Permit •
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n CITY OF TIGARD ELECTRICAL PERMIT
1114 `. - COMMUNITY DEVELOPMENT Permit #: ELC2009- 001.77 •
Date Issued: 04/22/2009
T € G A [{ D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1 S136AD04000
• // 9 7 Jurisdiction: Tigard
Site address: 101F80 SW PACIFIC HWY
Subdivision: Lot: 0 •
Project: Pacific Terrace
Project Description: Reconnect (1) RTU and move disconnect.
Owner: FEES
PACIFIC TERRACE COMMERCIAL LLC Quantity Description Date Amount
BY EDITA M SMITH, 833 NW 170TH DR 1 crt Branch Circuits 04/22/2009 $46 85
BEAVERTON, OR 97006 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 04/22/2009 $5.62
Contractor: Electrical
R C COSTELLO ELECTRICAL CONTRACTING INC
PO BOX 336 •
AURORA, OR 97002
PHONE 503 - 982 -7400
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FAX: 503- 982 -7400
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $52.47
Required 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 with 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 d ATTENTION Oreg a • ires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 -0 1 -0010 through OAR 952 -00 ' 100 Yo -y obtain a copy of the rules or direct questions to OUNC by calling 503 246'6699 or 1.0.3322 •4.
Issue y: ,. : 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'
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SIGNATURE OF SUPR. ELEC'N r Date:
LICENSE NO. l � —
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 tho job site at the time of each inspection.
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Apr 17 2009 6:46AM HP LASERJET FAX
p . 1
Apr 16 2009 9:32AM WILLA! T
i COVED 5039482597 page 2
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Electrical Permit Application I ov (,i,, L.1,:
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City of Tigard APR. VC ZOO'S it.dwd . •
.,V #
Peimat Nx. 2- °'.. 40/ 7 7
1 13125 SW Hill Blvd., Tilhad, OFt 97223
' 6,7 .. Pli oar 503,639 4171 Fax: 303. 598.1tairry OFT1GARD ! I COW Perri'
loWootien Line 103.639.4173 )15 I 10 **Papa for
intense*. www.tigard-cmgov ed/hteno. /Li [ Seephrosentel Informed.
ISSIMEMainner7-..:.*7 !1'74!::r:V:41!:°:r'
a i;i aiiiiitintilMOWilligiSZ.k
Please cheek on tom reply (plamit 1 ram ' o( plum eel chocked Wow):
El New construction El Addition/alienation/replacement
DSovvor eg header 100 amps or mom 0 Relicting we three Ptiries.
12 Demolition 0 Other: wbere the oval:Ibis flat mood 0 Marian gad %sem&
.. •IPIP. - . ... ,!.. •', .r. exaceds 10)00 aropa as 150 vans ar GI Moog bleier.
'''' '''''' 'z' ''' ''' - 0''''''''''' VS= -..., .,-. -= . -.-- i.j,.k. .. -, ..1 - .-.,.:
i '''''. 71 - , .4,44.i . .1 . ' At :A.,: „_ ., -'. .. . ,...,..--,,,'''', ,;?:I.g'i.", less lo around, or exceeds Kam 0Ccoolognikae apieelhaal
I 0 1- and 2-family dwelling El Commercial/industrial 0 Accessory building amps foe all Mires iastalliatons. teillrliega-
0 MUlli-family 0 Master builder 0 Other: 0 Far piano Climatic= et 75 KvA or
us teparately thrived mien
MISMINEE=MIStraA4 ,1.. c.:' .. • _ ,, ..,,, Obraerreey syn..
, _.„.., .. _ ..,,,..0 r4 .71:71;;,. • ,,..;-..:; ^. . i . ClAcklmoo a fney. meter load of 0 "IC . 'V, " 1 - - 1 - 3 - ,
1001.1:1 or more. 0=
Job no : lob site address: 11505 SW Pacific Hwy MIR Of Mvri fasiJernial trots 0 Roues/awed vehicle fedi.
C ily/SulteMP . Tigard OR 0 Heakh-earc f Bei ties El Supply vo:lage fbr more her
C1Heragekous tocatioog. 600 voila ecconal.
