Permit b'- - f CITY OF TIGARD RD ELECTRICAL PERMIT
I N PERMIT #: ELC2007 -00278
COMMUNITY DEVELOPMENT DATE ISSUED: 4/26/2007
TIGA ` +e 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102C B -00302
SITE ADDRESS: 13285 SW PACIFIC HWY 7 -11 ZONING: C -G
SUBDIVISION: PARK STREET SQUARE LOT : 033 JURISDICTION: TIG
PROJECT: 7 -1 1
Project Description: Job No 12838 Tenant Improvement, 5 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: 4 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:
ALADDIN MOTOR INNS BECK ELECTRIC INC
BY BENZENISTE, IRVING 15600 SE FOR MOR CT #B
10155 SW CAPITOL HWY CLACKAMAS, OR 97015
PORTLAND, OR 97219
Phone: Contact #: PRI 503 - 656 - 7396
FAX 503 - 656 -4397
FEES
Description Date Amount Reg #: ELE 3 -5C
[ELPRMT] ELC Permit 4/26/2007 $73.45 LIC 2629
[TAX] 8% State Surcharge 4/26/2007 $5.87 SUP 5024S
Total $79.32 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.
c
Issued By: C yyt 7 Permittee Signature: j I ■,ii `. 4- `..,.
/ 1
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.
Flpr L 7 09:O1a p . 2
Elect Permit Application , I FOR OFFICE USE ONLY
�1 RECEIVED ED Received
11111 Ci ty of T \"iii a r: ` aV
" 312 S�V Hall Blvd., Tigard, OR 97223
e Plan Review Other Permit:
1 hone: 503.639.4171 Fax: 503.598.196A^ De/B
2 5 2007 Date/Br: PcnnitNo.eCA c
T I GARD Inspection Line: 503.639.4175 Date Ready /By: Allis: ® See Page 2 for
Internet: www.tigard or.gov CITY OFTIGARD Notifred/Metkod: Supplemental Information
TYPE o.T w. ,DING D1ViSI N : 4N :.REV :ifw .
•
['New construction Addition /alteration /replacement Please aleck all that apply (submit a 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.
'. CATGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or El Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling CommerciaUindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family Master builder ❑ Other: El A or
. m.
Fire pump. Installation of 75 KV
0 system larger separately derived system
lot:, SJ TP! IN 'ORMATION AND LOCAT N ` , ❑ Addition of new motor load of ❑ "A" "E" "I.2" "I -3"
Job no.: Job site address: p !�`,' 100 HP or or a more. occupancy.
I ���� � � O J ✓ V v L ``�(��
El Six or more residential traits. ❑ Recreational vehicle parks.
r-�
Cily /Sta[eiZIP: 1 f O � 0 Health-care facilities. 0 Supply voltage for more than
['Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: - 7 --1 1 5.-.1W2__ ❑ Service or feeder 600 amps or more
- FEE SCHEDULE.
Cross street /directions to job site: Description 1 Qty. 1 Fer. 1 Total 1 •
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 1
Tax map /parcel no.: Limited energy, residential 75 00 2
•11tESC i1PT1ON : OF' WORx , . with above sq. ft.)
Limited energy, multi - family 75.00 2
t J Gk,_TS - '�
4 e,yvt.0a AL_ . residential (with above sq. R.)
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 1 2
Name: 401 amps to 600 amps 160.60 , 2
601 amps to 1,000 amps 240.60 1 2
Address: Over 1,000 amps or volts 454.65 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 1 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
' ❑ . APPL1(CAT1T I E. CONTACT PERSON .' 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, 46.85 2
first branch circuit 1
Address: Each add'I branch circuit t 6.65 )A9 2
Miscellaneous (service or feeder no included)
City /State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
._
GON'[RrkG"EbR' Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name:
eG�. E e tL , . .1_,,,„c- energy panel, alteration, or
Address: tSki9w S r--6'K 1"'` ' c.T. *$ extension. Describe: Page 2
City /State /ZIP: C_ i , V �� - (s � Crib i s Each additional inspection over allowable in any of the above
r - 1p Per inspection 62.50
Phone: (F cCJS (, - -7 . 91� Fax: (SO (pS (O 4 J ! investigation per hour (1 hr min) 62.50
CCB Lico,,,C-7 Electrical Lic.: 3 -s � Suprv. Lic.: 5 1 Industrial plant per hour F 73.75
01- ' :: :..ELEC' ICAL_PEl2MfT 'PEES
Suprv. Electrician signature, required: �� 1 Subtotal: 73 ,r-f s
� a + I
Print name: c k ( ,,- VNAt , Date:(. 15101 U1 Plan review (25% of permit fee):
` 11 State surcharge (8% of permit fee): 5, 551
Authorized signature: t diket i TOTAL PERMIT FEE: lq, 3 Z—,
� ,r S NP l5 "f —� This p e rmit application has case if a permit is nc obtained within 100
� k Print name: Date: U7 days after it has bes en n accepted as complete.
• Number of inspections allowed per permit.
1'= BuildingTermits 'ELC- PennitApp.doc 05/23/06 440 46I5T(II!05 /COWIVER