.O\1.1
Received `� ` _ ^D4�ry
City of Tigard
Date/B �, / //�� Permit No: L (J JJ
IN
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit:
T I c i A R 1) Inspection Line: 503.639.4175 Date Ready/By' _____________ See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction Please check all that apply(submit 2 sets of plans w/items checked below):
®Addition/alteration replacement
❑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 ®Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","I-2","I-3",
Job no.: Job site address: 15115 S W Sequoia PKWY#200 t00FIPormore. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
❑Health-care facilities. ❑Supply voltage for more than
City/State/ZIP:
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: �Q Q Project name:Sumner College ❑Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. 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'1 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential 7500 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 75.00 2
Branch circuits for T.I. residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits—new,alteration,or extension,per panel
❑ APPLICANT 1 ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first I
56.18 56.18 2
branch circuit
Address: Each add'I branch circuit 20 . 7.42 148.40 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Phone:( ) Fax: :( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: R.C.Costello Electrical Contracting Inc. Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address: P.O.Box 336 Each additional inspection over allowable in any of the above _
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Aurora OR 97002 Investigation(I hr min) 66.25/hr
Phone:(503)504-6758 Fax:(503)982-7401 Industrial plant(I hr min) 78.18/hr
��l Inspections for which no fee is 90,00/hr
CCB Lie.: 87402 1I I 1; Electrical Lic.: 3-344C Suprv. Lic.: 3934S specifically listed(4 hr min)
/J ELECTRICAL PERMIT FEES
Suprv. Electrician signature,requiredV/'��5-- l ---- -
Subtotal: 204.58
Print name: Roger C.Costello Date: 11/10/14 Plan review(25%of permit fee):
State surcharge(12%of permit fee): 24.55
Authorized signature: TOTAL PERMIT FEE: 229.13 t�
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I.\Buitding\Perm its\ELC_PermitApp_ELR_ERE.doe Rev 05/21/2013 4404615T(t I/05/COM/WEB
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15115 SW SEQUOIA PKWY 200, TIGARD, OR,
97224
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2014-00638
Chip Barnett
Violation Summary:
Inspector Contractor