Permit CITY O F TIGARD G w R D ELECTRICAL PERMIT
t „ 1 VH PERMIT #: ELC2007 -00808
COMMUNITY DEVELOPMENT DATE ISSUED: 11/29/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S112AD
SITE ADDRESS: 06650 SW BONITA RD ZONING: I -
SUBDIVISION: PAUL SCHATZ FURNITURE LOT : 001 JURISDICTION: TIG
PROJECT: THOMASVILLE FURNITURE
Project Description: (1) service (2) 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: 1 W /SERVICE OR FEEDER: 2 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:
PACIFIC REALTY ASSOCIATES ALLEN JOHNSON ELECTRIC
15350 SW SEQUOIA PKWY #300 -WMI P 0 BOX 411
PORTLAND, OR 97224 AURORA, OR 97002
Phone: • Contact #: PRI 503 - 250 -3952
FAX 503 - 639 -0639
FEES
Description Date Amount Reg #: ELE 24 -142C
[ELPRMT] ELC Permit 11/29/200' $93.60 LIC 34879
'TAX] 8% State Surcharge 1 1/29/200' $7.49 SUP 2602s
Total $101.09 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 d- s 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 N• ific -tion 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 • OU C . 5•.3.246.6•' • • .800.332.2344.
r`�
Issued By: Permittee Signature: l ir, /
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.
Eliectracal Permit Application FOR OFFICE USE O NLY`
City of Tigard Received I Penult No. 7. D t •
a y l � .�� ��� 13125 SW H Blvd., Tigard, EC Plan Review
C Phone: 503.639.4171 Fax. 503.598
Other Permit:
.196Q Date/By: T LG AR D Inspection Line: 503.639.4175 1t ' U V `� Date Ready /By: h s. ® See Page 2 for
Internet: www.tigard- or.gov CITY OF 1100.9D Notified Method. Supplemental Information
T ` DIVIR N PLAN REVIEW ,
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction , Addition /alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CAT_ EGORY OF CONSTRUCTION . , ` . 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 /T ?ommercial /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 JOB system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 5 7$ ,L) ?(>41 s { Six or or more. occupancy.
❑
❑ Six or more residential units. Recreational vehicle parks.
City /State /ZIP: /'} t� El He facilities. ❑ Supply voltage for more than
l r r v 1 ❑Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: l Project name:° 7ws-5 U't de...._ ❑ 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'l 500 sq. ft. or portion 33.40
Limited energy, residential 75.00 2
DESCRIPTION- OF WORK (with above sq. eldet
IOC? Limited energy, multi- family 75.00 2
C 4 eIk O p ( 'to <p lr /� residential (with above sq. ft.)
F Services or feeders installation, alteration, and/or relocation
FIR` I I L `e- 200 amps or less l 80.30 3'0,) 2
PROPERTY OWNER / ❑ TENANT 201 amps to 400 amps 106.85 2
Name: Pa.i C / ` Pi i0�-t'es 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 4600 Ve.4..), 0 p I Over 1,000 amps or volts 454.65 2
City/State /ZIP: V A , y — 04. g72...2-ti Temporary services or feeders installation, alteration, and/or
relocation
Phone: (5 ...4 c op Fax: (S;53 ) 63e7 -06, 3 Gj 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 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date:
A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 ✓ 1 � 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'l 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 2
Signal circuit(s) or limited -
Business name: ti 'l/ b7 Ge t
• (/ energy panel, alteration, or
O Address: ) t ex' V // y r 4.31 extension. Describe: Page 2 2
IV' C /ZIP: / 4 1 ,, - t o Y� 7z) ]'0 G3 \ Per inspection 62.50
Each additional inspection over allowable in any of the above
\
1
Phone: (5P5 ) 5 G ' 3 ej Z Fax: ( ) l I� % \ Q t 111
7 D Investigation per hour (1 In min) 62.50
C CCB Lic.: ,34 ( 9-7 7 Electrical Lic.: .24/_/ Suprv. Ltc.: .L / C Industrial plant per hour 73.75
7 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: ; r,,.- Subtotal:
Print name: / V/ e . -r) , oi/vs a Date: // —2_9,-07 Plan review (25% of permit fee).
