Permit .
CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00777
DEVELOPMENT SERVICES DATE ISSUED: 10/13/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S103DD -00800
SITE ADDRESS: 13815 SW PACIFIC HWY 110 ZONING: C -G
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: 1 service w/12 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: 1 W /SERVICE OR FEEDER: /rf2 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 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:
D.W. SIVERS COMPANY R C COSTELLO ELECTRICAL CONTRACTING
4730 SW MACADAM AVE PO BOX 336
#101 AURORA, OR 97202
PORTLAND„ OR 97201
Phone: Phone: 503 - 982 -7400
FEES Reg #: LIC 87402
ELE 3 -344C
Description Date Amount SUP 3934S
[ELPRMT] ELC Permit 10/13/200' $160.10
[TAX] 8% State Surcharge 10/13/200: $12.80 REQUIRED ITEMS AND REPORTS
Total $172.90
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 95 - 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- -2
Issued By: J.& 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.
t..
Electrical hermit A IVE® roll owlet ,.si.: ()N LV
City of Tigard Received d0 . : '16 Permit No: . o 0 - /07 ► 7
13125 SW Hall Blvd., Tigard, OR 97223 13 2005 Plan Review •
Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 u,. i Date/By.
Inspection Line: 503.639.4175 „..44,11- 'I �., Date Ready/By: u•': — ® See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: • Supplemental Information
;,, , OW IUN PLAN REVIEW
❑ New construction i Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ['Hazardous location
['Service over 320 amps - rating ['Bulldog over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi- family ❑ Master builder ❑Other: ['Building over three stories ❑Feeders, 400 amps or more
:Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ['Egress/lighting plan RV park
Job no.: Job site address: / 383 iS SW /Acf1k. /44)k.,/ ❑He care ofp facility ['Other:
Submit 2 sets of plans with any of the above.
City/State/ZIP: S ,� 4ri /0 The above are not applicable to temporary construction service.
1 3
FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name:
ea 11L I m✓ Description I Qty. I Pee. I Total I ..
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: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential _ 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less / 80.30 600 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
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
relocation
Phone: ( ) Fax: ( ) 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
❑ APPLICANT 1 ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each f a 6.65 YO 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address: Each add'l branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2
E - mail: • Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: tFC OA -1:e• I to
Address: pa 7•; 3 Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: ✓ro r% n g 9 Investigation per hour (I hr min) 62.50
Phone: Cr 03) C a& - )qdu Fax: (503 ) q g 2,7 q a / Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: g7 j Z Electrical Lic.: 334tj c I Suprv. Lic.: y3Gf -c Subtotal I (Q) ,rD
Suprv. Electrician signature, required Plan review (25% of permit fee)
Print name: S , C a s +t A Date: job 3 jo f
State surcharge (8% of permit fee) .
/ TOTAL PERMIT FEE r 7 a1A•0
Authorized signature: This permit application expires if a permit is 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.
i:\Building\Permits C- Perm itApp.doc 12/03 440.4615T(10/02/COM/W®
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES: •
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
•
Check Type of Work Involved:
El Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System
❑ Vacu Systems*
❑ Other:
COMMERCIAL WO ' ONLY:
Fee for each commercia •ystem. . $75.00
(SEE OAR 918 - 260 -260
Check Type of Work Involy :
El Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication In tallatio
❑ Fire Alarm Installation
El HVAC
❑ Instrumentation
El Intercom and Pagi ' g Systems
❑ Landscape Irri:- ion Control*
❑ Medical
•
El Nurse Cal
❑ Outdoo Landscape Lighting*
El Prot tive Signaling
•
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is\ Building \Permits\ELC- PamitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00777
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/13/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 11/22/2005 TIME: 7:02AM PAGE: 24
SITE ADDRESS: 13815 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: e A` IG Jity P ZZ
DESCRIPTION: 1 sery w/12 branch circuits. 11/21105: Added (10) branch circuits.
