Permit 1 , t,' CITY OF TIGARD ELECTRICAL PERMIT
a PERMIT #: ELC2008 00216
IN
° COMMUNITY DEVELOPMENT
DATE ISSUED: 4/15/2008
TIGARD' 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: TI. Installing (20) branch 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: 19 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 BROADWAY ELECTRIC - COCHRAN INC
BY CAP ADVISORS 626 SE MAIN ST
38345 W TEN MILE RD, STE 170 PORTLAND, OR 97214
FARMINGTON HILLS, MI 48335
Phone: Contact #: PRI 503- 234 -6564
FAX 503 - 238 -2098
• FEES
Description Date Amount Reg #: ELE 37 - 546C
[ELPRMT] ELC Permit 4/15/2008 $173.20 LIC 72942
TAX] 12% State Surchar 4/15/2008 $20.78 SUP 34475
Total $193.98 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 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.
Issued By: .�' i L - -- - Permittee Signature: —> - .G'�/ / -� r � G/f,��/
o 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: 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.
•
INSPECTOR'S SIGNATURES ARE NOT
Inspections Required for: r� a -u >S�— �J�'16 REQUIRED ON GREEN INSPECTION CARD.
✓ Code I Inspection Description I PASS Date By ✓ Code Inspection Description I PASS Date I By
BUP - Building Permit ELC - Electrical Permit
405 Excavation 105 Underground /slab cover
410 Fill 110 Temporary electrical service
415 Grading 115 Electrical service
205 Footing x" 120 Electrical rough -in
805 MFG- Structure grading /footing \ 125 Wall cover
210 Foundation walls 130 Ceiling cover
215 Footing drain 135 Low voltage
220 Slab 140 Sign installation
310 Crawl drain 145 A/C or heating unit circuit
225 • Post /beam structural 150 Hot tub /spa /pool •
230 Underfloor insulation 195 Misc. inspection:
235 Shear walls /anchors _ 199 Electrical final
240 .Exterior sheathing
245 Firewall
250 Roof nailing ELR - Restricted Energy Permit
255 Wtr proofing basement walls 135 Low voltage
260 Tilt -up panel 195 Misc. inspection:
265 Masonry 199 Electrical final
270 Reinforcing steel (rebar)
275 Framing
810 MFG- Structure set -up MEC - Mechanical Permit
280 Insulation 605 Post /beam mechanical •
285 Drywall nailing • 610 Gas line
287 Suspended ceiling 615 Mechanical rough -in
295 Misc. inspection: 620 Hydronic piping
899 MFG - Structure final 625 Duct work
498 Grading final 630 Fire damper
_ 299 Final inspection 635 Smoke detector shutdown
640 Exhaust hood
695 Misc. inspection:
699 Mechanical final
BUP - Fire Protection System Permit •
905 Sprinkler underfloor /slab PLM - Plumbing Permit
910 Sprinkler rough -in 305 Plumbing underslab
915 Fire alarm rough -in
920 Suppression trip test 310 Crawl drain
995 Misc. inspection: 315 Post /beam plumbing
998 Alarm final 320 Plumbing rough -in
999 Sprinkler final 322 Shower pan
330 Water service
335 Rain drain
340 Storm drain
SIT - Site Work Permit . 505 Sanitary sewer
405 Excavation 345 Culvert/catch basin
410 Fill 350 Septic tank
415 Grading 395 Misc. inspection:
205 Footing 399 Plumbing final
210 Foundation walls
215 Footing drain
420 Sprinkler supply lines SWR - Sewer Permit
495 Misc. inspection: 505 Sanitary sewer
498 Grading final 595 Misc. inspection:
499 Final inspection 599 Final inspection
I:\ Building \Forms \InspCard- AOP- Blanlcdoc 02/02/07
I
r
Community Development R
TIGARD
Request for Permit Action ' VED
APR 1 52008
TO: CITY OF TIGARD CITY OF 'GARD
'
Building Division Services Coordinator BUIL N G r�
13125 SW Hall Blvd., Tigard, OR 97223 VISION
Phone: 503.718.2430 Fax: 503.598.1960 www. tigard- or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor d City Staff
(check one)
REFUND OR Name: N /4/. INVOICE TO: (Business or Individual) Mailing Address:
V 0 1 I City/State /Zip:
y /° / Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
CANCEL PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
. ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: E k.0 AOp g - 0 6p
n 0 'oZ /
Site Address or Parcel #: /34 c54.0 / /GC. A4.4/
Project Name:
Subdivision Name: Alhq- Lot #: 49-
EXPLANATION: Pukfi TT) ,A) f../a6 (rfe (,O #dT,Q 5
i N 77/6" - �j � */. /c -77o
es, �.
