Permit tItol
• CITY OF TIGARD U ELECTRICAL PERMIT
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• ° COMMUNITY DEVELOPMENT Permit #: ELC2010 -00323
T [ GAD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/30/2010
Parcel: 2S102C000500
Jurisdiction: Tigard
Site address: 13500 SW PACIFIC HWY 92
Subdivision: Lot: 0
Protect: Fantastic Sam's
Project Description: Electrical for TI. 8/10/10, adding low voltage for stereo wiring.
Owner: FEES
13500 PACIFIC CORP Quantity Description Date Amount
BY CAPOZZOLI ADVISORY FOR PENSIONS
INC, 21500 HAGGERTY ROAD, SUITE 100 15 crt Branch Circuits 06/30/2010 $160.06
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/30/2010 $19.21
Electrical
Contractor: 1 ea Signal circuit or Limited 08/10/2010 $75.00
TED MEEKER ELECTRIC Energy Panel
P.O. BOX 788 0 ea 12% State Surcharge - 08/10/2010 $9.00
NEWBURG, OR 97132 Electrical
PHONE: 503 - 538 -3845
FAX: 503 - 537 -5011
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $263.27
•
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. ATTENTIO • I. -gon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0011 rough OA •52 -0' 100. You may obtain a copy of the rules or direct questions to OUNC by calling 503-246.6699 or 1.800.332.2344.
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/ � /� 1 Permittee Signature:
�i iLLC�
Issued': Y� 9
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.
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.
7' '�. ELECTRICAL PERMIT
K :: CITY OF TIGARD
ip
- COMMUNITY DEVELOPMENT Permit #: ELC2010 00323
Date Issued: 06/30/2010
R
41GAD 13125 SW Hall Bivd , Tigard OR 97223 -503.639.4171
Parcel: 2S102CC00500
Jurisdiction: Tigard
Site address: 13500 SW PACIFIC HWY •92
S ubdivision: Lot: 0
Project: Fantastic Sam's
Project Description: Electrical for TI.
Owner: FEES
13500 PACIFIC CORP Quantity Description Date Amount
BY CAPOZZOLI ADVISORY FOR PENSIONS
INC, 21500 HAGGERTY ROAD, SUITE 100 15 crt Branch Circuits 06/30/2010 $160.06
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/30/2010 $19.21
Electrical
Contractor:
TED MEEKER ELECTRIC
P.O. BOX 788
NEWBURG, OR 97132
PHONE: 503- 538 -3845
FAX: 503 - 537 -5011
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $179.27
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 952- 001 -0100. You may obtain a copy oft - • - sr,or,•1 -= questions. to OUNC by calling 503.246.6699 or €332.2344.
_ -
Issued By . - Permittee Signature: X
OWNER INSTALLATION ONLY
•
•
The installation is being made on property 1 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 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.
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" ' A ,� ?FOf2 USF,ONI ti i �`
Electrical Permit Application o � 0 Received 1 , i a 3 .w. ,,, . ,, ti. �� /� . •i`Yh bo��s d•�h as 1hJ+ `.�`.0 v. ?Aa d:A '..
City of Tigard c " ff.,. % 0 ^ 4
4 Permit No.;
° 13125 ^ SW Hall Blvd., Ti azd, OR 97223 �\ ,•DateB : (� [�� P dip __ '
g �\ � ' , C. ��Plant
14
M . ' Phone: 503.639.4171` Fax: 503.598.1960 , r . f °?P' x` eview
Other Permit: ,y / �„
I G A It D Inspection Line: 501639.4175 „1 OK c ' ;� r : Bate Ready/By: 1 See Page 2 for ,
• Internet: www.tigard /\� Notified/Method: Supplemental Information
TYPE IOF WORK _ iv �P,LAN `REVIEW
❑. New construction M. 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 ❑ Marinasand boatyards.
`` s CATEGORY OF CONSTRUCTION : ,.t t 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. .: ❑ Installation of 75 KVA or
- - • — - - ❑ Emergency system. larger separately derived system.
