Permit •
CITY TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT
*4 DEVELOPMENT SERVICES PERMIT #: ELR2006 - 00208
'` ' �J I \ 13125 SW Hal Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/1/2006
PARCEL: 2S 101 AC - 01900
SITE ADDRESS: 12615 SW 72ND AVE ZONING: C -
SUBDIVISION: LOWE'S HIW, INC LOT: JURISDICTION: TIG
Project Description: Data for self check - out.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
LOWE'S HOME IMPROVEMENT BROADWAY ELECTRIC - COCHRAN INC
1000 LOWE'S BLVD. 626 SE MAIN
MOORESVILLE, NC 28117 PORTLAND, OR 97214
Y
Phone: Contact #: FAX 503- 238 -2098
PRI 503- 234 -6564
FEES Reg #: ELE 37 -546C
LIC 72942
Description Date Amount SUP 3447S
[ELPRMT] ELR Permit 9/1/2006 $75.00
[TAX] 8% State Surcha 9/1/2006 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: 6, L a Permittee Signature: t' gA
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
' Electrical Permit Application 2006 FOR OFFICE USE ONLY
CI of Ti and dl_i� U COOS Received ��� 66 permit
`J g Date/8 o`V0i �0/..
3125 SW Hall Blvd., Tigard, OR 97 OF 4 g Y OF rIGARD 44. a P1anRevie
Phone: 503.639.4171 Fax: 503.SQ$.�6 Other Permit:
� Date/B
Inspection Line: 503.639.4175 Et�D UUUU I_UI�{a DIVISIO �aJ,l E ' DateReady/By: 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: — Supplemental Information
.. XPE OF • WORK • ,- ..• t. . .. 'PLAiNREYIEW .
❑ New construction Addition/alteration /replacement Please check all that apply:
12 Demolition ❑ ther: ❑Service over 225 amps, comm'l ['Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
'- - CAT O)Y OF' CONSTRUCTION'. •'• ' ' . of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ,mmercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑E plan RV park
�, rM Job site address: � 1� 1 / ( � ❑Health -care facility ❑Other:
Job no.:
!ri� 7�J ad, 1 � Submit 2 sets of plans with any of the above.
City /State/ZIPT OR-. a The above are not applicable to temporary construction service.
`� r < FEE *. SCHEDULE. `. "
,
Suite/bldg. /apt. no.: Project name: �W�
Description I Qty. I Fee. Total
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 I 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
• DESCRIPTION OF WORK . Each manufactured or modular
•
If ; `„ I (tom{ n �, ( dwelling, service and/or feeder 90.90 2
(� Services or feeders installation, alteration, and/or relocation
I (LOD 7 40 GIC 200 amps or less 80.30 2
CI. PROPERTY OWNER , ❑ TENANT. 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 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 I 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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
• . " ' . ❑ APPLICANT L . ONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
^�
Business name: l 0 ` branch circuit
Contact name: 1"1/ M�(� -� (� B. Fee for branch circuits
VVtt without service or feeder fee, 46.85 2
each branch circuit
Address: Each add'l branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: (t05) °3 - I�I I Fax :: ( )
Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: (, ac) 0G. Curl. Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: ' Page 2 2
Business name: \
3. . 6. •W a \I a c. .t•.L
Address: Z 5 1\1\ acv`
icj Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: 'p 1 _ .\ c,..,,,, 09-- c n 2 A Li Investigation per hour (1 hr min) 62.50
Phone: (503) 234 _c,5-c,,, l., Fax: (51.3) ?,Fa, -^Z,o ct $ . Industrial plant per hour 73.75
ELECTRICAL- PERMIT FEES * :
CCB Lic.: "7 2gt{2 Electrical Lic.:3/ -S t Suprv. Lic.: 3 S Subtotal 1S
Suprv. Electrician signature, required: /f)// /v' Plan review (25% of permit fee)
Date:
State surcharge (8% of permit fee) t/1 .00
Print name:
�Le�v,e�h V. c '"�� TOTAL PERMIT FEE 4,t,.
V
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building industry Service Board
•• Number of inspections per permit allowed.
i:l Buildng \Petmits\ELC- PermitApp.doc 12/03 440 -4615T(10 /02/COM!WEB
CITY OF TIGARD
A _.
BUILDING DIVISION PERMIT #: ELR200 &-00208
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/1/2006
Phone: (503) 639- 4171gl�l
Inspection Requests (24 Hrs.): (503) 639 -4175 ...'�� -
INSPECTION WORKSHEET FOR DATE: 10/1312006 TIME: 7:00AM PAGE: 53
SITE ADDRESS: 12615 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: LOWE'S HIW, INC LOT #: TYPE OF USE:
PROJECT NAME: LOWE'S
DESCRIPTION: Data for self check-out.
OWNER: LOWE'S HOME IMPROVEMENT, PHONE #:
CONTRACTOR: BROADWAY ELECTRIC-COCHRAN INC y PHONE #: 503 - 234 -6564
Inspection Request Scheduled For: Date: 10/13/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 038134 -01 503-407-9800 Y
1G\ A F i mil. "-----
Corrections /Comments/ Instructions:
•
JKZAS
❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
111 FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 6 • ' 1 v Qv t Date: 1 a j 13104) Phone #: (503) 718-14