Permit _e « �3 ry CITY OF TIGARD ELECTRICAL PERMIT
c COMMUNITY DEVELOPMENT Permit #: ELC2010 -00168
"T (G AR D' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 04/14/2010
Parcel: 25111 DD00201
Jurisdiction: Tigard
Site address: 15917 SW HALL BLVD
Subdivision: Lot: 0
Project: Hall Pizza & Pub
Project Description: Replacement of meter base.
Owner: FEES
ROSEHILL INVESTMENTS LLC Quantity Description Date Amount
2001 SIXTH AVE STE 2300
SEATTLE, WA 98121 1 ea Services or Feeders - 200 04/14/2010 $100.70
amps or less
PHONE: 1 ea 12% State Surcharge - 04/14/2010 $12.08
Electrical
Contractor:
DYNALECTRIC
5711 SW HOOD AVE
PORTLAND, OR 97239
PHONE: 503 - 226 -6771
FAX: 503 - 226 -7720
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $112.78
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 ' ccordan - ith 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. TENTION: Orego I- • requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 1 -0010 through OAR 9 .-001-01. You may obtain a copy of the rules or direct questions to OUNC by cal .246.6699 or 1.800.332.2344.
l c
Is ued By: 1 `►� ��. 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
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
CaII 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 Application RECEIVE I 1.012 OFFICE t?Sf, ONI.Y
Received �� Permit No.: ���
City o �' Date /By: "T t lO l • !f 10 p2 -' D
i 4 13125 SW 11n11 Tigard, OR 9722 APR 1 2 2010 Pi" Revle,v (hherVermit.
Phone: 503,639.4171 Fax: 503.598,1960 Date/8_y.
- r 1 c A R D Inspection Lim: 503.639.4175 Date Ready /By: t RI ■ee Page 2 fnr
Internet: www.tigard- or.gov CITY OF TIGAR D Notified /Method: J�� Sul piemental Information
„;:,:,....f ' 1 i .,,. r t 411) I l .i:iPpo I nitu` :
`', to fgt'G� ttiitA
F Ir . i N 1 +I "f - ; i ;l W . ,', , f l ' , ), l . + 1 11 , rU 'I „ 1 {1 Itl
li!I Ibl '.::: :;!;;; i, l lS i�''gii , .'I1. `i'•i i 1liAI i( :`'`i�lt1�li?3L g"' Zia titufirir iiiE II' ,r) Klttl(l1.111gf -'''I 1 Ilei: 1 .. � t .'t' tH . I , , , r, tmdn{ , i.;,r Ol ;t ext „ , , ti l s � „s ;
'.
❑ New construction Addition /alteration /replacement Please check an that apply (submit 2 sets of plan w /items chri krd belt' +v)
❑ Service or feeder 400 amps or more ❑ But ding over three stories.
❑ Demolition ❑ Other where the available Wit current ❑ Ma inns and boatyards.
IJ, ; ;i ;fa ?Eli:iit . 1 , pp u , ' 11 1 !'l i I irl4 i t p i 3# exceeds 10,000 amps at 150 volts or ❑ Flo tin buildings.
.:hill ' , 1 re .s,.!!:.,. ∎1a1,,. b it nslRf � Tr7 .t& i .I t 111.:1 6
1 ixr d . ,A. tt less to ground, or exceeds 14,000 ❑ col unereial -use agricultural
a[1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations but lings.
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump ❑ lnsi illation of 75 KVA or
t t „ I , . II
, Emergency system. tart tr separately derived system
1 ii 1 R 41 (tl,IT1,%p� B • t r� 1l:MM 1
I ' 1 . H r I � f �11h•1ti ' A d
t ,,,,,iii:;.!! l •••:"• M id sHti • ° , 1, ,, q a„1,- 'rife ,' ids, ❑ ditionof new motor load of ❑.. ,. 12 .... 1 „
1 00Hr cm MVO:. OCC ipancy,
Job no.: ��� �✓f, Job site address. 459 7 e - ,) ♦, , / , 0 Six or more residential unirs. 1:1 Re, eational vehicle parks.