• 490-SITE INFORMATION' AND LOCATION - �` Addition new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
no.: Job site address: C W G /� / ❑ IOOHP or more. occupancy.
Job no
. ' �� v A G ! I ` b 7 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: 7) O 1141 g t? q 2_ Z 3 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Z Project name: St � 5p, ❑ Service or feeder 600 amps or more.
`? :FEE∎ SCHEDULE '
, Cross street/directions to job site: Description 1 Qty. 1 Fee. Total 1 "
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: I,000sq. ft. or less 168.54 4
Ea. add'I 590 . sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OE WORK ' "- (with above sq.:ft.) 67.84 2
p , Limited energy;,multi- family 67.84 2
6 L q j / , residential (with above sq. ft.),
• Services or'feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
' - ❑ •:PROPERTY, OWNER. ,' ' ' • ` " E `TENANT " 201 amps to 400; amps 133.56 2
401 ampS,to.600:amps 200.34 2
Name:
601 amps to 1 amps 301.04 2
Address: Over 1,000 amps.orvolts - 552.26 2
City/State/ZIP: Temporary services,orfeeders installation, alteration, and /or
Y relocation
Phone: ( ' ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 . 2
Owner installation: This installation is being made on property that I own which is not
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 extension, per panel
. Owner signature: Date: A. Fee for branch circuits with
.. above service or feeder fee
_ „ CA
MI APPLICANT, , ❑ 7:42 2'
each branch c
`Business name: ,7�/� nice e -� B. Fee for branch circuits without
1, "r'/ !' service or feeder fee, first 5 l8 2
Contact name: / � 4j, -P,,f'L- branch circuit S �, I
n c Y Each add'l,branch circuit i 7.42 ( ,' 2'
Address: , D, B 7 X Miscellaneous (service or feeder ndt'included)
111 ) r 4 0 O 1 q 7/3 Z___ E dwanimag, s a d/ nd/o r f feeder r 67.84 _ 2
City/State/ZIP: ellin,seice ar ede
Phone: (' } '!� — F ax: : Y
Reconnect only 67.84 ' '2v •
o Z g X03) 53 ' - G1 - Pump or irrigation circle 67.84 2'
E -mail:
Sign or outline fighting 67. 84 2
...
. • ._, ,' 1.. . , , CONTRACT OR , ,r • , , _ „_ _- _ .• . Signal.circuit(s)'or limited- energy
-Business. name: r e e/(e�- ti, panel, alteration, -or extension. Page 2 2
Each additional inspection over allowable in•any of the above
' Address: p9 0o4, 7 q 9 n Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: � „/ f1 i e D (2- q �] /3 Investigation (1 hr min)
v ” ! / Industrial plant (9 hr min) 66.25/ hr 78.18/ hr
Phone: Fax: Q Inspections for which no fee is
3) �3, _ � ecif i cally listed (%: hr min) 90 00/ hr
specifically
CCB Lic. /O Q%/ Z Electrical Lic 3 -*>y - Suprv. Lic.: 3 475
:.'f 1 L- ECTRICAL P,.ERIIIIT FEES? • ”
Suprv. Electrician signature, required: o Subtotal: 1 GO, V
: review (25% of permit fee): • Print_name: T L° e /J G t---__ Date: C —369 --.16 St (12% of permit fee): 11 . "?. i
f TOTAL PERMIT FEE:
Authorized signature: This permit ap expires if a permit is not obtai ned within 180
days after it has been accepted as. complete.
Print;name: Date: * Number of inspections allowed per permit.
IABuiliiiiiglPermits \EL ()<- PetAppL�10 /07709k—C „-- 440- 4615T(1'1/05 /COM/WEB
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
'RESIDENTIAL`WORK ONLY:_ _ .. ,
Fee for all residential systems combined $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
,' . 1
Fee for each commercial $67.84
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system
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(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
n Intercom and Paging. Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 10/01/09