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Permit
• CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2008-00619 COMMUNITY DEVELOPMENT DATE ISSUED: 11/3/2008 • TIGA D I 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S 110AB -00200 SITE ADDRESS: 14297 SW PACIFIC HWY ZONING: C -G SUBDIVISION: CANTERBURY SQUARE LOT : 1 -3 JURISDICTION: TIG PROJECT: MALAI THAI Project Description: Install (1) sign lighting. 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: 1 LIMITED ENERGY: 401 - 600 amp: SIGNAUPANEL: MANF HMI 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: 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: KOLVE, G C CHANCO INC 14389 SW PACIFIC HWY 3521 SW CARSON TIGARD, OR 97224 PORTLAND, OR 97219 Phone: Contact #: PRI 503 - 245 -7774 FAX 503 - 244 -4804 FEES Description Date Amount Reg #: ELE C209 [ELPRMT] ELC Permit 11/3/2008 $53.40 LIC 171892 [FAX] 12% State Surchar 11/3/2008 $6.41 SUP 688S Total $59.81 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 d. . ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -0. -0010 thr... h OAR 952- 01 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6.99 or 1.800.332.2344. Issued B / y Permittee Signature: ( r 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: . iL�� .� iI DATE: LICENSE NO: , 1 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. ' e l e ctrical Permit Application ;� i �- ,. . FO oFF ICE :U SE O N % ` . .: , ...1,: v .. t. ' A iQei*? L3:'_5 -,on- 'a*er+s: /D cii Q .,lre r� /,, r " #? "`� Received Cam` T/ " -VVJ�9 R City of Tigard Date/By: Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: : '�'' Inspection Line: 503.639.4175 Date Ready /By: Juris: ® See Page 2 for �T. G n R.D N otified/Method: S Internet: www.tigard- or.gov Supplemental Information . . TYPE OF WORK . • . _ •'• PLAN REVIEW . , . ❑ New construction ❑ 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. r ❑ Demolition ❑ Other: _. , ...0 AttJ(c - S \ C� i Q. 'j LAc where the available fault current ❑ Marinas and boatyards. 1 exceeds 10,000 amps at 150 volts or CATEGORY OF. CONSTRUCTION P 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 JOB SITE INFORMATION:AND LOCATION - A ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ", Job no.: Job site address: IOOHP or more. occupancy. I aT �' , �. tiW ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: n n ❑ Health -care facilities. ❑ Supply voltage for more than Tc. t ,� 1 `o ©„ � l / -7 L\ ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: Project name: MakA •4,4 ( ❑ Service or feeder 600 amps or more. FEE: SCHEDULE. Cross street/directions to job site: CAL Q p_1 S J ��2� Description 1 Qty. 1 FFee. 1 Total 1 • \ New residential single- or multi- family dwelling unit. S (A — CI)? C� ,? (1 '3 C-1,1 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 •' DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 �P LA��`S Limited energy, multi -family 75.00 2 Gl residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation ' _ 200 amps or less 80.30 2 :t5PROPERTY OWNER ❑ .TENANT 201 amps to 400 amps 106.85 2 Name: ( 1,-1.1 CS- 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: (1/4i.2e Sw PA.c... 4W .( Over 1,000 amps or volts 454.65 2 City/State /ZIP: j G Pr 2U 0 2 "l7 2 '* Temporary services or feeders installation, alteration, and/or t relocation Phone: Gf1 6,13 851-7 I Fax: .Elitk 92. i l 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 se, rent r ex ange, according to ORS 447, 449, 670, nd 701. 401 amps to 599 amps 133.75 2 3 Branch circuits — new, alteration, or extension, . er . a Owner signatur ' Date: l A. Fee for branch circuits with . ❑ APPLICANT • . I ❑ 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 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 ` 53.40 60 2 �V C / t , Signal panel, or limited - Business name: C. 4 C-, energy panel, alteration, or Address: 3 5 --p_ 1 1 Si,_) CA- Q O extension. Describe: Page 2 2 City/State /ZIP: Pc2 pi • 6 9 Tic 1 Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: (13) aCls' 7'7'7 L.. Fax: 3) J q(4 486 Li Investigation per hour (1 hr min) 62.50 CCB Lic.:171 pe `1 Electrical Lic.: cao9 Suprv. Lic.:� Industrial plant per hour 73.75 p� 1 ELECTRICAL PERMIT FEES *. Suprv. Electrician signature, required: Subtotal: g 3. go Print name: n(4 `� C Na Date: Plan review (25% of permit fee): —�— State surcharge (12% of permit fee): 6-1// Authorized signature: TOTAL PERMIT FEE: S g' t This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. ' Number of inspections allowed per permit. 