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Permit CITY OF T I GAR D ELECTRICAL PERMIT PERMIT #: ELC2005 -00368 d .44 ; i ' DEVELOPMENT SER VICES DATE ISSUED: 6/13/2005 JI 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171 PARCEL: 2 S 112 D D -00300 SITE ADDRESS: 15900 SW 72ND AVE ZONING: I -L SUBDIVISION: LOT : JURISDICTION: TIG Project Description: New fuel system. 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: 2 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: 10 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: TIME OIL CO BOYLES ELECTRIC, INC. P 0 BOX 24447 P.O. BOX 1227 SEATTLE, WA 98124 BORING, OR 97009 Phone: 206- 285 -2400 Phone: 503 - 668 -7440 FEES Reg #: LIC 137002 ELE 3 -465C Description Date Amount SUP 3404S [ELPRMT] ELC Permit 6/13/2005 $263.35 [ELPLCK] ELC Pln Rev 6/13/2005 $65.84 REQUIRED ITEMS AND REPORTS [TAX] 8% State Surcharge 6/13/2005 $21.07 Total $350.26 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 - 3344. Issued By: ,7 4 Permittee Signature: 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. \ - ` - 5 YO r\ ®r../ Zoe,) or • >t FOR OFFICE [tSE: ONLY Electrical Application . Received A ,� i Electrical © DateB : — I r G' . � Permit No.: 6 L C_Z 6 &) - 3 6 City of Tig • j . CE ENE Planning Approval Sign 1 1 DateB : Permit No.: S 13125 SW Hall B v.. Plan Review Other Tigard, Oregon 972 1 DateB : Permit No.: s Phone: 503 -639 -417r" Fax: '50 -5 -1960 Post - Review Land Use a. /u,,., !!', `� Date/ Case No.: (/t Internet: www.ci.ti RD ■ • I I Contact �� See Page 2 for 24 -hour Inspection ',. � 71 75 ' """�' ° ""' �.. P Name/Method: I Su. le Page Information. x. .. ;y � ar tqa: Qr Ai s; ', 4. . i ? ' t..,- ., :a:..:g:, T ' . i , -'3a 'tat t i a ,i, _ ., - S•' . ' ...2.14e....... 1' . : f " " , = ❑ New construction ❑ Demolition • Service over 225 amps- ■ Health -care facility commercial ❑ CP P: Addition/alteration/r • lacement ❑ Other: ❑ Hazardous location Service over 320 amps- rating of 0 over 10,000 ,000 square feet, � is re /a 00 ( D, s E j a? t i) t , R;r 5; tE 1 & 2 family dwellings four or more residential units in ❑ 1 & 2- Family dwelling 21 Commercial/lndustrial ❑ System over 600 volts nominal one structure ❑ Building over three stories ❑ Feeders, 400 amps or more Accessory Accessory Building ❑ Multi-Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other: :t , .ftit 11h , r! i Icy i A b u1a -Te � S STIW Submit sets of plans with any of the above. The above are not a hcable to tem . ora construction service. Job site address: /,S oo S w 7 a t^ - r;- , 5 t 9 x, -X x .: . ,� �. , �, T -wr, rWT �. ;. ,', : Suite #: 1 Bldg. /Apt. #: Number of inspections per permit allowed Project Name: 7 M a O I L.. CO- Description Qty Fee (ea.) Total 1 Cross street/Directions to job site: New residential- single or multi - family per 1 dwelling unit. Includes attached garage. � 1 _A p 4" .5 (...> LtQ )-" 0 63 Service included: O 1 1000 sq. R or less 145.15 4 Each additional 500 sq. ft or portion thereof 33.40 1 Subdivision: I Lot #: Limited energy, residential 75.00 2 Limited energy, non residential 75.00 2 Tax ma • / • arcel #: Each manufactured home or modular dwelling 74%`, s i Ti r W - V•• ,, . r ' ,i �� ,, ' 3' service and/or feeder 90.90 2 � Services or feeders - installation, N [ p i,A./ — t .S S 4- .".