City/State/ZIP: , -,,„z...._ tL El Health-care fa cIIiiies. El Sul ,,ly voltage for more than
i 7
, ❑ I-tazardous locations. Go( volts nominal
Suite/bldg. /apt. no.: Project name : /� ❑ S or feeder 600 amps or more
-- _ - w 11il+ p i,'' i44ll.{l l I i ! 1 p h.li1t ) 0 11', C ! -, l t i'. 7
Cross street /directions to job site: nom. tort _ Mrli F. f •— rotal 1 •
New residential single- or multi - family ( welling unit.
includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft, or less 168,54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.. Limited energy, residential 67 R4
RENT' 101 y�aa'a� yHg' 1 1 aq n m (�(� q un , a �j Li 'i , t f ,,, I t i qq 111 ( -`Lill w' h above s.. ft. 2
1,:,, ,I�il.::
i.: : :r: 111N1fii i'...,`• ni) t t 1,11tItt }Dif ��� .t 100 { I�'t }I' , � 3, t rt v
limited energy multi- family 62 2
®� �� /:% residential (with above sq. 8.)
Services y r feeders installation, altera it n, and /or relocation •
200 amps or less /' 100.70 /1Gi 7)1 2
. t . .i ... x1t�u l,.t,� ,.alilj t ' !I'° r 1 ,� �,. I i , I ,., il � l l .�.
j #dul l €i —1::: 111 .
1 Itil' !0 , J r . : 11 , r,r„ltnN�.. ' fiI�i.:, ii !
ii ? I „i f l i ; 3 ' ; r '� ;r'ii!!! I t 1t rcos1:! i .a 1 ; �' ,1ll1„i iii1i'I 201 amps to 400 amps 133 -56 2
Name: 401 amps to 600 amps 200,34 2
601 amps to 1,000 amps 301,04 2
Address: Over 1,000 amps or volts 552.26 2
.v - Temporary services or feeders installati in, alteration, and /or
City /State /! -1P: relocation
_ _
Phone: ( ) 1 Fax: ( ) 200 amps or less µ — 59.36 _ I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125,08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670. and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or ext :rising), per panel
Owner signature: _ Date: A. Fee for branch circuits with
E.,� I {1 %jidii �•.,.. t I�•'•r l 11Ii'j' f1;11j1 11 1 1�l H m P 11 t I' . 11 ', 1 ,
` h I 1i �f ■ 1 n {tl above service or feeder fee,
P 111 Vt1h1Eli; ls,; i l �t>, . , s r' ;t, d ;It�,u e ll ' N , I n H l t • I s " 1 ■ . t alt, each branch circuit 7.42 7_
Business name: B. Fee for branch circuits
without service vr feeder fee,
Contact name: ' ,/ first branch circuit 56.18 2
Address: Each add'l branch circuit 7,42 2
Miscellaneous (service or feeder nut Inc uded)
City /State /Z1P: Each manufactured or modular
67,84 2
dwelling, service and /or feeder
Phone: ( } ) 7 .... ? ',- Fax:: ( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67,84 2
!;1'!?tl i ,5d,.;, i ;l - ° ',':uPAIllirn ' I `r` 111G1(Ilrl 1lt i ' 3' t . 7a s ” l ; l i � l 1 1 y � li•11 ! 1' Sign or outline lighting 67.84 _ 2
u,t>; {o
( { ,,al:..., �. l l.,ciii lki; .-.,:”, 111 {all,, .!• • to �at a Lr. 1 , 1 I 1 �� Mf r,,,, '' ;, H} f � I_' i: ,l:l q�, 8 1? g
'
Signal al ( or limited
Business name:
energy panel, alteration, or
Address: . ►i
extension. Describe: Page 2 2
City /State /ZiP: A � � A / Ai Each additional inspection over allows! le in any of the nbovc
r Per inspection III. 66.25
phvne: ( 3 a, , - � r '7 Fax: (�3) ; . Investigation per hour (1 t r ,pin) 66.25
A CCB Lic.: S •A S uprv. Lic.: Industrial plant per hour 78.18
r� iii 1 i .I f 11" • ' [ , %r 1i+II 1 E � { F�!g�� .., ,1 1
'I' 11 1 11 l ... V . h '11n1 ! .: �!�'tlll��lW�!f7.ii,irhrll. i,,...,,LG
Suprv. Electrician signature, required , j R K��i. 2 ! i i � 1 _ Sul total: /c '.
I Dat 4 /4 111 pi) Plan revicw (25 %ofpermi fee):
Print name. �.� P. �y ) Q
. State surcharge (I2 % ofpermi fee)_ •
Authorized signatur =_.. �i � TOTAL I'lr16 FEE: //R. 7,
si ' Phis permit application expires if a permit snot obtained within 130
Print name: .' e — . at day, after it has been accepted as complete.
* Number of inspections allowed per permit,
a - 1 5 1(11 /p5 /(:UMAVEB
to nuilding \Pcrmit6 \EI,C- PermiAPP.Oc 1 uN1 /09