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Permit n CITY OF TIGARD ELECTRICAL PERMIT 1 COMMUNITY DEVELOPMENT Permit#: ELC2015-00682 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/02/2015 Parcel: 1S 136CD02200 Jurisdiction: Tigard Site address: 7850 SW DARTMOUTH ST Project: Costco Fuel Facility Subdivision: PALMER ACRES Lot: 3 Project Description: (2)200 amp services and(52)branch circuits for 3 phase service for fueling station. Includes(9)dispensers,(5) tanks,canopy lighting&low voltage for data&a gas monitoring system. Contractor: INTERIOR ELECTRIC Owner: COSTCO WHOLESALE CORPORATION 21428 167TH AVE SE PROPERTY TAX DEPT 111 MONROE,WA 98272 999 LAKE DR ISSAQUAH,WA 98027 PHONE: 360-863-8678 PHONE: 425-313-8100 FAX: FEES Quantity Description Date Amount 2 ea Services or Feeders-200 09/02/2015 $201.40 Specifics: amps or less 52 crt Branch Circuits w/Purchase 09/02/2015 $385.84 Type of Use: COM Service or Feeder Class of Work: ALT 2 ea Signal circuit or Limited 09/02/2015 $150.00 Energy Panel Type of Const: 1 ea 12%State Surcharge- 09/02/2015 $88.47 Occupancy Grp: Electrical 1 ea Plan Review Electricial 09/02/2015 $184.31 Total $1,010.02 Required Items and Reports(Conditions) This permit i e 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 ' 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. TTENTION: Oregon law -.r -s you to follow the rules adopted by the Oregon Utility Notific. Center. Those rules are set forth in OAR 952- 1-0010 thro gh OAR 95 X01,'0090. ay obtain a copy of the rules or direct questions to OUNC by calling•r .�, .1987 or 1.800.332. 344. I ued By: , sue/ 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: c' LICENSE NO. 1/6 q/ S 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 Applicat CE1 M EP , (I,z . 1, 1 l ,,r O\I O. City of Tigard Received i?�� 'j-C�o(5-ob �g�. i Permit#: lig 13125 SW Hall Blvd.,Tigard,OR 9'# j 2 2 5 Plan Review /� � Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Janet" Related Permit#: A!�#'aCI''Mc , Inspection Line: 503.639.4175 di,' v 1`r ti6AKD Ready D: : II luris: 0 See Page 2 for I I t i 1 R L) Internet: www.tigard-or.gov ppa�l..�. 1 OF Notified/Method: Supplemental Information TYPE la itablIG DlVISIOf+ t PLAN REVIEW ®New construction ❑Addition/alteration/replacement .A Al I C►l'1 Please check all that apply(submit 2 sets of plans w/items checked): ❑Demolition ❑outer: 09.4 1,4 ❑Service or feeder 400 amps or more ❑Building over three stories. where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. ❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural ❑Multi-family ❑Master builder ❑Other: Fire for all other installations. Installation ati ❑Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived Job#: ' Job site address:7850 SW Dartmouth Street El Additioo of new motor load of system 100HP or more. ❑"A" "E" "1-2" "1-3" City/State/ZIP: Tigard,OR 97223 0 Six or more residential units. occupancy. ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Project name: ®Hazardous locations. ❑Supply voltage for more than ❑Service or feeder 600 amps or more 600 volts nominal. Cross street/directions to job site:From Hwy 99W turn on Dartmouth Street FEE SCHEDULE and Costco will be on your right. Description I Qrr• I Each I Total I New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 I DESCRIPTION OF WORK Limited energy,residential (with above sq.ft.) 75.00 2 200 amp,3 phase service for gas station kiosk which includes(9)dispensers, Limited energy,multi-family residential(with above sq.ft.) 75.00 2 (5)tanks,LED canopy Itg and low voltage monitoring system for station. _ Renewable Energy ❑ See Page 2 ❑ PROPERTY OWNER l ❑ TENANT Services or feeders installation,al$on,and/or relocation Name: Costco Wholesale 200 amps or less 9�, 100.70 100.70 2 Address:999 Lake Drive 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP:Issaquah,WA 601 amps to 1,000 