Signature: , L ! 1 , j A Al Date: 7 /5
Print Name: `fl Eg6/ /- NS/ /
Refund Policy
1. The Director or Building Official may authorize the refund of
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date /roe-- B figrif Rte to Bldg Admin: Date j, B
Refund Processed: Date it/ /9- By Invoice Processed: Date By
Permit Canceled: Date 3020 8' By, Parcel Tag Added: Date By
Receipt # Date / Method _ Amount $
I:\ Building \Forms \RcgPermitAction.doc Rev 07/26/07
Electrical Permit Application FOR OFFICE USE ONLY
City,of Tigard �� DateBy: y (f'( OS, (T ' ennit No.: , �� - UU�I�
:�= ''a 13125 SW Hall Blvd. Tigard, O R 97223 Plan Review
C Phone: 503.639.4171 Fax: 503.598. CIO Q Date/By: Other Permit:
T I G A R D Inspection Line: 503.639 A o Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard -or.gov 0 1 t• w , Notified/Method: Supplemental I nformation
TYPE OF WORK P ^ •��C7 PLAN REVIEW
❑ New construction ® Addition/alteration/r e O`"` Please check all that apply (submit 2 sets of plans w /items checked below):
Cr v\� ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: `'` where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONST'ION 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "I -3 ",
Job no.: %j Z y 8 Job site address: 3 IOOHP or more. occupancy.
33 , oo S tN PPk'I FIG Hwy ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: ri 6ia 0 0)2, e, 7 2 2 3 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: H 1f . 1 -- ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I 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
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
i-i 9 7 /Y 6 t/P (, i 9-o& t. itSii Re iQl er e i rci rS f- residential (with above sq. ft.)
1 K V Services or feeders installation, alteration, and/or relocation P. 200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
1, ` 601 amps to 1,000 amps 240.60 2
Address: t ( i x 1 1 v) ) of pz Over 1,000 amps or volts 454.65 2
City/State /ZIP: w , Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) L7 / /I� ,(j T py , 2 00 amps or less 66.85 1
Owner installation: This installation is being made on property that own h ich is not 201 amps to 400 amps _1 \ 00.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 _ 2
Owner signature: Date: Branch circuits— new, alteratio , o of xtension, per panel
A. Fee for branch circuits with (f r.
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: ((! 1 S eer /y �-�-- B. Fee for branch circuits
cc��' // � t f" without service or feeder fee, ,
Contact name:
r - (D` _, 46.85 4 2
first branch circuit .
h add'I branch circuit 6.6 _.
Address: . Jrini. (2� '? E ,�, rF —� I -- t 2
4WA cellaneous (service or fe er nut included) )
City/State /ZIP: h e ach manufactured or modular 90.90 2
Phone: dwelling, service and/or feeder
( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: gvta c wt¢�/ e /EC , energy panel, alteration, or
Address: 6 Z 6 5 if ttit P-1Yv sr.
extension. Describe: Page 2 2
City/State /ZIP: Po y-F a„r„ci o 4k . 9 7 z i y Each additional inspection over allowable in any of the above
1, Per inspection 62.50
Phone: (gam 3) 2 3 v , 65-6 y Fax: ( 5' ° �� /) 2.3 S720? e Investigation per hour (I hr min) 62.50
CCB Lie.: ' e `7 Ad Electrical Lie. `3, be Suprv. Lic.i...3 47,g Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: J� 1;)
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: /9- g 1
This permit application expires if a permit is not o withi . 180
Print name: Date: days after it has been accepted as co pn p ere.
• Number of inspections allowed per permit.
