Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2012 -00108
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/21/2012
Parcel: 1S136CD02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
'Project: Costco Subdivision: PALMER ACRES Lot: 1 -3, PLL
Project Description: (4) branch circuits to disconnect and reconnect (2) deli ovens.
Contractor: COCHRAN INC Owner: COSTCO WHOLESALE CORPORATION
7550 SW TECH CENTER DR. #220 ; PROPERTY TAX DEPT 111
TIGARD, OR 97223 999 LAKE DR
ISSAQUAH, WA 98027
PHONE: 503 - 234 -6564 PHONE:
FAX: 503 - 238 -2098
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 02/21/2012 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/21/2012 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0010 through OA; • 2- 001 -0090. You may obtain a copy •.•'T7ni� or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. -
_
Issued By: L % - - = Permittee Signature: _
�11
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 503.839.4175 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.
01 �^ 11:43:48 02 -21 -2012 1/2
Electrical Permit Appli \� \e 10k 01.1.1(1.: l'sl ()NIA
• : NI
City Tigard Received
1111 g 131 Hall Blvd., Tigard, 7223 1 1 V11- V11- Phone: 503.639.4171 Fax: 503.598z� Dat • : Permit No.: _/ ... z .../ _
Plan Review
Date/By: Other Permit:
T I t i :� a 1, Inspection Line: 503.639.4175 P l� Date Ready /By: kris: 0 See Page 2 for
Internet: www.tigard-or.gov O '' G V`c \O A Notified/Method: ( 'y Supplemental I Information
: �: ii,1Y; {l:.+;. :' •.r•- - ; - '�.i' L n - 7.l•,'• .;
t on /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction - Addition/al
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other.
where the available • available fault current ❑Marinas and boatyards.
7 ` :1 ¢ ^'�r;;;:` 7 ''i ±i' dii; r'ih'r'�; exceeds at150voltsor
g,?".,,,,,,_ -(' ' ,,,.'CA`If;ECQRYti b ....: NS77.UC;I.... . ❑ buildings.
'•' '. .: � , �:.': ":.. �r . h.. .. i ,.e.,.,...,...., . rirnif �:•. /':: �:/ _';!! �I��` %i` .. ., . g ga,
. � ., i °• `' : i less to groun or exceeds 14.000 ❑Commercial -use a
1- and 2-family dwelling ommercial /industrial 8"COIt°ml
❑ Y g ❑Accessory building amps for all other installations. buildings.
❑ Multi family Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or
JOB. SITE; IIY FORly11ATiO1V AND; . 00 7 TJON ❑Emergency system. larger separately derived system.
.. „'::..;.: 0 Mdiuoo f new motor load of ❑
Job no. y3 3�535/ Job site address: 7t b �
SW ��r /you h ❑ � I00HP or more. occupancy.
_ (� Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: ??LnA 0f 9 7Z - Z3 ❑ Healthcare facilities. ❑ Supply voltage for more than
❑ Hazardous !orations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: (J7 .. y3 /z _ 535 _ ❑S erviceorfeeder600am
� � � 1 � ps or more.
Cross street/directions to job site: .s& J 4rt/nou '/h q. //tot/ 99 w De scription ;::'' ^FEE'. SCHED !: y 't:
/ QtY• I Pee i Total 1 •
New residential single- or multi- family dwelling unit.
•
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 - 4
Tax map /parcel no.: Ea. add'1500 sq. R. or portion 33.92 l
Limited energy, residential
::'.: ;, ..: ; • . ..
. _.; i 'DE WORK :' `: - . . (with above sq. R.) 2
Limited energy, multi - family 75.00 2
,b/S, 00/7/ /el tier ` /� ZJ \ be (j D Iff n S_ • residential (with above sq. R.)
Services or feeders installation and/or relocation
bbd t1G/2.e / ! ° . cia3 -x.02 - 73 7. 200 amps or less 100.70 2
: PROPERTY ;O�WNER� 'i'r` ; � , : A 'TEiANT 201 amps 10
, ..... . :'r`li`. 'a r ., , . !;t.. . .. . ,. .. !. 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 I
• Owner installation: This installation is being made on property that i own which is not 201 amps to 400 am - 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
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
. . . ❑;:APPLICANT .. _'I'' :hy i •. ?; bo e se rvice or eeder fee, 7
�G-' P�,RSQN �� - ' .42 2
��� .� , . .. . ` ' a
each v branch circuit f
Business name: X� . C�, �-�- N '. I B. Fee for branch circuits without
4. c -C U� service or feeder fee, first
Contact name: branch circuit j 56.18 2. 14/1? 2
Address: Each add'I branch circuit 3 7.42 Grp 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) F ax: : ( ) Reconnect only 67.84 2
E -mail:
Pump or irrigation circle 67.84 2
.:.: .
..., . , :: . 67.84 2
.. ' .... ,. :. .'..... :CQ CTOR . . Sign or o lima ed
n gne circuit(s) or hmrt - energy
Business name: ext) \ c panel, alteration, or extension. Page 2 2
C Each additional inspection over allowable In any of the above
5
Address: - 1 5 50 W ( e�h \ r e -'tom #Z,, 0 _ Additional inspection (1 hr min) 66.25/ hr
City/State/ZiP: a 6. ( 0 � 9 72 Z Investigation (I hr min) 6625/hr
rJ _ Industrial plant (I hr min) 78.18/ hr
Phone: 603) 13eh. ( c/ Fax: (5:)3 ) 2.38' - Z0 9 Inspections for which no fee is 90.00 / hr
specifically listed Gs hr min)
CCB Lie.: - 7 z5,42 Electrical Lic.: G/� C Suprv. Lie.: LJ1.147 j '' ;" �': ,4 , ,': �,t.DLR
/79 � :...: "� ..: , CTRi,GAL;pERiNIT::FjgES:�::' : �: : •'.:�.- . /•
Suprv. Electrician signature, required: Subtotal:. '7 , 4/7
P lan review (25% of p ermit fee):
Print name: 1 - t 4 � Date: g - �Z - State surcha (12% of permit fee): 7 9/
e r r1 ,
TOTAL PERMIT FEE: S�
Authorized signature: 67, / ���� /oa This permit application expires if a permit is not within 180
Print name: l e) 2 d after it has been accepted as complet e.
t�� G i Date Z zj -1 ? • Numb of inspections allowed per permit.
i 1euitdinsrermiirE.C- PermiApp.doc onrol•to 440.61s70 Iros•COmuwee