amps 301.04 2 Phone:(425)313-8100 Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 ® APPLICANT I ® CONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name:Wayne Marvin DBA Interior Electric above service or feeder fee, 7.42 289.38 2 each branch circuit Contact name:Michelle Marvin B.Fee for branch circuits without 6.9‘ Address:21428 167th Ave SE service or feeder fee,first 56.18 2 branch circuit City/State/ZIP:Monroe,WA 98272 Each add'l branch circuit 7.42 2 C--- ) Miscellaneous(service or feeder not included) Phone:(425)478-3931 - Fax::( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email:interiorelectric @aol.com Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name:Wayne Marvin DBA Interior Electric Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy , Address:21428 167th Ave SE panel,alteration,or extension. )�Page 2 !w' 2 Each additional inspection over allowable in any of the above City/State/ZIP:Monroe,WA 98272 Additional inspection(1 hr min) 66.25/hr Phone:(360)863-8678 Fax:( ) Investigation(1 hr min) 90.00/hr Email: interiorelectric @aol.com Ill l ti 1011114 Industrial plant(l hr min) 78.18/hr Inspections for which no fee is 9000/hr CCB Lic.: 136721 111(1111 Electrical Lic.: 37-852C Suprv.Lic.: 4641-S specifically listed(%hr min) • ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: j)A f J'�f ( Subtotal: 5407aE 75 • Print name: Wayne Marvin Date: 8/20/2015 ®Plan Review Required(25%of permit fee): 135r9Y i gq, State surcharge(12%of permit fee): 0.44* cl h'17 TOTAL PERMIT FEE: .J39:'JT ----.-,2. Authorized signature: U1 . This permit application expires if a permit is not obtained withinn8� Print name: Wayne Marvin Al`"1`'■ Date: 8/20/2015 days after it has been accepted as complete. VU * Number of inspections allowed per permit. 1:\Building\Permits\ELC_PeanitApp_ELR_ERE.doc Rev 06/17/2015 440-46151(11/05/COM/WEB L ► Electrical Permit Application— City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Descrlpttou I Qty. I Each I Taal 1 * Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01to15kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 • 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 n Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 ❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva-no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(V2 hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES I Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): (SEE OAR 918-309-0000) • Number of inspections allowed per permit. Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ® Data Telecommunication Installation ❑ Fire Alarm Installation n HVAC ❑ Instrumentation 17 Intercom and Paging Systems n Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls n Outdoor Landscape Lighting* n Protective Signaling ® Other: Gas Monitoring System Total number of commercial systems: 2 *No licenses are required. Licenses are required for all other installations 1:1 Building\Permits\ELC_PemdtApp_ELR_ERE.doc Rev 06/17/2015 ,er t ; 1 ErDYG Electrical Permit Applicatio4RECEjVED r(]lz or. r I ,,I (1v1 1 City of Tigard Received #: 13125 SW Hall Blvd.,Tigard,OR 97223}�AUG 2 Q L 015 Plan Review Phone: 503.718.2439 Fax: 503.598. 0 Date/B : Related Permit#: Inspection Line: 503.639.4175 (. lTY OF T!GARD Ready Date/By: June: H See Page 2 for I I(i A R 1) Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK PLAN , , , W ®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 ,of plans w/items checked): ❑Demolition ❑Other: ❑Service or feeder 400 amps or • e ❑Building over three stories. where the available fault cure t ❑Marinas and boatyards. TEGORY OF CONSTRUCTION exceeds 10,000 amps at 1 .volts or ❑Floating buildings. ❑ 1-and 2-family dwelling !Ti Commercial/industrial ❑Accessory building less to ground,or exce'. 14,000 ❑Commercial-use agricultural amps for all other ..allations. buildings. ❑Multi-family ❑ ■.