Permit CITY OF T I G A R D ELECTRICAL PERMIT
e A, PERMIT #: ELC2001 -00261
I� DEVELOPMENT SERVICES DATE ISSUED: 5/21/01
" ' I- ' 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171
PARCEL: 2S112DA -00800
SITE ADDRESS: 15115 SW SEQUOIA PKWY 100
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of (2) 200 amp service /feeders and (40) 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: 2 W /SERVICE OR FEEDER: 40 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:
PACIFIC REALTY ASSOCIATES R C COSTELLO ELECTRICAL
15350 SW SEQUOIA PKWY #300 -WMI ROGER COSTELLO
PORTLAND, OR 97224 1439 SE 17TH LOOP
CANBY, OR 97013
Phone: Phone: 266 -8483
Reg #: SUP 3834S
LIC 00087402
ELE 3 -344C
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 5/21/01 $426.60 2720010000( Elect'I Service
Elect'I Final
5PCT CTR 5/21/01 $34.13 2720010000(
Total $460.73
This Permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Spedalty 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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Permit Signature: Issued By: _ . / L
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: S 6/
LICENSE NO: - q
Call 639 -4175 by 7:00pm for an inspection the next business day
- Electrical Permit Application
�a.ni Date received: Permit no. �','? / - a 22(�
`i i I �! ;, r
,,I City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receiptno.:
Phone: (503) 639 -4171 l!
Fax: (503) 598 -1960 ( Case file no.: Payment type:
PP
Land use approval:
TYPE OF PERIIIT
❑ 1 & 2 family dwelling or accessory "A - ommercial/industrial ❑ Multi- family i !4 Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: V 115 s 04 01 D TV Bldg. no.: 7 Suite no.: /0Q Tax map /tax lot/account no.:
Lot: I Block: Subdivisioir
Project name: jf G97 2 I Description and location of work on premises: Co ,y 77
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDI1LE
Job no: Fee Max
Business name: Fe //J � Description Qty. (en.) Total no. Imp
S K �b New residential - �tgle or multi- family per
Address: 1u39 LE /2y 1, dwellingtmitlncludesattachedgarage.
City: j ClState:0 I ZIP: q 7 0 1 Servicemchtded:
Phone: 2441/is 3 I Fax: u3 -23 I E -mail: _ 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: U07 I Elec. bus. lic. no: 3 - 3'1 C Limited energy, residential 2
Citernetro ic. no.: y / -7Q /0 /01 l 01 Limited energy, non- residential 2
512- � 0 ( Each manufactured home or modular dwelling
Signs of supervising electrician ( uired) Date (� Service and/or feeder 2
Sup. elect. name (print): - i i '.Sdti( License no: , 3 5 �ryr orfeeders — installation, \
alteration or relocation:
PROPERTY OWNER 200 amps or less 2- 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: 'State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - . .
which is not intended for sale, lease, rent, or exchange according to Installation, alteration, orrelocation:
200 amps or less 2
20
ORS 447, 455, 479, 670, 701. 201 1 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am s 2
Branch circuits - new, alteration, .
or extension per panel:
Name= A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 40 2
City: I State :. I ZIP: B. Fee for branch circuits without purchase
Phone: Fax E-mail • of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
❑ Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps -rating of 1&2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable In any of the above:
❑ Egress/lightingplan ❑ Other Per inspection I 1
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other ‘-/
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ / °� n
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: I / within 180 days after it has been State surcharge (8 %) .... $ 3% / •
Expires accepted as complete. TOTAL $ 5/10 el 23
Name of cardholder as shown on credit card •
$
Cardholder signature Amount 440.4615 (6100/COM)
Electrical Permit Fees: Limited Energy Fees: r�', � ;;
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items . Cost Total `I' Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 El Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 El Burglar Alarm •
Limited Energy $75.00
Each Manuf'd Home or Modular Garage Door Opener
Dwelling Service or Feeder . $90.90 2
Services or Feeders 0 Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less , $80.30 llaDio 2 Vacuum Systems`
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2 I I Other
601 amps to 1000 amps _ $240.60 • 2
. Over 1000 amps or volts $454.65 2
Reconnect only $66.85 • 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 -260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved: .
Over'600 amps to 1000 volts,
see "b" above. Audio and Stereo Systems
Branch Circuits ❑ Boiler Controls
New, alteration or extension per panel ,
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee. /
Each branch circuit '� 0 $6.65 012S(0// 40 2 0 Data Telecommunication Installation
b) The fee for branch circuits' •
without purchase of service ❑ Fire Alarm Installation -
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
•
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems ,
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 Landscape Irrigation Control' •
Minor Labels (10) • $125.00'
El Medical
Each additional inspection over
the allowable in any of the above Nurse Calls •
Per inspection $62.50 -
Per hour $62.50 ❑
In Plant $73.75 Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ 49%440 (v0 I I Other
8% State Surcharge $ • / _ Number of Systems
25% Plan Review Fee
* No licenses are required. Licenses are required for all other installations
See "Plan Review" section on $
front of application.
Fees:
Total Balance Due . $ 440. r73 Enter total of above fees • $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
iAdsts\fomu\elc- fees.doc 10/09/00 •
•
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested � AM PM BLD
Location /T7/ S S- 5-1 o/ w Pkt4.7 Suite fr� � MEC
Contact Person j ie,..iC e t14" /Cli �Z Ph 574 75- O / PLM
Contractor AC (o s I e/ I 0 Ph SWR
BUILDING Tenant/Owner 1p e w /i / 0' / kQ r q/, ELC 2evl GD Z
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof _
Misc: l / 42 S
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
�-- - w24 4410
Service ,kale -
Rough In
UG /Slab
Low Voltage
Fire Alarm
ASS PART FAIL
S
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA Q Approach /Sidewalk Date 6,2 ! r Inspector 7 � Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
-:CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 5_ 2 7 AM PM BLD
Location /5/ S cJ ,Sept D/ ,e Suite - -/(') MEC
Contact Person A.' J / . - 3 7 , S(.11 14 too Ph 5) JZ y 7s k PLM
Contractor Ph SWR
BUILDING Tenant/Owner
ELC � i /4 2- G /
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: • SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final //1J� l s
PASS PART FAIL 6 / l \
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
qLEGIiIalalt
Service
Rough In w CvvL
UG /Slab
Low Voltage
Fire Alarm
Fi
ASS RT FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk V/ r
Other Date Inspector nspec E
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
WITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUD
/
L%
Date Requested (DM AM PM BLD
Location 1 S -1 1( if awi Suite `Ub MEC
Contact Person Ph PLM
Contractor Ph a<1 4 13C/ SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR o261 Q'/ '2.
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: J�
Slab i JCS I`4 �C? e SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc: l f h G; q rd �� .
Final , J Q
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS T FAIL
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL •
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Other oach /Sidewalk Date 6"--- /4/- , ( Inspector 4,4 Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.