Permit a CITY OF TIGARD ELECTRICAL PERMIT
., COMMUNITY DEVELOPMENT Permit #: ELC2010 00489
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/10/2010
Parcel: 1S126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 510
Subdivision: Lot: 0
Project: Gress & Clark
Project Description: Electrical 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 8 crt Branch Circuits 09/10/2010 $108.12
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/10/2010 $12.97
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 $121.09
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 at other applicable law. All work will
be done in accordance with approved plans. This permit will expir 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 s a ted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the ru direct questions to OUNC by calling 503.246.669• - ; ' '.332.344.
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Issued By. —rte — 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.
CaII 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.
Electrical Permit Application I Received
FOR OFFlrh: 1 St: tONLY l� �q
City of Tigard ��� DDate/By: ( d Permit No.: _•�t.�) U' t - 1 P i
13125 SW Hall Blvd., Tigard, OR 97223 0 2010 Plan Review / �
)
Phone: 503.639.4171 Fax: 503.598.1960 SEP 1 Date/By: Other Permit: t 0 -0 LR - 7
Ins ection Line: 503.639.4175 C jlr 1N Date Ready/By: Juris: la See Pali 2 for
flt; \R11 p r "-
Internet: www.tigard or.gov O otified/Metho LP Supplemea al Information
CoM G i pliSIii ''.
TYPE OF WORKpu1 lri PLAN' REVIEW : ,
❑ New construction ( Addition /alteration/replacement Please check all that apply (submit 1 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building ojc r three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas anal boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating bul dings.
less to ground, or exceeds 14,000 ❑ Commercta -use agricultural
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installationlof 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ",' °1 - ", "1 - 3 ",
II I00HP or more. occupancy.',
Job no.: Job site address: C102 S1,J U_k S h i I yk7 4 Rd• ❑ Six or more residential units. 0 Recreationa vehicle parks.
( � ❑ Health -care facilities. ❑ Supply vol ?age for more than
City/State /ZIP: M Q r� O 7 2_7_3 ❑Hazardous locations. 600 volts naaninal.
Suite Idg. /apt. no.: J 5 I 0 Project name: G ress 4 C l r V ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qtr. 1 Fee. I 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
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
. DESCRIPTION OF WORK (with above sq. ft.) 1
• (` Limited energy, multi - family
+B� 11 C- 1 r I mm u 1+ S To /- -r _ • residential (with above sq. ft.) _ 75 2
'j�
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.5 2
401 amps to 600 amps 200.3.4( 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.4 2 -
Temporary services or feeders installation, alteration, and/or
City /State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration, or extension per panel
Owner signature: Date: A. Fee for branch circuits with
above service or feeder fee, 7 4' i 2
❑ APPLICANT 0 CONTACT PERSON each branch c 1
B. Fee for branch circuits without
Business name: service or feeder fee, first /
branch circuit
56.1 5 B 2
Contact name: 5 I q 4
Each add'l branch circuit r] 7.4 2
Address: Miscellaneous (service or feeder not included) :
Each manufactured or modular
67.84 2
City /State /ZIP: dwelling, service and/or feeder _
Reconnect only 67.8( 2
Phone: ( ) Fax: ( ) I
Pump or irrigation circle 67.8E 2
E -mail: Sign or outline lighting 67.81 2 ,
CONTRACTOR S ignal circuits) or limited energy
II,, panel, alteration, or extension. Page 2 ,
Business name: , C C. Costello E l ee +ric.* I C o n 4 c_4 c Each additional inspection over allowable in any of the above
Address: 'pp / I� O 33 t , Additional inspection (I hr min) 66.25/ it
Investigation (1 hr min) 66.251. it
City/State /ZIP: /L)ttrDr 0 k C] 100 Z Industrial plant (1 hr min) 78.18/ hr
Phone: ( 503 w pp 2 ` --)/4 Fax: F („r 092 - -? L/o / Inspections for which no fee is 90.00 / v
specifically listed (%= hr min)
CCB Lic.: 8 r) qOz Electrical Lic.: 3 .34 c Suprv. Lic.: 3g 3 y- S ELECTRICAL PERMIT' FENS •
l Subtota /Q 8 / 7
Suprv. Electrician signature, required: Plan review (25 %ofpermit fee):
/�
I I I I Q State surcharge (12% of permit fee): ___L ), br?
Print name:
F03 zr r Lo S 'I'Z I I O Da te: I !!! ,'/
TOTAL PERMIT FEE: I 1KJ
Authorized signature: This permit application expires if a permit is not o anted within 180
days after it has been accepted as com t i I U�
Print name: I Date: • Number of inspections allowed per permit.
1:\ BuitdingTermitsELC- PermitApp.doc 07/01/10 440- 4615T(t I /05 /C0M/WEB