Permit A- ,CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00165
DEVELOPMENT SERVICES DATE ISSUED: 3/21/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S115BA-02500
SITE ADDRESS: 16200 SW PACIFIC HWY W ZONING: C -G
SUBDIVISION: TIGARD TOWNE SQUARE LOT : 001 JURISDICTION: TIG
Project Description: 4 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: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 3 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:
SN INVESTMENT PROPERTIES R C COSTELLO ELECTRICAL
1121 SW SALMON STE 400 ROGER COSTELLO
PORTLAND, OR 97205 1439 SE 17TH LOOP
CANBY, OR 97013
Phone: 503 - 242 -2900 Phone: 263 -2385 FAX
266 -8483
FEES Reg #: SUP 3834S
LIC Description Date Amount EL E 3 --344344
3
3-344C
[ELPRMT] ELC Permit 3/21/2005 $66.80
[TAX] 8% State Surcharge 3/21/2005. $5.34 REQUIRED ITEMS AND REPORTS
Total $72.14
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 952 - 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- 0- 332 -2344.
Issued By: - , Permittee Signature G- �^
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.
Electrical Permit Ali' t V E D FOR OFFICE USE ONLY
City of Tigard Date/By: 3/a l /o5 � Permit No4t od 0I/65
13125 SW Hall Blvd., Tigard, OR 97223 A ^ Plan Review
Phone: 503.639.4171 Fax: 503.598.196 0'I N ( 005 4.—lliok,i,iI"'� Date/By: Other Permit:
Inspection Line: 503.639.4175 ! CY. I i Date Ready/By: J El See Page 2 for
I
Internet: www.ci.tigard.or.us CITY OF TIGAI n Notified/Method: 7/G Supplemental Information
R1 1 Tt INC T!1-V J II I , • . . `. •••• PLAN REVIEW '
❑ New construction ❑ Addition/alterfation/replacement Please check all that apply:
❑ Demolition (Other: I .1 , ❑Service over 225 amps, comm'l ❑Hazardous location
. OService over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION - • • of 1- and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling dirommercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑ Other: 0 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: /6 s •� ❑Health -care facility ❑Other:
f k/� Submit 2 sets of plans with any of the above.
City/State /ZIP: T, ad // The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: V j Project name: S pee A(�l FEE* SCHEDU LE_ , e..
0 P Description I Qty. I Fee. 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'I 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 2
❑ PROPERTY OWNER ' ❑ 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 • .. I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, SS
2
each branch circuit 1 46.85 �6 -
Address: 6.65 � 9,4,�
Each add branch circuit 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-
's") , . CONTRACTOR energy panel, alteration, or •
0 � extension. Describe: Page 2 2
1 Business name: a e . I
M Ad -PG J x �'� \ i D Each additional inspection over allowable in any of the above
Per inspection 62.50
1 City/ State/ZIP: i fk, n , r ,„ 0 2 9-)00L v j Investigation per hour (1 hr min) 62.50
Phone: ( 5)3 ) 982 -y Fax: (So)) la,- - )yo j Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
L CCB Lic.: 9, ypZ Electrical Lic.: 3 —3 Lig Suprv. Lic.:3Gl if S Subtotal bi
Suprv. Electrician signature, required: : Plan review (25% of permit fee)
Print name: //?? // Date: State surcharge (8% of permit fee) 5 3 �
�J� Qi- Iv v°S� �Cu 1 /
TOTAL PERMIT FEE -ZA • /
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 \Pemtits\ELC- PemiitApp.doc 12/03 440- 461Sr(i0 /02/COM/WEB
Electrical Permit Application - City of Tigard °`'
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY: - •
•
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i :\Building\Permits\ELC-PetmitApp .doe 04/03
CITY OF TIGARD "
BUILDING DIVISION PERMIT #: ELC2006 -00165
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 3/21/2005
Phone: (503) 639 -4171 ZIllit
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/12/2005 TIME: 7:09AM PAGE: 12
SITE ADDRESS: 16200 SW PACIFIC HWY W2 CLASS OF WORK:
SUBDIVISION: TIGARD fOWNE SQUARE LOT #: 001 TYPE OF USE:
PROJECT NAME: CHRISTIAN BOOK CENTER
DESCRIPTION: 4 branch circuits.