Suiteibldg /apt. no.: I Project name: 71 SI &meg of feeder 600 mope eg mote.
_:,... vorkonif
7 '
Cross street/directions to job site' Dom r i rot i •
New residential single- or mu 111-family dweillag suit
lacteal attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft. or less 145.15 4
Ea add'I 500 sq R. or portion 13.40 ' I
Tax map/paroe/ no.: Limited energy, residential
rt (wall above sq. a ) 75.00 2
Limited energy, multafamily
i is to 2
4 1.___ .. .11■1a...' • - .. • _ ... 4111.1.1 residential (witli More sq. ft I
Services or kedera instalialtoryskeratkin, and/or relocation
1.— 200 amps or lets 80.30 2
g'. :‘ A.''.. 201 sinin io 400 anrs 106 85 2
401 amps to 600 imps 160 60 2
Name: 601 amps to 1,000 amps 240 60 2
Address; Over 1,000 steps or volts 45.1,65
2
City/State/ZIP: Temporary swims or feeders initalladon, alteration, and/or ,
relocation
Phone: ( ) ----r Fax: ( ) 200 amps or less 66.85 l
Owner Installation: This installation is being made on property that 1 awn which is not 201 arr,ps to 400 amps 100.32 2 i
tntended for sale, lease, rent, or exchange, accord ing to ORS 447, 449, 670, and 701. 401 amps to 599 amps 13315 _ 2 I
Breath circuits - sew, alteration, or extension, no panel
Owner sign tinier... Date: A. For for branch circuits tordi
4
i ii i - ,,I.; , ;1;_. - igtif*011it r . ,:1344 I ..[' :21,401itaigOttWit i itrg above service Dr fiedil fiC, 6.65 2
-, .- ..7/ 7 f 4 cad; moon circuit
Simmer s name: 4) / 4 , c ee e „ B. F for branch circuits
C43ntact name. 771,(--ti‘E/ (114/s- f0
,virhow service or feeder fee,
Each !Wel branch circuit 6 65 2
11rst branch circuit I 46.85 2
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Address: . 77 5 5 4) Q. ... a 4 . fre 57 ,,,,,.
Miseellaneons (service or feeder sot anduded)
City/State/ZIP. ; I/ 5 Kcl C /e q -7/) 3 Bich manufaoured or modular 90.90 I_ 2
Flam m (a) 6 0,0143 y I Fax: : ( 4-3 g ,s ' 9 7
6 dwcnp. saviee anclior feeder - 4
Reconnect only 66.85 2
E-mail: Purop or Irrigation circle 53 40 i 2
L'l,i,_:7-1]::'i■:4 Maitil*PAIWERM1111;4;::=',-121::;i: d;:f.174.,fr.ry,., Sign Or OUtlint lighting 33.40
Busin i 2
....-2 Signal cireou(s) orliraited- i
ess raule L.-0 q /4 ZieLl i a 4.0,s7 7 . - e'Y - •... energy panel, alteration. Or
",
eategnion. Dell tribe . i Page 2 I I 2
Address:O., 3 ,e :1/6 Ai
1 (.1 r a rt.
Citydiede/Z11 A, ri? ,. - 4. C Z 01'1002 Each additional hap ectioa over allowable hi as of the above
Per inspection I 62.50
Phone. Ica) qs,2, ... 9 Li 0 o I Fax: (54,2 q 82.- '1 f-ya / Investigation per hour ti is Imo 6230
CCB Lic.: 04/02_ I Electrical Lie.: 3 - 3 L-146 Suprv, Lic.: 3q34/.. S Industrial . ant . er hour i
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Suprv. Electrician signature, required. ....r. ...----' - Subtotal j,.. f .. C
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Plan review (25% of permit fee)
Print name: R. e r c C s - 4 0 1 , Date i-1 I I I
State suiebssge (12% of pcnnit be) , 1 p f ) - - ,
Authorized signature: , PERMIT FEE_ 52.. y -7
Tha permit epplication maims if a pertmt1 is oet a wand enema lab
Print rame: . Date.
1 days meter k !sr bees screened m complete.
• Numbed of mepectiong anovrod per permit
LTA dreItenriti (name 440,151ST(11/0S/COMMIIII