Permit • � CITY OF TIGARD ELECTRICAL PERMIT
P t
'. «. COMMUNITY DEVELOPMENT Permit #: ELC2012 -00069
Tid RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
. Parcel: Date.l 01/31/2012
1 S136CD02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Project: Costco Subdivision: PALMER ACRES Lot: 1 -3, PLL
Project Description: Alter (1) branch circuit for office remodel.
Contractor: MOUNTAIN F ENTERPRISES INC Owner: COSTCO WHOLESALE CORPORATION
25973 S MOEHNKE LN PROPERTY TAX DEPT 111
BEAVERCREEK, OR 97004 999 LAKE DR
ISSAQUAH, WA 98027
PHONE: 503 - 313 -0761 PHONE:
FAX: 503 - 632 -5521
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 01/31/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/31/2012 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 ION: Ore.: law r...ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules re set forth in OAR
952 -001 -0 0 thro gh OAR 95: 01 may obtain a copy of the rules or direct questions to OUNC by callin 503.232.1987 r 1.800.332.234
Issued / 'L / ,�
- Permittee Signature:
y: f
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:
C NTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' A,, j Date: -3J_i 7 LICENSE NO. jf 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 Applicatl :[, CEIVED Re FOR OFFICE USE ONLY
City of Tigard DateB f 1/ 6:9, Permit No.: eheaelljr �?
y
'1 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
IN
C Phone: 503.718.2439 Fax: 503.59871W 3 1 2012 Date /By: Other Permit: 6 �
TI GAR Inspection Line: 503.639.4175 Date Ready/By: luris: El See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information
,' TYPE:1 'I , . - ' _ _ . .r . ". ' -P1, 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.
Vi e`, ,, , "; `- '".'_, ° - , • ' .. CATEGORY; OF CONSTR_ UCTION- `- . - 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 N ❑ 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 INF AND,7 LOCATION , El Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 1 Q C, r 100HP or more occupancy.
-[ V J��1�I t [: t ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: �Q,�p� / � y D _ ❑ Health-care facilities. 0 Supply voltage for more than
T � r ` T �v �� 7 L 3 ❑ Hazardous locations ocations 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: Desorptio ' n FEE S ` . . Qty. I Fee. I Total ,
New residential single- or multi -family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
" - .. - DESCRIPTION OF WO RK ' (with above sq. ft.)
Limited energy, multi - family
OFV LG/7, �"
[ residential (with above sq. ft.) 75.00 2
lN���o �� V Services or feeders installation, alteration, and/or relocation
1� 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: ( ) I 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
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, per panel
Owner signature: Date: A. Fee for branch circuits with
.APPLICANT above service or feeder fee,
❑ 'CONTACT PERSON' each branch circuit 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first
Contact name: branch circuit f 56.18 i 2
Each add'l branch circuit 7.42 2
Address: 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
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
._ . • _ CONTRACTOR _ : - Signal circuit(s) or limited- energy
Business name:M .p igN a PI' Tot ci2,a t AsAki ' + G � M1j F + ,i panel, alteration, or extension. Page 2 2
�l 1 �l� Each additional inspection over allowable in any of the above
Address: lr7 i S . Motp_t,rkj 5 Additional inspection (1 hr min) 66.25/ hr
-
City /State/ZIP: .i Investigation (1 hr min) 66.25/ hr
=_ •_.• ' ' ` r 7 • 'rr 6 - t — Industrial plant (1 hr min) 78.18/ ltr
Phone: (C j 3) Z i 3 C)1-' t � Fax: �) (Z � 5 Z ( Inspections for which no fee is 90.00 / hr
Y specifically listed (%2 hr min)
CCB Lie.: l s cis. 1 Electrical Lie.: - ? Suprv. Lie.: Z j Z1 ELECTRICAL PERMIT FEES ' ' ` '
Suprv. Electrician signature, required: i -7 /sli / 7 Subtotal: yt4 1 6
�.. i' .� i 2E- 4,44..A-- Plan review (25% of permit fee):
- - - Print name: N,,,,,.., Date: State surcharge (12 %of permit fee): 49.-1-4
,' TOTAL PERMIT FEE: LP C ,
Authorized signature: •• , i
1\∎ t . C� l./�• This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: > [- 1 Date:
* Number of inspections allowed per permit.
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