Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008 -00321
COMMUNITY DEVELOPMENT DATE ISSUED: 6/6/2008
• TI 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 102 C C -00500
SITE ADDRESS: 13600 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: TIGARD MARKETPLACE LOT : JURISDICTION: TIG
PROJECT: H MART
Project Description: Installing service for bakery oven.
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: 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:
13500 PACIFIC CORP COCHRAN ELECTRIC
BY CAP ADVISORS BROADWAY ELECTRIC
38345 W TEN MILE RD, STE 170 626 SE MAIN
FARMINGTON HILLS, MI 48335 PORTLAND, OR 97214
Phone: Contact #: PRI 503 - 234 -6564
FAX 503 - 238 -2098
FEES
Description Date Amount Reg #: ELE 37 - 546C
[ELPRMT] ELC Permit 6/6/2008 $80.30 LIC 72942
[TAX] 12% State Surchar 6/6/2008 $9.64 SUP 34475
Total $89.94 REQUIRED ITEMS AND REPORTS
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 1.800.332.2344.
Permittee Signature:
J� -� 1
Issued By: / , _sue � � _ g � GY`�
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.
FROM COCHRRN— BRORDWRY g�� Rl)JUN 8 2008 7: 03 /ST . 7: 02 /No. 7500000412 P 1
Electrical Permit Application. ..∎
— -1 \ { t ` EE iew gar \`SW Hall Blvd., Tigard, OR 97223 \ \V ' �1 1
Phone: 503.639.4171 Fax: 503.598.1960 J ���► y Other Permit:
I . t i It l Inspection Line: 503.639.4175 ` i cC `1 \ eady /By: /uric: la See Page 5 for
Internet: www.tigard or \ ' �` �`�AN Noufied/Mcthod: Supplemental Information
E OF WOR \����� . PLAN REVIEW • 111 New construction Ai Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION • exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. 0 Installation of 75 KVA or
' • ' • JOB SITE INFORMATION AND LOCATION ' • = ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "1i ", "1 - 2 ", "1 -
100HP or more. occupancy.
Job no.: ' 2f L `{ Job site address:
\ \ ,-- C c LA- '..e.,_(,_1.::(- \c \_, Six or more residential units- 1:3 Recreational vehicle parks.
City /State /ZIP: T' ` ❑ ❑Health -care facilities. 0 Supply voltage for more than
. J' - ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ,` ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: Description [ Qn• I Pee t Total I
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limitcd energy, residential •
75.00 2
DESCRIPTION OF WORK. _ 1 ,: (with above sq. ft) •
\ cu ` Limited energy, multi - family 75 00 2
ed c j a.�1- -E'.r. \ r`S tt < v1 residential (with above sq. ft.)
\ Services or feeders installation alteration, and/or relocation
200 amps or less , 80.30 toe_ 2
•:: ❑ PROPERTY OWNER'. - .. ❑ TENANT: 201 amps to 400 amps 106.85 2
Name: \ 7 `--
401 amps to 600 amps 160.60 2
r � � �- C Cc, ,f 0 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or.volts 454.65 2
City /State /ZIP: r c_ ��` � \` `�� � -� Temporary services or feeders installation, alteration, and/or
v \ \ relocation
Phone: ( ) Fax: ( ) 200 amps or Tess 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 599 amps 133 75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
'', ❑ APPLICANT; '• - . ❑ CONTACT PERSON' " ' i ;c.'. above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee,
first branch circuit 46.85 2
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: ' Pump or irrigation circle 53.40 2
- CONTRACTOR ' :: >•..;•`., Sign or outline lighting
r outhn 53.40 2
` / ( � C Signal circuit(s) or limited -
Business name:
c,.4770(\ — Ale 7 t^\ C'X k (,1 V-scil r... tea e___energy panel, alteration, or
Address: LY 2_ (a �1 � 31— extension. Describe: Page 2 2
City /State /ZIP: �r� ,1 J � O� ` ! '7 Z (C� Each additional inspection over allowable in any of the above
C7 Per inspection 62.50
Phone: (5 =r4) 2 3C4 -Go (,r'4 Fax: ( g03) 2 — 2..0 Investigation per hour (I hr min) 62.50
CCB Lie.: 7pr Electrical Lic.: -SylpC, Suprv. Lic.: l-11u9._Cm Industrial plant per hour 73.75
• - - ELECTRICAL PERMIT FEES • .
Suprv. Electrician signature, required: ■,_ — Subtotal: , 30
Print name: \ Date: < � Plan review (25% of permit fee):
vw State surcharge (12% of permit fee): L
Authorized signature: TOTAL PERMIT FEE: I
This permit application expires if a permit is not obtained within 180
`/
Print name: V .e sN,,. C ` \<� \ Date: C 4- (053 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I .\auilding \Permits \ELC•PermitApp doc 05/23/06 440.4615T(11/05/COM/WEB
CITY OF TIGARD
BUILDING DIVISION ` PERMIT #:EJL2O$•00321
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 - 4171' ^,�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 0 TIME: PAGE:
SITE ADDRESS: PAO b vi NNevEj -1I, , CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: tivA .
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 4(0 1 0 t5 Pour Time:
Code # Inspection Description Confirm # Contact # Message
1 c\
Corrections /Comments/ Instructions:
� I
gu
PASS n PARTIAL APPROVAL CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
��11
Inspector: Cr 1\1 o e ( Date: b 1i Phone #: (503) 718- 144 •