•ster builder ❑Other: ❑Fire pump. ❑Installation of 150 KV A or JOB SITE INFO V , .TION AND LOCATION ❑Emergency em. larger separately derived Job#: Job site address: : 0 SW Dartmouth Street ❑Addition.'new motor load of system. 100HP , more. ❑"A","E","1-2" "1-3'. City/State/ZIP:Tigard,OR 97223 El Six. more residential units. occupancy. ❑ .Ith-care facilities.0 vehicle parks. a .• zardous locations. ❑Supply voltage for more than Suite/bldg./apt.#: Project name:Co a Gas Station •Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site:From Hwy 99W turn 1 . Dartmouth Street- FEE SCHEDULE Costco on right Description I Qty. I Each I Total I • New residential single-or multi-family dwelling unit. Subdivision: Lot •• li■4. Includes attached garage. • _ 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'i 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 200 amp,3 phase service for gas station kiosk which includes(9)"spa.sec (with above sq.ft.) 75.00 2 Limited energy,multi-family 75.00 2 (5)tanks,LED canopy lighting,and low voltage monitoring s ,Ajo, o station. residential(with above sq.ft.) ® PROPERTY OWNER lib 7 • S Renewable Energy ❑ See Page 2 Services or feeders installation,alteration,and/or relocation Name:Costco Wholesale X. 200 amps or less 1 100.70 100.70 2 �Address:999 Lake Drive 201 amps to 400 amps 133.56 2 V • ''1 amps to 600 amps 200.34 2 City/State/ZIP: Issaquah,WA 60 . ps to 1,000 amps - 301.04 2 Phone:(425)313-8100 I Fax:, ‘..• ` Over 000 amps or volts _ 552.26 2 Email: Tempo ry services or feeders installation,alteration,and/or I. relocatio r Owner installation: This installation is : ' P on .0.• that I own which is not 200 amps or -ss 59.36 1 intended for sale,lease,rent,or exchang•, :ccor• 'g to •'S 447,449,670,and 701. 201 amps to 41 t amps 125.08 2 Owner signature: Date: 401 amps to 599 .s 168.54 _ 2 APPLICANT CONTACT PERSON Branch circuits- ew,alteration,or extension, r panel - A.Fee for branch c' its with Business name:Wayne Marvin DBA In nor Electric above service or f:=,- fee, 45 7.42 333.90 2 each branch circuit Contact name:Wayne Marvin MN V-Ne11 e M ar J',n B.Fee for branch circuits ithout Address:21428 167"'Ave SE service or feeder fee,f CL'l 1 25 'yam 5'3931 branch circuit 56.18 2 City/State/ZIP:Monroe,WA 982 Each add'l branch circuit 7.42 2 Miscellaneous(service or f ,er not included) Phone:(360)863-8678 Fax: :( ) Each manufactured or modular 67.84 2 Email:interiorelectric @aol.c' i dwellin_ service and/or feeder Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name:Wayne M: in DBA Interior Electric Sign or outline lighting 67.84 2 Address:21428 167th Av: SE Signal circuit(s)or limited-energy panel,alteration,or extension. ® ''• Page 2 150.00 2 Each additional inspection over allowable in any of the above City/State/ZIP:Monroei WA 98272 Additional inspection(1 hr min) 66.25/hr Phone:(360)863-8678 Fax:( ) Investigation(1 hr min) 90.00/hr Industrial plant(1 hr min) 78.18/hr Email:interiorelectrk @aol.com Inspections for which no fee is 90.00/hr CCB Lic.: 136721 Electrical Lic.: 37-852C Suprv.Lic.: 4641-S specifically,listed(Vi hr min) I ELECTRICAL Suprv.Electrician signature,required: s_ PERMIT FEES o Subtotal: 584.60 Print name: Wayne Marvin Date: 8/17/2015 ®Plan Review Required(25%of permit fee): 146.15 State surcharge(12%of permit fee): 70.15 Authorized signature: Al k- TOTAL PERMIT FEE: 800.90 1 This permit application expires ifs permit is not obtained within 180 Print name: Wayne Marvin Date: 8/17/2015 days after It has been accepted as complete. • Number of inspections allowed per permit. L\Building\Pemnts\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/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 7850 SW DARTMOUTH ST, TIGARD, OR, 97223 Commercial - Electrical 199 Electrical ﬁnal PASS - No C of O ELC2015-00682 Jeff Grove Violation Summary: Inspector Contractor