Permit
n CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2010-00019
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/13/2010
Parcel: 1 S136DD05300
Jurisdiction: TIGARD
Site address: 11850 SW 67TH AVE, STE# 100
Subdivision: TIGARD TRIANGLE COMMONS Lot: 13
Project: Spec Space
Project Description: (9) branch circuits for TI
Owner: FEES
PNWP LLC#2 & Quantity Description Date Amount
PNWP LLC, 6600 SW 105TH AVE #175
BEAVERTON, OR 97008 9 crt Branch Circuits 01/13/2010 $115.54
wo/Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 01/13/2010 $13.86
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 $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. ATTENTIO regon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 rough oA 52-001u may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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 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 thejob site at the time of each inspection.
•
�' CITY OF , 'TIGARD
ELECTRICAL PERMIT
, 011 s 1: COMMUNITY DEVELOPMENT Permit #: ELC2010 00019
111GARD1 13125 SW Hall Blvd., Tigard DR 503.639.4171 Date Issued: 01/13/2010
Parcel: 1 S 136DD05300
Jurisdiction: TIGARD
Site address: 11850 SW'67TH AVE,, STE# 100
Subdivision: TIGARD :TRIANGLE COMMONS Lot: 13
Project: Spec Space
Project Description: (9) branch circuits for TI
Owner: FEES
PNWP LLC #2 & Quantity Description' Date Amount
PNWP LLC, 6600 SW 105TH AVE #175
BEAVERTON, OR 97008 9 crt Branch Circuits 01/13/2010 $115.54
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 01/13/2010 $13.86
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 $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. ATTENTIO ' regon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 rough OA 52-001-0 0. You may obtain'a copy of the rules or direct questions to OUNC by calling.503:246.6699 or 1.800.332.2344.
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' y ,..-r Date:
LICENSE NO.
Calf 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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City Of Tigard • Receed
7 Date : O Permit 1\1°.' ' 13125 SW Hall Blvd., Tigard, OR 97223. Plan Review , '
Phone: 503.639.4.171 Fax: 503.598.1960 Date /B :: Other Permit: 6a 'YI "ad' /0 i A
I I G A R D inspection Line: 503 639;4175 • Date Ready/By: 7uris: • ® See Page 2�for
" Internet: www.tigard- or.gov Notified /Method: Supplemental Information
„ HYPE, OF WOR _. PLAN REVIEW '.
❑ New construction I _ Addition /alteration/replacement Please'check all that •apply "(submit 2 sets of plans w /items checked below)
❑ Service or feeder 406 amps or more ❑ Building over three, stories.
❑ Demolition • ❑ Other: where the available fault current ❑ Marinas and boatyards.
' t " CATEGORY' 'CONSTRUCTION - ` exceeds 10,000 amps;at 150 volts or El Floating buildings.
❑
less to ground, or exceeds 14,000 Commercial -use agricultural
❑ 1- and 2- family dwelling [V]�Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder . ❑ Other: ❑Fire pump. ❑ Installation of 75 KVA or
_._: ,• _ _ _ ❑ Emergency system. larger separately derived system.
';' •,JOB SITE INFORMATIO AND .LOCATI - ,
.. - .. _ - � ❑ .Addition of new motor'load of ❑ "A» ; "E `1 -2" "1 -3 "
1 /650 S r, n � 100HP or more. occupancy.
Job no.: Job site address:' fl .rlJ W t /
6 ✓e Six or more residential units. ❑ Recreational' - ve_hicle;pa - rks ;
City /State /ZIP: !� �f� A q. � LL ,0 H ealth-care facilities. ❑ Supply voliage for more than
v �� p/"' 1 C . ❑Hazardous locations. 600 volts nominal. _ -
CD bldg. /apt. no.: 1 0 O Project name: I7 ❑Service or feeder 600 amps or more: •
FEE SCHEDULE
Cross street/directions to job site: Des 1
cription � Qty. � Fee. .1 Total 1 "
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'1 500 sq. ft. or portion 33.92 1
Limited. energy, residential
67.84
2
.DESCRIPTION OF. WORK , ..`.: , . (with above sq. ft.)