OWNER: SIVERS C' PANY, D.W. PHONE #:
CONTRACTOR: R C COSTEL ELECTRICAL CONTRACTING PHONE #: 503-982-7400
Inspection Request Scheduled For: Date: 11/22/2005 Pour Time:
Code # I • i Description Confirm # Contact # Message
199 Electrical final 022262 -01 503-504 -6758 N
Corrections /Comments/ nstructions:
Th Si■PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: R' Or Phone #: (503) 718 - 2,1/16-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00777
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/13/2005
Phone: (503) 639 -4171 r
Inspection Requests (24 Hrs.): (503) 639-4175 ! . .
INSPECTION WORKSHEET FOR DATE: 11/21/2005 TIME: 7:13AM PAGE: 20
SITE ADDRESS: 13815 SW PACIFIC HWY 1 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: JI N1S PIZZA
DESCRIPTION: • service w/12 branch circuits. •
OWNER: SIVERS COMPANY, D.W. PHONE #:
CONTRACTOR: R C COSTELLO ELECTRICAL CONTRACTING PHONE #: 503.982 -7400
Inspection Request Scheduled For: Date: 11/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 022096 -01 503 -504 -6758 N
Corrections /Comments/ Instructions:
) Fb ck- ALL TS&Ar u
Cs►t) ► N , a a .cz �..
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
IR FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: CS—Nt NOt)t. E Date: Vit 4 ■) 5 Phone #: (503) 718-
•
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00777
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/13/2005
Phone: (503) 639 - 4171,
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/15/2005 TIME: 7:02AM PAGE: 44
SITE ADDRESS: 13815 SW PACIFIC HWY 110 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: GARLIC JIMS PIZZA
DESCRIPTION: 1 service vv/12 branch circuits.
OWNER: SIVERS COMPANY, D.W. PHONE #:
CONTRACTOR: R C COSTELLO ELECTRICAL CONTRACTING PHONE #: 503.982 -7400
Inspection Request Scheduled For: Date: 11/15/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
13N Ceding cover 021283.01 503-504 -6758 N
Corrections /Comments/ Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: _ Date: /././ Phone #: (503) 718-
_CITY OF TIGARD _- •
$ BUII IG DIVISION PERMIT #: ELC2005-00777
131., 0VV Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/13/2005
Phone: (503) 639 -4171 �..�+11�p�'ii�
Inspection Requests (24 Hrs.): (503) 639 -4175 !�-
INSPECTION WORKSHEET FOR DATE: 10/25/2005` TIME: 7:10AM PAGE: 7
SITE ADDRESS: 13815 SW PACIFIC HWY 110 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: GARLIC JIMS PIZZA
DESCRIPTION: 1 service w/12 branch circuits.
OWNER: SIVERS COMPANY, D.W. PHONE #:
CONTRACTOR: R C COSTELLO ELECTRICAL CONTRACTING PHONE #: 503 -982 -7400
Inspection Request Scheduled For: Date: 10/25/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
125 Wall cover 019285 -01 503. 504 -6758 N
w p LLs 6 (-1t _
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FA L ❑ C ' LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �� / / Date:0 Phone #: (503) 718- 24
CITY OF TIGARD
ELC2005 -00777
BUILDING DIVISION PERMIT #: 10/13/2005
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 : �� i l l
Inspection Requests (24 Hrs.): (503) 639 -4175 —61— 1_-
10/24/2005 7:02AM 22
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
13815 SW PACIFIC HVVY 110
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: GARLIC JIMS PIZZA LOT #: TYPE OF USE:
PROJECT NAME: 1 service w/12 branch circuits.
DESCRIPTION:
SIVERS COMPANY, D.W.
OWNER: R C COSTELLO ELECTRICAL CONTRACTING PHONE #: 503-982-7400
CONTRACTOR: PHONE #:
10/24/2005
Inspection Request Scheduled For: Date: Pour Time:
Cot # I s ecti co Description a�1 5Q 6758 Mellage
A L,
Corrections /Comments /Instructions:
• IM 0 %. 1 VX Lo w VIA:\► (7S. 'N \ e S i ki) V ), A 1 -1.
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
V FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G+--- Date: / , Phone #: (503) 718-