Permit CITY OF TIGARD ELECTRICAL PERMIT
E'! � ' COMMUNITY DEVELOPMENT ELECTRICAL
ELC2015-00120
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/26/2015
Parcel: 25101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 500
Project: University of Phoenix Subdivision: VARNS ACRES Lot: 9
Project Description: (9)branch circuits for TI.
Contractor: R C COSTELLO ELECTRICAL CONTRACTING 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
9 crt Branch Circuits wo/Purchase 02/26/2015 $115.54
Specifics:, Service or Feeder
1 ea 12%State Surcharge- 02/26/2015 $13.86
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $129.40
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 c•Via.,.,,,- es or direct questions to OUNC by calling 503.232.19 .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' 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 ``) Si FOR OFFICE l SE ONLY
City of Tigard t,��l V Date/B :
11111
G DateB d Permit No.: _ - OC-15-- ,A
_ 13125 SW Hall Blvd.,Tigard,OR 9w'' I Plan Review ,o
Phone: 503.718.2439 Fax: 503.5`:. r�01�
Date/8 : Other Permit: !u/ c�U i l
T I G n tt t> Inspection Line: 503.639.4175 �� U �Q Date Ready/Fly- B See Page 2 for
Internet: www.tigard-or.gov �( O�1\°119`1 •itified/Method: Supplemental Information
TYPE OF WOR.j�`-C( �C ,p1 PLAN REVIEW
❑New construction E Addition/alterati tja ment 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 E 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: 13221 SW 68 th PKWY I001IP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard OR ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:5 th fl Project name:University of Phoenix ❑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
Tax map/parcel no.: Ea.add'l 500 sq.ft.or portion 33.92 I
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.R)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER 7 ❑ 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
relocation
Phone:( ) Fax:( ) -
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 I ❑ 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 8 7.42 59.36 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular 67-84 2
Phone:( ) Fax: :( ) dwelling,service and/or feeder
. 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(1 hr mm) 66.25/hr
Phone:(503)5046758 Fax:(503)9827401 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 87402 Electrical Lic.: 3344c Suprv.Lic.: 3934s specifically listed('/:hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal: 115.54
Print name: Roger C.Costello Date: 2/24/15 Plan review(25%of permit fee):
— State surcharge(12%of permit fee): ...1341-7 13,8-c,
Authorized signature: TOTAL PERMIT FEE: ,I- Ii f f j 4:t(V
This permit application expires if a permit is not obtained within ISO
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(I l/05/COM/WEB