L _ Limited energy, multi- family
IBranc h - r ire. v i-f j 'Po r 1. _.. residential (with above sq. ft.) 67:84 2
Services or feeders installation, alteration, and /or relocation
200 amps or Tess 100.70 2
-
El PROPERTY OWNER 1 :0- TENANT , 201 amps to 400 amps 133.56 2
Name: 401 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: ( ) 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. 40Lamps 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner.signature: Date: A. Fee for branch circuits with
- ❑ APPLICANT+ ❑ CONTACT PERSON .1 above service or feeder fee,
7.42 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee,
A
first branch circuit 56.18 IS
Contact name: p" - 2
Address: Each,add'l branch circuit 7.42 7.340 2
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
E -mail: Pump or irrigation circle 67.84 2
"` ` CONTRACTOR . ` " .' i' Sign or outline lighting 67.84 2
,Business name: W C Co s 110 E le (..'1n (a I (y -1- }y,1 e
Signal circuit(s) er or t limited- o or
h /G � energy panel, alteration, or
Address:—p0. - 0 X 'A 3 extension. Describe: Page 2 2
City/State /ZIP: A U( J,.. C1)002 Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: ( S�3) 01 8 �. 1 go 0 Fax: ( 03) 3g2_ 1 Llv 1 Investigation per hour (I hr min) 66.25
CCB Lic.: S11_0 Z Electrical Lic.: 3 1...141" C Suprv. Lic.: 3c3L1 S` Industrial plant per hour 78.18
l - •ELECTR /PERMITJ;FEESar -:,,;,
Suprv. Electrician signature, required: ��� - Subtotal //5.5`1 y
D'�� 6 ft Dater ".i 1 11 /6 Plan review (25% of permit fee): e -
Print name:
r� S / State surcharge (12% of permit fee): /3 . 840
Authorized signature: TOTAL PERMIT FEE: /A9, ¥O
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:\ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
•
Page 2 - Supplemental Information
•
LIMITED ENERGY PERMIT FEES:
:RESmENTIAL `W.,,ogK ONLY �•: • -
Fee for all;residential systems combined .. $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COIVIMERCIAL'W.ORK
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 System
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*■o licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 10/01/09 •
Electrical Permit Application
Re=eiv
City of Tigard D
ate/By: Permit No.: i 4',1 e A0/0- 6vo/
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 DateB Other Permit: ~u d
Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
,,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 Commercial/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 ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A", "E", "1-2", "1-3
S 100HP or more. occupancy.
Job no.: Job site address: tOlve- ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: e f~ ❑ Health-care facilities. ❑ Supply voltage for more than
DI- ❑ Hazardous locations. 600 volts nominal.
Suit bldg./apt. no.: (Q U Project name: El Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description Fee. Total
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'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 67.84 2
DESCRIPTION OF WORK with above s q. ft.
_ Limited energy, multi-family 67.84 2
t^ Ae 're- V141 J r I . Z . 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
Name: 401 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: ( ) 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
Branch circuits - new, alteration, or extension, er panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON 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,
rp•l
first branch circuit 56.18 2
Address: Each add'I branch circuit $ 7.42 2
Miscellaneous service or feeder not included
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
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: (~S-}e ~fu -1 /y Signal circuit(s) or limited-
ri Cy.%4,lGt c-4-4 energy panel, alteration, or
Address:-Po OX 3 C~, extension. Describe: Page 2 2
City/State/ZIP: J o Z 01) 0 UZ Each additional ins ection over allowable in an of the above
Per inspection 66.25
Phone: ( SO) OI $Z• -7L/00 Fax: (503) q 82_ t4t1 Investigation per hour (I hr min) 66.25
CCB Lic.: 140 Z Electrical Lic.: 3 - Z./y C Suprv. Lic.: 313L S Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: Q~ ca S~" IL Date: ( ~L Plan review (25% of permit fee): B-
State surcharge (12% of permit fee): 13.8(0
signature: TOTAL PERMIT FEE: Ia ,io~D
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.
1:tBuildingtPermitstELC-PermitApp.doc 10/01/09 440-4615T(11/09COM/WEB