Permit CITY OF TIGARD ELECTRICAL PERMIT
III ' COMMUNITY DEVELOPMENT Permit#: ELC2017-00010
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/05/2017
T'GA RD 9
Parcel: 2S112DC01400
Jurisdiction: Tigard
Site address: 15865 SW 74TH AVE 110
Project: SC Labs Subdivision: FANNO CREEK ACRE TRACTS Lot: 4
Project Description: (11)branch circuits for TI.
Contractor: R C COSTELLO ELECTRICAL CONT INC Owner: JDS LLC
PO BOX 336 CRITERION CREEKVIEW LLC
AURORA, OR 97002 BY SPECTRUM REAL ESTATE ADVISORS
1125 SE DIVISION ST#209
PORTLAND, OR 97202
PHONE: 503-982-7400 PHONE:
FAX: 503-982-7400
FEES
Quantity Description Date Amount
Specifics: 11 crt Branch Circuits wo/Purchase 01/05/2017 $130.38
Service or Feeder
1 ea 12%State Surcharge- 01/05/2017 $15.65
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $146.03
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 OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ia �..-,. Permittee Signature: - -' -7-------
AOWNER 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 503.639.4175 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 Application
I ( l 1 l( 1: l S1 1)Ni 1
City of Tigard , Received
9 13125 SW Hall Blvd.,Tigard,OR 9722"kiEF l E ») aL�.�ij/,i �'t#: - - , .y 1
6)
C Phone: 503.718.2439 Fax: 503.598.1111 `f ' "s Plan Review y
Date/B : Related Permit#:
1 ,, „i� Inspection Line: 503.639.4175 . 71 017 �D , - t
Internet: www.tigar g i AN , ! R S See Page 2 for t
d-or. ov Notified/Method: iiiiMI
Supplemental Information
,TYPEOF WO 9 f F 1 l 6R4D PLAN REvww
❑New construction Addition/alter DI � '�'r Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition ❑Other ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current
0 Marinas and boatyards.
CATEGORY OF CONSTRIJCTION
❑ I-and 2-family dwelling [1/Commercial/industriallessto exceeds Io,00o or amps at 1501volts or 0 Commercial-usearing buildings.
❑Multi-fatal! 0Accessory buildingground, exceeds 14,000 0 agricultural
Y ❑Master builder ❑Other: amps for all other installations. buildings
❑E0
JOB S!'Fh INFORMATION AND LOCATION , Fire pump. ❑Installation of KVA or
Emergency system. larger separatelyly dderived
Job#: I Job site address: /'. 8 6 S kJ 7 LT
I L� ❑Addition of new motor load of system.
City/State/ZIP:
10011P or more. ❑ A^, g,X1_2,`l_3",
0 Six or more residential units. occupancy.
llltIds./apt #: ❑Health-care facilities. 0 Recreational vehicle
10 I Project name: e C L G b S ❑Hazardous locations. ❑Supply voltage for more than
Cross street/directions to job site: 0 Service or feeder 600 amps or more. 600 volts nominal
FEE SCHEDULE
Description I Qty. I Each J Total I •
Subdivision: New residential single-or multi-family dwelling unit.
I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or fess 168.54 4
DESCRIPTION OF WORK Ea.add'!500 sq.ft.or portion 33.92 1
Limited energy,residential
rq/1G J i C 4// 7t"S- / J.2.-. (with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
❑ PROPERTY OWNER 1 ❑ itatiANT Energy Q See Page 2
Name: ServicesRenewable or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56
2
City/State/ZIP: 401 amps to 600 amps 200.34 2
Phone:( ) 601 amps to 1,000 amps 301.04 2
I Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
Owner installation:This installation is beingmade relocation
on pro perty that I own which is not 200 amps or less 59.36 I 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400
Owner signature: amps 125.08 2
11 Date: 401 amps to 599 amps 168.54 2
0 `�` � t 0 CONTA PERSON Branch circuits—new,alteration,or extension,per panel
PPLICANTBusiness name: A.Fee for branch circuits with
above service or feeder fee,
Contact name: each branch circuit 7.42 2
B.Fee for branch circuits without
Address: service or feeder fee,first
branch circuit
if 56.18 3-6,18 2
City/State/ZIP: Each add'!branch circuit
/C) 7.42 -7 Li.2.4; 2
Phone:( ) I Fax::( ) Miscellaneous(service or feeder not included)
Each manufactured or modular
Email:
dwelling,service and/or feeder 67.84 2
CONTR+IGT()R
Reconnect only 67.84 2
Pump or irrigation circle 67.84
Business name:F,C? eo s'.e l ic' E/ , Sign or outline lighting2
/� � � l^ CC( / n,_,/_7.,,, 67.84 2
Address: /?V- C.70 x- 336Signal circuit(s)or limited energy
' panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: AU pa 0 - Each additional inspection over allowable in any of the above
Phone:( ) �/_ r c�ay I Fax:( ) Additional inspection(1 hr min) 66/5/hr
Investigation(I hr min) 90.00/hr
Email: rtCos.ie //o a ie C a Q v 1, Go Industrial plata(1 hr min) 78.18/1w
ECCB
maElectrical Lic. Inspections for which no fee is
Lic.:
-74/0 Z Lic.:3-3 L/L/�j Suprv.Lic.: 3c 31f-.5 specifically listed(%,hr min) 90.00/br
Suprv.Electrician signature,required'�� ELECTRICAL PERM1bt FEES
Print name: p Subtotal: /3 D, 38
\9e'/- C, ,as,11/fV I Date: //l,.f i i'7 El Plan Review Required(25°%of permit fee):
State surcharge(12%of permit fee): /5. 65
Authorized signature: TOTAL PERMIT FEE: /La 0 3
Print name: I Date: ( This permit applicationithaexpsires if a permit is not obtained within 180
J days after been accepted as complete
I:58uilding�Petmils�ELC PetrauApp ELR ERE.dac Rev 06/17/2015 * Number of inspections allowed per permit / ''—
440.4615T(I I/05/COM/WEB 7•( ,, "
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15865 SW 74TH AVE 110, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Electrical ELC2017-00010
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor