Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00288
4 A. 4, DEVELOPMENT SERVICES DATE ISSUED: 4/28/2005
° - 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 25101 DC -00200
SITE ADDRESS: 13535 SW 72ND AVE 150 ZONING: C -P
SUBDIVISION: 72ND AVE OFFICE BUILDING LOT : JURISDICTION: TIG
Project Description: (6) Branch circuits.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 5 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
PACIFIC NW PROPERTIES LTD PTNSHP RC COSTELLO ELECTRICAL CONTRACTING
9665 SW ALLEN BLVD STE 115 PO BOX 336
BEAVERTON, OR 97005 AURORA, OR 97202
Phone: 503 - 626 - 3500 Phone: 503 - 982 - 7400
FEES Reg #: LIC 87402
ELE 3 -344C
Description Date Amount SUP 3934S
[ELPRMT] ELC Permit 4/28/2005 $80.10 •
[TAX] 8% State Surcharge 4/28/2005 $6.41 REQUIRED ITEMS AND REPORTS
Total $86.51
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699 or
1- 800 - 332 - 2344 �
Issued By: :-Z/,l_fi& 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'N: 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.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard ��
Deceive <, �� Yvl permit No.: 64472 ,05--. 00.2./
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 '• �h,:;w +, Other Permit:
r r I Date/By:
Line: 503.639.4175 ;' _,, Date Ready/By: Ju HI See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: /Il Supplemental Information
ir.• - NrA L ','S7-A i "°gy .as'• ffili1° y i a Y afi , r`' . 14, t}i t a ,':c try r i ' ii
,
t L_ ss.4 �. [�i t_... �.'�w�+ra. #i'tti � _.. .IFa. r .. i -. v_;. a ..�'.5 . i
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition Other T� ['Service over 225 amps, comm'I ❑Hazardous location
.0 - x n ^ .y ''' ` ❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
. .
el u ' • 4� `�- +� Mg a� ' ' t6 - a iP : "s 1 of 1- and 2- famil dwellings 4 or more new residential
ar i+ ..r �n � l.:4< :u...-:' v.K1" :7 5 c_ _ .'`,ts- t.�•.::' d - - ° 4.
❑ 1 and 2 family dwelling L Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi 0 Master builder ❑Other:
ul i - cr 1 „ F ,e builder , {� r �� Occupant load over 99 persons ❑Manufactured structures or
` 0 9 + , v rt e.. x ,� i :. i �a 1 6-, j 'w�.a-- !` :sw - i ^ � : i il. as g gP RV
2 , •� fi ry , K W*Iff 7 -"` . , ❑E hti ran park
P
Job no.: Job site address: / 3 5 3 S S 92n Sl /5 ❑Health -care facility ❑Other•:
Submit 2 sets of plans with any of the above.
City/ State/ZIP: T, a r A 0 FR The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: I Project name: C re d i -f U n i o,rl game L oa i ",s.,- > . '� i ` ` r C ` y ..
Duerlptlon I Qty. I Fee. i Total 1
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea. add') 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel no.:
7h L wTm r r a x s { r r Limited energy, non - residential 75.00 2
^; ra x " :4„ , t 1 i a ya . .. Lvi :a ` . e� a; a ,e •« M�.p c Each manufactured or modular
dwelling, service and/or feeder - 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
`` - vlx t �k. i� $ a' ' " 201 amps to 400 amps 106.85 2
- ttom . 7, tF F W -! A j,� 401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
xc N, "4:'="4 "s "c ` ` `° " P �' ; 1 V t f 17 -N.�' 7- N A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 7 2
Address:
Each add'1 branch circuit 5 6.65 . 13 . ,2.5 -. 2
City/ State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) I Fax: ; ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
} E � - mail: Signal circuit(s) or limited -
i i .N . . 3 . � 'a N : �
Y �} s , �'' �j 1ri r °' energy panel, alteration, or
s.� f W _ L -i . 6 `- +: ,::=
extension. Describe: Page 2 2
Business name: Re r6s-Iello Ekkc -r;cci' a rig f +iv C - 1"
y-� J Each additional inspection over allowable in any of the above
Address:
b �U L�U 3,./ Per inspection 62.50
` t City/ State/ZIP: A V ro f r^ 0 Investigation per hour (1 hr min) 62.50
") Phone: (5 ) C gZ - /.4 l Fax: X503) 98L' �D I Industrial plant per hour 73.75
� n _ -
1 CCB Lic.: 6'�L40 2 Electrical Lic.: 3 -3L. /G/ C Suprv. Lic.: 3 y',j� S Subtotal / 6
. Z,, tea.
Suprv. Electrician signature, required: Plan review (25% of permit fee)
L � State surcharge (8% of pemtit fee) (- / /
Print name: ) /2 -- C In S `If I ' Date: -/ /Z 8 io ( TOTAL PERMIT FEE 6 S -r
Authorized signature: This permit application expires if a permit 1s not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
1: B3uildiag \Pemtiu\ELC- PermitApp.doc 12/03 440.4615r(10/02/COM/WEB
CITY OF TIGARD
•
BUILDING DIVISION PERMIT #: ELC2005 -00288 -
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/28/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/23/2005 TIME: 7:08AM PAGE: 27
SITE ADDRESS: 13535 SW 72ND AVE 150 CLASS OF WORK:
SUBDIVISION: 72ND AVE OFFICE BUILDING LOT #: TYPE OF USE:
PROJECT NAME: CREDIT UNION HOME LOAN
DESCRIPTION: (6) Branch circuits.
OWNER: PACIFIC NW PROPERTIES LTD PTNSHP. PHONE #: 503 - 626.3500
CONTRACTOR: RC COSTELLO ELECTRICAL CONTRACTING PHONE #: 503.982 -7400
Inspection Request Scheduled For: Date: 5/23/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 007501 -01 503- 504 -6758 N
Corrections /Comments/ Instructions:
C
(f-
C \S \ Ur f C V 1, A Of C4 L
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �"-' Date_, 3 Phone #: (503) 718 -