OWNER: SN INVESTMENT PROPERTIES. PHONE #: 503- 242 -2900
CONTRACTOR: R C COSTELLO ELECTRICAL PHONE #: 263 -2385 FAX
Inspection Request Scheduled For: Date: 4/12/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 Ceiling cover 004316 -01 503.504 -6758 Y
199 Firv
Corrections /Comments/ Instructions:
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 4 Date: (74-7 Z — OS' Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 00165
13125 SW Hall Blvd., Tigard, OR 97223 DA TE ISSUED: 3/21/2005
Phone: (503) 639 -4171 / v.dh ' t''1x
Inspection Requests (24 Hrs.): (503) 639 -4175 . 4 'I L
INSPECTION WORKSHEET FOR DATE: 4/12/2005 TIME: 7:09AM PAGE: 11
SITE ADDRESS: 16200 SW PACIFIC HWY W2 CLASS OF WORK:
SUBDIVISION: TIGARD TOWNE SQUARE LOT #: 001 TYPE OF USE:
PROJECT NAME: CHRISTIAN BOOK CENTER
DESCRIPTION: 4 branch circuits.
OWNER: SN INVESTMENT PROPERTIES, PHONE #: 503 - 242 -2900
CONTRACTOR: R C COSTELLO ELECTRICAL PHONE #: 263-2385 FAX
Inspection Request Scheduled For: Date: 4/12/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 004316 -02 503 -504 -6758 N
Corrections/Comments/Instructions:
rSPASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 1 ^ Of Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00165
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/21/2005
Phone: (503) 639 -4171 / xl � � l '
Inspection Requests (24 Hrs.): (503) 639 -4175 5 :1_..
INSPECTION WORKSHEET FOR DATE: 4/6/2005 TIME: 7:10AM PAGE: 80
SITE ADDRESS: 16200 SW PACIFIC HWY W2 CLASS OF WORK:
SUBDIVISION: TIGARD TOWNE SQUARE LOT #: 001 TYPE OF USE:
PROJECT NAME: CHRISTIAN BOOK CENTER
DESCRIPTION: 4 branch circuits.
OWNER: SN INVESTMENT PROPERTIES, PHONE #: 503 - 242 - 2900
CONTRACTOR: R C COSTELLO ELECTRICAL PHONE #: 263 -2385 FAX
Inspection Request Scheduled For: Date: 4/8/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 Ceiling cover 004110 -01 503- 504 -6758 N
Corrections /Comments/ Instructions:
•
16,4 * -44Fow.
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: - ff Gw, Date: Phone #: (503) 718-
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: ELC2005-00165
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/21/2005
Phone: (503) 639 -4171 ; iii i \
Inspection Requests (24 Hrs.): (503) 639 -4175 - __..
INSPECTION WORKSHEET FOR DATE: 3/22/2005 TIME 7:13AM PAGE: 47
SITE ADDRESS: 16200 SW PACIFIC HWY W CLASS OF WORK:
SUBDIVISION: TIGARD TOWNE SQUARE LOT #: 001 TYPE OF USE:
PROJECT NAME: SPEC SPACE
DESCRIPTION: 4 branch circuits.
OWNER: SN INVESTMENT PROPERTIES, PHONE #: 503-2412900
CONTRACTOR: R C COSTELLO ELECTRICAL PHONE #: 263-2385 FAX
Inspection Request Scheduled For: Date: 3/22/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
125 Wall cover 002431 -01 503 -504 -6758 N
Corrections/Comments/Instructions:
,Lf= tei a z /ii6e. / A g 1/moo dV /e, 7* -dog
I t/ ��-C,e ia-ifre.:- (9/t/eL>
4
❑ PASS ' KPARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (9/4Ar Jf_/ J Date: "Al Phone #: (503) 718-