Permit
_ ITY OF TIGARD ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT Permit#: ELC2010-00020
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/13/2010
Parcel: 1 S126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 100
Subdivision: Lot: 0
Project: Pacific NW Title
Project Description: (6) branch circuits for TI. 2/18/10, adding (1) feeder and (5) branch circuits.
Owner: FEES
WISCO REAL ESTATE EQUITY Quantity Description Date Amount
FUND I LTD PARTNERSHIP, BY WYSE
INVESTMENT SRVS CO, 1501 SW TAYLOR ST 6 crt Branch Circuits 01113/2010 $93.28
wo/Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 01/13/2010 $11.19
Electrical
Contractor: 0 ea 12% State Surcharge - 02/18/2010 $16.54
RC COSTELLO ELECTRICAL CONT INC Electrical
PO BOX 336 1 ea Services or Feeders - 200 02/18/2010 $100.70
AURORA, OR 97002 amps or less
PHONE: 503-982-7400 5 crt Branch Circuits w/Purchase 02/18/2010 $37.10
Service or Feeder
FAX: 503-982-7400
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $258.81
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 acc ce wi Pf~roved 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. ATT ION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001 010 throu h OAR 952-001- 10 u ma obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Iss ed 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 an inspection that business day.
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.
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� �q CITY OF TIGi4®
ELECTRICAL PERMIT
... Permit #: ELC2010 -00020
COMMUNITY DEVELOPMENT
13125 SW Hall Blvd., Ti
Date Issued: 01/13/2010
�1�',1i�17 and OR-97223 503.639.4171 9.
Parcel: 151266001506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 100
Subdivision: Lot: 0
Project: Pacific NW Title
Project Description: (6) branch circuits for TI
Owner: FEES
WISCO REAL ESTATE EQUITY Quantity Description Date Amount
FUND I LTD PARTNERSHIP, BY WYSE
INVESTMENT SRVS CO, 1501 SW TAYLOR ST 6 crt Branch Circuits 01/13/2010 $93.28
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State.Surcharge - 01/13/2010 $11.19
Electrical
Contractor:
RC COSTELLO ELECTRICAL CONT INC
PO BOX 336
AURORA, OR 97002
PHONE: 503 - 982 -7400
FAX: 503- 982 -7400
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $104.47
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. ATT • ': • - •on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0 through OAR • •2 -0' 0100 You'may obtain,a'copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
•
Issued L - < Permittee Signature: V
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 an inspection that business day.
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.
IV 1 '�' 'F -..w,,,,, , .., .. • re . 3 Ik t,!(d 4s Nl.r °W. � ,: �W" 4 • b 'i 4 °w dki .,: y khhwi' li 'IpYn'a ! 11. t 1(°" ocf
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- Electrical Permit Application , ° G J� ' " ° ,, R O z FI`ICE ONL�I : (1^1 ,. � '
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a Received >/ Pemu s n
7 City Of Tigard Re e iV : I '. Gif OfO�U
13125 SW Hall Blvd., Tigard, OR 97223. Plan Review
® Phone: 501639.417,1 Fax; 503.598.1960 Date /B : Other Permit. 6m,6 moo,?
1' I GA R. D Insp Line: 503 Date Ready /By: • Jurist . • ® See Page'2.for”
Internet: 'www.tigard- or.gov Notifed/Method: _ _ , , _,' ..Supplementahlriforniation
a: : ,YPE, OF WORK:- „ . ' , . +PL W • AN REVIE g
- P l e ase check all thatapply (submit 2 sets of plans w /items checked below).
' ❑New construction Addition /alteration /replacement
❑ Service or feeder 400. ainps'ormore ❑ Building over three stories
Demolition ❑ Other: where the available.faultcurrent ❑ Marinas and boatyards:
CATEG RY OF CONSTRUCTION e xceeds 10,000 amps at'150 volts ❑ Floating building's.