I :\ Building \Permits\ELC- PermitApp.doc 05/23 /06 440- 4615T(II /05 /COM/WEa
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
•
r RESIDENTIAL WORKONLY:
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: - l
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
p Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ 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
FROM COCHRAN - BROADWAY <MON) APR 14 2008 11:02 /ST. II:OI /No. 7800000760 P 1
Elect Permit Application ') Il ovvit II I,ii i 1• I 1
• .: City of Tigard Reabei Permit No.: E --cog':
.1. --- 13125 Hall Blvd., Tigard, OR 97223 pqo Review �+
Phan 303.639.4171 Fax: 503.598.1960 Drellly. Other Permit:
. �. � , 1 .. , , Inspection Line: 503.639.4175 Owe Iteady/By. kris: I nit see Page 2 fw
Internet: www.tig8�or.gov l S1tp1ssW t er .
TYPE of WORK Harr REVIEW
❑ New construction 0 Addition/alteration/ eplaernxnt Please a that apply ( 2 sea of plan streams rLeeloee tadmwx
0 service a Leader 400 amps a more 0 melding over three nodes
❑ Demolition ❑Other
wave the available 6 k cwvea 0 Mamas mid boatyards.
CATEGORY OF CONSTRUCTION aceeeds 10,000 in a 150 volts or 0 Fig buildings.
leas to gonad. or exceeds 14.000 0 Camel -use agricultural
❑ 1 - and 2- family dwelling ® Commercial/mdustria! 0 Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other O Fire pomp. O Immallaiam of 75 KvA or
larger JOB SITE INFORMATION AND LOCATION 0 y a separately derived system-
p Addition anew motor load of 1:1 "E', °1 -2 ^, "1 -3 ^, .
lob no.: 139 Z 96 lob site address: i 3 600 S PMr N +v 1 Az six or more. ooa aney.
Y o sa .. err or
residential units. p eeaea;ooal veld* porker.
City/State/ZIP: ri 6 fib Q 0 0 Q , � 7 2 .� 3 0 Health-care E d dies. 0 Supply voltage for more than
_ p Hazardous loeaio . 600 voter nominal
Su ite/bldgJapt. no.: I Project name: H -• 1,,,t w-� r- D service or reader 600 er g mom
Cross street /directions to job site: - MEMOIR I ocr. I N. I Tor I •
New reeide4tW single- or wolti -famiy dweffiog snit.
Ldides attached wage.
Subdivision: I L no.: 1,000 sq. R Or less 145.15 4
Tax map/parcel no.: Ea. midi 500 s9. ft. or portion t i 33.40 �� _ 1
Limited energy, residential ... - . f >
DESCRIPTION OF WORK (aitb aboae aq 0.)
Gi 7 4 11 N la �/P612*OE 4464 /2P ibi ' $ t:4".st_: —.:_ ;;".-11'-;
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_ -`.' • • .FOR ' \' _ ;1 , . . ; < � A,. __- ' u . o3. Yefv.3•
Fi
' ' ' - �.;..o �serviee or Rader teat
' �� 's" s Lath nssiuf se4 or modular
dwelling, service and/or frock 90.90 2
. Fax:: ( ) Reoonmoct only • 66.85 2
r. -mail: Ptmnp or irrigation cafe 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: g✓DQ dL4A 47 e nee. energy p al or limited- or
energy panel, alteration, err
Address: , z 6 5 j ? AA A.,,,,, s r-. extension. be: Page 2 2
City /State/ZIP: PO ✓ t1 aMd Q ON - 9 7 Z )4/ . Each additional im over peeloo ov allow la a of the above
I Per inspection 62.50
Phone: ( 6 j b 5) 2 3 4 f , 65 V Fax (sir>) 23 r2y a Investigation per how p hr min) 62.50
CCB Lic.: .7° f 8 d T J Electrical Lic. P . I Suprv. Lic, j Y1 i Industrial plant per ho - 73.75
� _ { hour P�CIRICAL EES
Suprv. Electrician signature, required: ` Subtotal: f'73.)
Print name: \� <�`K`` Plan Rview (25% of permit fee):
, Date. (kkkA l O� surcharge State vcharge 0214 of permit fee): . ? e •
Authorized signature: TOTAL PERMIT FEE: IQ Q y
Print name: I fie: 71kb penal' atrllicatkm aphis if • permit Is Not *barbed alibis UM
days efts bliss tors saepied a sapless
• Numba of mepectioes aflowod per permit.
Mg. g,au:...,n....:ran rp,..^.: a... .a. gw, a �nre•strI �nvrr•:wco