∎ alteration or relocation: 200 amps or less 80.30 2 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 s 1 to ? i `'_`so ' 4.b N +a c iii ;>t 601 amps to 1000 amps 240.60 2 Over 1000 amps or volts 454.65 2 Name: 7 ry1 P Q i l ( o Reconnect only 66.85 2 Address: Po Lao .4, .P4(4 y 7 Temporary services or feeders - installation, Q q alteration, or relocation: City /State /Zip: S e o w&I L•- [ �s P 1 4 200 amps or less 66.85 1 • Phone: Fax: 201 amps to 400 amps 100.30 2 if-CI F� t fi € r ?C +.M1r"�i 'Y , it +u .. zY J ,; -'? 401 t0 600 amps 133.75 2 Branch circuits - new, alteration, or Name: extension per panel: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 6.65 2 Cl /State /Zi : B. Fee for branch circuits without purchase of eS p service or feeder fee, first branch circuit 1 46.85 2 Phone: 1 Fax: Each additional branch circuit 1 U 6.65 L i, - g 50 2 e E-mail: S8 r) i ' . l 5 Mtsc.(Service or feeder not included): r x �` �•_ 6. ` , ,-s - k .r_. r z7 a'`ls_.� ,. ; • Each pump or irrigation circle 53.40 2 t : c r'`$'r�- ...liJ� �1 (x1_ J7 T'' t }._..YS.. i " �� q Each sign or outline liRlrtinR 53.40 • 2 Job No: 0 Z _ 0 7 1 6) 4 N So 3 r ? p 1' D 5 1i) Signal circuit(s) or a limited energy panel, q 75": 1-0 ( K� alteration or extension d— age 2 2 Business Name: BOy Lt c�Zt C 1 "—C. Descri lion: r Address: Po L o - 1 `) ' 1 F'Kr LSsSA-w —J 74.1)1<- Moj -62 I\ /S/Zi G '16(1? Each additional pection o r the allowable in an of the above: CI t City/State/Zip: Qo R 1 N tit —/ Per inspection per hour (min. 1 hour) 62.50 Phone: 7 G f S A/ Investigation fee: h61� - �w�o �. 66 � I__ CCB Lic. #: , )oo3— Lic. #: 3— Y6 S CA/ , Other: 5 :: x 1t M ln.!fg.i.i...: .:..d' .' °`'''�y` � L 1,4'&, Supervising electrician Subtotal $ - 63. signature required: Plan Review (25% of Permit Fee) $ e. < . . t Print Name:�ilw- L J l s Lic. #: 3 4 0 K S St Surcharge (8% of Permit Fee) $ II Q') Authorized I - — TOTAL PERMIT FEE $ _ S O. 2e, Notice: This permit application expires if a permit is not obtained within Signature: Date: 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. (Please print name) i:\Dsts\Perrnit Forms \ElcPermitApp.doc 0 1/03 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems $75.00 Check Type of Work Involved: El Audio and Stereo Systems Burglar Alarm 0 Garage Door Opener 0 Heating, Ventilation and Air Conditioning System 0 Vacuum Systems El Other • COMMERCIAL WORK ONLY: Fee for each system. $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: D Audio and Stereo Systems E Boiler Controls • C] Clock Systems 0 Data Telecommunication Installation El Fire Alarm Installation HVAC • Instrumentation El Intercom and Paging Systems O Landscape Irrigation Control Medical Nurse Calls • Outdoor Landscape Lighting 0 Protective Signaling Other 1 ,".�x 5, 4-c .v. P y -\ d "it tea Number of Systems * No licenses are required. Licenses are required for all other installations i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03 I CITY OF TIGARD �= BUILDING DIVISION PERMIT #: ELC2005 0036$ 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 6/13 /2005 Phone: (503) 639-4171 o ��,a'i �g� i l Ins Requests (24 Hrs.): (503) 639 -4175 .„' WO- "_.. INSPECTION WORKSHEET FOR DATE: 8/9/2005 TIME: 7 :05AM PAGE: 39 SITE ADDRESS: 15900 SW 72ND AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: JACKPOT FOOD MART DESCRIPTION: New fuel system. OWNER: TIME OIL CO, PHONE #: 206 - 285 -2400 CONTRACTOR: BOYLES ELECTRIC, INC. PHONE #: 503- 668 -7440 Inspection Request Scheduled For: Date: $/9/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 013166-01 503- 668 -7440 Y Corrections /Comments/ Instructions: V\ Z‘NSS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Weil "'v ' f Date: v q 0s Phone #: (503) 718-