State surcharge (8% of permit fee): '-i. % 9
Authorized signature: TOTAL PERMIT FEE: /0/, 09
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.
I \ Building \Permits\ELC - PermitApp.doc 05/23/06 440- 4615T( l l /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - •Supplemental Information
LIMITED ENERGY PERMIT FEES:
: RESIDENTIAL WORK'ONI:Y: j
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other:
COMMERCIAL WORK. ONLY:
Fee for each commercial $75.00
system
•
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ 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 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: FLC2007-00008
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11!29/2007
Phone: (503) 639-4171 ihoo, A
Inspection Requests (24 Hrs.): (503) 639-4175 Ail' 42.
INSPECTION WORKSHEET FOR DATE: 1/24/2008 TIME: 7:02AM PAGE: 51
SITE ADDRESS: 06650 SW BONITA RD CLASS OF WORK:
SUBDIVISION: PAUL SCHATZ FURNITURE LOT #: 001 TYPE OF USE:
PROJECT NAME: THOMASVILLE FURNITURE
DESCRIPTION: (1) SerViCe (2) branch circuit,
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: JOHNSON ELECTRIC, ALLEN PHONE #: 503-250-3952
Inspection Request Scheduled For: Date: 1/24/2008 Pour Time:
Code # Inspection Description - 65Tifitm4 Contact # Message
199 El at 'cal final 063831 503
Corrections/Comments/Instructions: •
C .PkpAss) PARTIAL APPROVAL Ei CANCEL fl NO ACCESS
LI FAIL j CALL FOR INSPECTION LI ADDITIONAL FEES ASSESSED
Inspector: qSQI Date: t ' CI% Phone #: (503) 718- 1,44-6e
CITY OF TIGARD
BUILDING DIVISION PERMIT #: EL F 007 ma
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/23/2007
Phone: (503) 639 -4171 null u p il
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1/73/2008 TIME: 7:00AM PAGE: 24
SITE ADDRESS: 06650 SW BONITA RD CLASS OF WORK:
SUBDIVISION: PAUL SCHATZ FURNITURE LOT #: 001 TYPE OF USE:
PROJECT NAME: THOMASVILLE FURNITURE
DESCRIPTION: (1) ;service (2) branch circuit::. .
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: JOHNSON ELECTRIC, ALLEN PHONE #: 503.250 -3J52
Inspection Request Scheduled For: . Date: 1/23/2008 Pour Time:
7 Code # Inspection Description / Confirm -# Contact # Message
199 Electrical final 063712 -01 503- 939.7631 N
Corrections /Comments /Instructions:
M o v %%IP V P q 02 - I N WW ON6t1• 04
N 01 G 1 '71'60 V' ciAp .
I I PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
►* FAIL p CALL FOR INSPECTION ❑ ADDITIONALFEES ASSESSED
Inspector: d" 68 Y Date: V'V6 Phone #: (503) 718 -'— t
CITY OF TIGARD L .
BUILDING DIVISION PERMIT #: ELC2007 -00808
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/29/2007
Phone: (503) 639 -4171 :o4p114
Inspection Requests (24 Hrs.): (503) 639 -4175 J
INSPECTION WORKSHEET FOR DATE: 12/19/2007 TIME: 7:00AM PAGE: 40
SITE ADDRESS: 06650 SW f3ONITA RD CLASS OF WORK:
SUBDIVISION: PAUL SCHATZ FURNITURE LOT #: 001 TYPE OF USE:
PROJECT NAME: THOMASYILLEFURNITURE
DESCRIPTION: (1) service (2) branch circuits.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: JOHNSON ELECTRIC, ALLEN PHONE #: 503 - .250-3952
Inspection Request Scheduled For: Date: 12/13/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
12f Well cover 1 819-01 503 - 250 -39%2 N
Corrections /Comments /Instructio :
V\Ac.Z2 66)1.
PASS n PARTIAL APPROVAL ❑ CANCEL H NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ` NW:. Date: 1 2 ' 1_f en Phone #: ,(503) 718- �*