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Permit C ITY OF T I GAR D ELECTRICAL PERMIT PERMIT #: ELC2005 -00459 it ,�i�� DEVELOPMENT SERVICES DATE ISSUED: 6/28/2005 = --' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S135BA-03302 SITE ADDRESS: 10520 SW CASCADE AVE ZONING: I - SUBDIVISION: OFFICE DEPOT LOT : JURISDICTION: TIG • Project Description: T.I. 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: 0 W /SERVICE OR FEEDER: 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: 1 PLAN REVIEW SECTION 1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: MARX, ERNEST L + BARBARA R BAILEYS ELECTRIC LLC TRUST 2160 SW LEEWOOD DR 2140 VELOZ DR ALOHA, OR 97006 SANTA BARBARA, CA 93108 Phone: Phone: 503 - 849 - 3134 FEES Reg #: LIC 159814 Description Date Amount SUP 31 p ELE 34 -388 9C [ELPRMT] ELC Permit 6/28/2005 $240.60 [ELPLCK] ELC Pln Rev 6/28/2005 $60.15 REQUIRED ITEMS AND REPORTS [TAX] 8% State Surcharge 6/28/2005 $19.25 Total $320.00 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 or 1 -; ►.: -332- 44. Issued By: a 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. Electrical Permit A FOR OFFICE USE ONLY pp Iicatio, m LY �� City of Ti and ( tl Received 6 permit No.: G . 13125 SW Hall Blvd., Tigard, O 9�2�2`3� r � O� Pla Review ' r -05" �� Phone: 503.639.4171 Fax: 503 98.1960 — /�' , . h' fi f`�• Date /B : & S �o ° Other Permit Inspection Line: 503.639.4175 V� Q --LW, ca 1 1 • , Date Ready/By: I , lugs ® See Page 2 for Internet: www.ci.tigard.or.us �!� , � N Notified/Method: 1T Supplemental Information ' � ` G PQ� T)'P EiOF PLAN REVIEW ❑ New construction ❑ Add itignnlieration/replacement Please check all that apply: ❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l ❑Hazardous location • ❑ Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential ❑ 1- and 2 family dwelling 'Commercial/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 ❑Egress/lighting plan RV park ❑Health -care facility ❑Other: . Job no.: Job site address: /0520 &t( e Q .re a Submit 2 sets of plans with any of the above. City /State/ZIP: -- 1; 6,31--w r p, 97 0 The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE Description I Qty. I Fee. I 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 4 Subdivision: Lot no.: Ea. add'I 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 dwelling, service and/or feeder 90.90 2 Services or feeders installation- sltaration, and /or relocation 200 amps or less _ , 80.30 2 . ❑ 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 f 240.60 ,2 YD, 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 • ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: branch circuit Contact name: B. Fee for branch circuits without service or feeder fee, 46.85 2 Address: each branch circuit Each add'I branch circuit 6.65 2 . City /State/ZIP: Miscellaneous (service or feeder not included) Phone: ( ) Fax::( ) Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E - mail: Signal circuit(s) or limited- CONTRACTOR energy panel, alteration, or Business name: BQ, /e s .t..-" a J LL extension. Describe: Paget 2 Each additional inspection over allowable in any of the above • Address: T, /l b� / ti.) 1- e wo ©D P2 • Per inspection 62.50 City /State/ZIP: /MIA ( 0 ,L.. i 2' i) Investigation per hour (I hr min) 62.50 Phone: ( 50 .) e fT e-9 _ 3; 3 U Fax: ( ) Industrial plant per hour 73.75 7 ELECTRICAL PERMIT FEES* . CCB Lic. S?VJ lectrical Lic 'q {oPe Suprv. Lic.: ..//...51.5 Subtotal ' ,AL/p, 4V) ' Suprv. Electrician signature, required: /..,gr, / / Plan review (25% of permit fee) bOti - ,x�J / e / . . i � 7 `/ F / 7 D a t e: — 6 ? F-05" - State surcharge (8% f � � ! Print name: - TOTAL PERMIT FEE A4 d 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:\ Building \Permits \ELC- PermitApp.doc 12/03 440-4615T(10 /02 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: - Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* El Burglar Alarm El Garage Door Opener* El Heating, Ventilation and Air Conditioning System* El Vacuum Systems* El Other: • I., COMMERCIAL WORK'ONLY: Fee for each commercial system $75.00 • (SEE OAR 918 - 260 -260) Check Type of Work Involved: El Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems El Data Telecommunication Installation El Fire Alarm Installation El HVAC El Instrumentation ❑ Intercom and Paging Systems El Landscape Irrigation Control* ❑ Medical El Nurse Calls El Outdoor Landscape Lighting* ❑ Protective Signaling • El Other • Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i:\ Building \Permits\ELC- PermitApp.doc 04/03 CITY OF :TIGARD BUILDING DIVISION PERMIT #: ELC2 0 '004 9 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/28/2005 Phone: (503) 639 -4171 emir >Npuvig16h�1��A Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 7/7/2005 TIME: 7:10AM PAGE: 2 SITE ADDRESS: 10520 SW CASCADE AVE CLASS OF WORK: SUBDIVISION: OFFICE DEPOT LOT #: TYPE OF USE: PROJECT NAME: OFFICE DEPOT DESCRIPTION: T.I. OWNER: MARX, ERNEST L + BARBARA R, PHONE #: CONTRACTOR: BAILEY'S ELECTRIC LLC PHONE #: 503 - 849.31 • Inspection Request Scheduled For: Date: 7/7/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 115 Electrical service 010957 -01 603- 849-3134 Y Corrections /Comm /Instructions: • PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 1 - Date: 7 - Phone #: (503) 718-