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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2005 -00257 DEVELOPMENT SERVICES DATE ISSUED: 4/14/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 -639 -4171 PARCEL: 2S110AC -01101 SITE ADDRESS: 11290 SW BULL MOUNTAIN RD ZONING: C -G SUBDIVISION: LOT : JURISDICTION: TIG Project Description: Upgrade to underground fuel system at storage tanks. (5) 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: 4 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: TEXACO REFINING + MARKETING INC STW, INC BY TAX DEPT P O BOX 1629 PO BOX 7813 SANDY, OR 97055 UNIVERSAL CITY, CA 91608 Phone: Phone: 503 - 668 - 7757 FEES Reg #: ELE 3 -502C Description Date Amount LIC 145981 SUP 2604S [ELPRMT] ELC Permit 4/14/2005 $73.45 [TAX] 8% State Surcharge 4/14/2005 $5.88 REQUIRED ITEMS AND REPORTS [ELPLCK] ELC Pin Rev 4/14/2005 $18.36 Total $97,69 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 - 332 -2344. Issued By: 12 Permittee Signature: d_t-Q_- ps 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. i.,lri ur i luyxli [ 0 0 01 E le i ical Permit A I 1 licat . r . . ' FOR OFFICE USE ONLY' - p R City of Tigard oceived - G 7 atel6 : .0 ---� Permit No.; r 13125 S W Hall Blvd.. Tigard, OR P R ev 97223 a '" p ` � (� Review Phore: 503.639.4171 Fax: 503.598,1960 APR 1 2 gty} {1 hate /By, Other cur. inspection Line; 503.69.4175 !;` pate Ready/By: Jude: See Page 2 for Internet: www.ci.tigard.or.us OF i Notified/Method: 1 ,lr $upp1emental information n."--- %.tr a ; , 'r77C. - tl :, "'""—'7,' - _ ,YYPE r PLAN REVIEW or constr Addition /alteration/replacement Please check all that apply: U Demo lition 0 Other: ❑Service over 225 amps, comm'1 azardous location ['service over 320 amps - rating ❑ Buildng over 10,000 Sq ft. CATE O ' RY..OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential ❑ 1- and 2- family dwelling 174 Commerciallindustrial ID Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi - famil ❑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 ' . ❑Egeess/lighting plan RV park - ❑Elealth -care facility ❑Other. Job no.: Job site address: ' i / t. Nit_ Submit Z sets of plans with any of the above. City /State /Z1P: ..1 6 A i ') ' 0 C -f,- t/ The above are not applicable to temporary construction service. Suite/bldg. /apt. n o . : P ro j e c t name: a c , G As 7 77 ) , FEE *. SCHEDt1I E , Deterl ptlo¢ Qty- 1 Fee. Total I *" Cloys street/directions to job site: New residential single- or multi - family dwelling unit. includes attached garage. 1,000 sq. ft. o r less I 145.15 4 Subdivision: Lot no.: Ea. add'I 500 sq. ft, or portion 33.40 I Tax map /parcel no,: Limited energy, residential 75.00 2 Limited energy, non-residential 75.00 2 DESCRIPTION OF WORK �� ' (e manufactured or modular 0 y! 6 /'1 o� )r\ t tJ + V - E6kr \A p' 1E dwelling service and/or feeder 90.90 2 ) / t (� V Services or feeders installation, alteration, and /or relocation 5' ./S /'� A-`- 5 )r-.146 C k S 200 amps or less $0.30 2 I 201 amps to 400 amps 106.85 ❑ PROPERTY OWNER 1 ❑ TENANT _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 I 10030 ' 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75] Z Owner signature: Date: Branch circuits - new, alteration, or extension, per panel ❑ APPLICANT ❑ CONTACT PERSON A -Fee for branch circuits wvirb W--- service or feeder fee, each G.65 2 Business name: branch circuit Fe1737 for branch circuits Contact name: _ without service or feeder fee, 46.85 %�a �� 2 Address: each branch circuit Each add'i branch circuit I 6.65 - 21 ) 4 i 2 City /State /Z1P: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 4 2 1 Phone: ( ) Fax: : ( ) _ Sign or outline lighting 53.40 E -mail: , Signal circuit(s) or limited - CONTRACTOR • energy panel, alteration, or — — extension. Describe: Page 2 I 2 Business 'name: ,� ame: , , J 1 Address: . t) /to Each additional inspection over allowable in any of the above �4 � '� Per inspection { 62.50 City/State/ZIP: f J "7 & � investigation per hour (1 hr min) 62.50 1 Phone:SZl3) ( ' 7 � 7 v Fax:,(C 3 ci N 0 Industrial plant per hour 73.75 y U `! ELECTRICAL PERMIT FEES* CCB Lic.: /[ 'E1 1 Electrical Lie.: 7 1 0 cl _C Suprv. Lie.: 3 Q ti S Subtotal - Suprv. Electrician Signature, required: \ f Plan review (25% of permit fee) 1 J �, J Y L State surcharge (8% of permit fee) " j' 1/ Print name: V Date: 4/....- ,rl 3 [ � TOTAL PERMIT FEE C' 90/ Authorized signature: This permit application expires it a permit is net obtaided within 180 days after it has been accepted as complete Print name: Date: • Fee methodology set by Td- County Building Industry Servire Board —, -- "" Number of inspections per permit all owed, c'.Guiklirg\Pcnlli tf■?I_C ;.YerrnitAnp.doC 1 ; 4 a5 - L. I 5T(I 0 OW wEa CITY OF TIGARD BUILDING DIVISION - PERMIT #: ELC2005 -00267 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/14/2005 Phone: (503) 639 -4171 - . ��n�� 1 °Npuyit��III\ Inspection Requests (24 Hrs.): (503) 639 -4175 `:_.. INSPECTION WORKSHEET FOR DATE: 4/25/2005 TIME: 7:10AM PAGE: 19 SITE ADDRESS: 11290 SW BULL MOUNTAIN RD CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: SHELL GAS STATION DESCRIPTION: Upgrade to underground fuel system at storage tanks. (5) branch circuits. OWNER: TEXACO REFINING + MARKETING INC, • " PHONE #: CONTRACTOR: STW, INC PHONE #: 503- 668 -7757 Inspection Request Scheduled For: Date: 4/25/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 105 Underground/slab cover 005280-01 503 - 849.7877 Y ,, _ Corrections /Comments /Instructions: A V, H______ l l , I Z , . \..),„...---) . • WO 3(,/c Fr .„ ;St PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 61 -(. - ;:sf Date: V 6 Phone #: (503) 718 -