1: \ Building 'Permits\ELC - PermilApp.doc 05/23/06 440- 4615T(11 /05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: ~'RESIDENTIAL: WORK ONLY: 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 $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: n 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* n Protective Signaling ❑ Other Total number of commercial systems: _ *No licenses are required. Licenses are required for all other installations I : \ Building \Permits\ELC- PermitApp.doc 03/23/06 Nov 03 08 04:57p MIKE OR DAVE CHANDLER. 5032444804 p.1 r r D CITY OF TI AR . COMMUNITY DEVELOPMENT ?E,`;, , 13125 SW Had Blvd., Tigard, OR 97223 503.639.4171 Electrical Signature Form IMPORTANT PERMIT NOTICE CHANCO INC 3521 SW CARSON PORTLAND, OR 97219 Permit #: ELC2008 - 00619 Date Issued: 11/3/2008 Parcel: 2S110AB -00200 Site Address: 14297 SW PACIFIC HWY Subdivision: CANTERBURY SQUARE Lot 1.3 Jurisdiction: TIG Zoning: C - Project Name: MALAI THAI Description: Install (1) sign lighting. Your company has been indicated as the electrical contractor for the permit referenced above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work. Please mail the form to: City of Tigard, Building Division, 13125 SW Hall Blvd., Tigard. OR 97223, or you may fax the form to: 503.624.3681. If you have any questions please call 503.718.2433. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: KOLVE, G C CHANCO INC 14389 SW PACIFIC HWY 3521 SW CARSON TIGARD, OR 97224 PORTLAND, OR 97219 • Phone #: Phone #: 503- 245 -7774 Reg #: ELE C209 L1C 171892 SUP 6885 AN INK SIGNATURE IS REQUIRED ON THIS FORM X IlIbt � .. • \ csi e c( L&.) �- t(}. v �,( € Signature of Supervising Electric ' Name (printed) SUP LIC # CITY OE ■ IGARD BUILDING DIVISION PERMIT #: EI C20023 -006 1 9 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1'113/7()Q Phone: (503) 639 -4171 ' Inspection Requests (24 Hrs.): (503) 639 -4175 ��' INSPECTION WORKSHEET FOR DATE: 1/7/2009 TIME: 7:01AM PAGE: 33 SITE ADDRESS: 14297 SW PACIFIC HWY CLASS OF WORK: SUBDIVISION: CANTERBURY SQUARE LOT #: 1 -3 TYPE OF USE: PROJECT NAME: MALAI THAI DESCRIPTION: Instaii (1) sign lighting. OWNER: KOLVE, G C PHONE #: CONTRACTOR: CHANCO INC PHONE #: 503 - 7774 Inspection Request Scheduled For: Date: 1/7/2009 Pour Time: Code # Inspection Description ` Confirm #`� Contact # Message 199 Electrical final \ \` 079443 -01 \ 503 -- 7 3336 Y Corrections /Comments /Instructions: \ 1/2Z i-R A),1110 . � 6928° • \,,,,,, U`- ' . rA, PA . ❑ PARTIAL APPROVAL Il CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION U ADDITIONAL FEES ASSESSED �� At q u I Inspector: G h 1 V C% LS Date: L" I ' Y Phone #: (503) 718- -H 1 1 CITY OF.TIGAR® ; • BUILDIIN.G DIVISION PERMIT #: ELC200I -00619 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1'1 /3/1CiOt "s Phone: (503) 639 -4171 �uil1 Inspection Requests (24 Hrs.): (503) 639 -4175 ...�� INSPECTION WORKSHEET FOR DATE: 12/12/2008 TIME: 7 :00At4 PAGE: 31 SITE ADDRESS: 1 SW PACIFIC HW( CLASS OF WORK: SUBDIVISION: CANTERBURY SQUARE LOT #: 1.3 TYPE OF USE: PROJECT NAME:. MAI_AI THAI DESCRIPTION: Install (1) sign Fighting. OWNER: KOLVE, G C, PHONE #: CONTRACTOR: C HANCO INC PHONE #: 50;3..245 - 7774 Inspection Request Scheduled For: Date: 12/1;,,~/20x8 Pour Time: Code # Inspection Description Confirm # Contact # \ssage 199 Electrical final 078971-01 503 - 793 -3336 Y Corrections /Comments /Instructions: NLNO 39. A(1'7I0 sw ki liTIJ4aks At e Fi Li I1 0vP, mowed& tip • U PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS N. FAIL `:1'f CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: " 168(-- Date: _ I 2 110 Phone #: (503) 718- 2.1