1 _ . " ' ` 1 • l ess to ground, or exceeds ` 14,000 ' ❑ Commercial -use agricultural
and 2 -family dwellin g Commercial /industrial Accessory buildin g amps for all other installations. buildings. ,
❑ Multi- family ❑ Master,builder ❑ Other: .❑ Fire pump. ❑ Installation of 75 KVA or
: ❑£mergency system. larger. separately derived system.
JOB SI TE .INFORMATION'_ AND ;LOCA
• , • ❑ Addition of new motor load of ❑ `A» ` =E "1 -2» "I -3»
Job no.: Job site address: �] 0 2 0 W I h (' n4 i x o r or more. occupancy.
t S wAS h �- -., • I4 r ❑ S or m residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ( ❑ Health -care facilities. ❑ Supply voltage :for more than
❑ Hazardous locations. 600 volts nominal. .
Suite Idg. /apt. no.:. /f)() Project name: 1 Q(..t. m o 7; 44, ❑ or feeder 600 anips or more.
t" °_ 'FEE SCH ' "
Cross street/directions to job site: Description �.' Qty .'1' - "Fee., 1 Total - 1
New` residential: single- or multi- fatrtily dwelling unit. •
Includes attached, garage.
Subdivision: Lot no.: 1;000 sq. ft. or less 168.54 4
Ea. add] 500'sq. ft. or portion 33.92 ' 1
Tax map /parcel no.:
Limited energy, residential 67 84
Li 2
- ,, -.DESCRIPTION OE WORK _ . , 7, (with above sq: ft.) •
Zra.n C /1 C 6 • rl; V l-�-/ .�j /. 'TT
Limited e energy, tial (with above multi-family 67.84 2
t 1 residential with a s ft.
Servicesor feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
PROPERTY OWNER x Er TENANT'_ , - 201 amps to,400 amps 133.56 2 .
Name: 01 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
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I 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 forsale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599.amps 168.54 2
; Branch circuits - new, alteration, or extension, ter panel
Ownersignature: Date: A. Fee for.branch circuits with
APPLICANT 1; , , ❑; CONTACTPERSON above service or feeder fee; 7 42 2 •
.each branch circuit
Business. name: B. Fee for branch circuits
Contact name: without service or feeder fee, I 1 56.18 . 2
first,branch circuit
Address: Each add'T branch circuit 5 7.42 44.52- 2
• Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 67:84 2
dwelling, service and /or
Phone: ( ) I Fax: : ( ) Reconnect only .67.84 2
E -mail: Pump or irrigation circle 67.84 2
A "R ' Si n;or outline li htin 67.84 2
CONTRACTOR - °� . _ g g g_
Business name :W Signal circuit(s) or limited,
c-re � l PC �r i r a aj prite)C �h energy panel, alteration, or
Address: po. - 3 0)e , 336 extension. Describe: Page 2 2
City /State /ZIP: w/a'.A 0 12 ,C1 70oz. Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: (5 Grd L '7490 0 I Fax: ( 50)) /S 1- o / Investigation per hour (1' hr min) 66.25
CCB Lic,: gi L142_ I Electrical Lic.: J -3GyC Suprv. Lic.: 39349 S Industrial plant per hour 78.18
required: Su
_ , ,ELECTRICA L :PERMIT:+FEES; . ,
Suprv. Electrician signature, re
p g q�� Subtotal: 9.6 • o
' name:- e. - C „C F j Date: / //2 rge % oermit fee): Print J/o State surcharge (12% of permit fee): • //: / 9
Authorized signature: TOTAL- PERMIT FEE: (nq'• f7
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.
. :C\ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11/05 /COM/WEB
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Electrical Permit Application - City
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Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAT YORK ONLY ,.: b
Fee for all,residential systems combined .. $67.84
' f
Check Type of Work Involved: •
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
CO1VI'MERCIAL WORK ONLYc..`
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
,❑ HVAC
❑ Instrumentation
❑ Intercom and Paging "Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
* `licenses are required. Licenses are required
*Other installations
I:\ Building \Permits\ELC- PermitApp.doc 10 /01 /09