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Permit CITY TIGARD ELECTRICAL PERMIT PERMIT #: ELC2004 -00705 �dl . DEVELOPMENT SERVICES DATE ISSUED: 11/4/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S136DC - 02504 SITE ADDRESS: 07295 SW DARTMOUTH ST SUBDIVISION: PP1995 - 013 ZONING: C G BLOCK: LOT : JURISDICTION: TIG Project Description: (2) circuits for heaters. • 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: 1 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: SUPERVALU HOLDINGS INC OREGON ELECTRIC CONST /GROUP BY BURKE + NICKEL 1010 SE 11TH AVE 3336 E 32ND ST #217 PORTLAND, OR 97214 TULSA, OK 74135 Phone: Phone: 503 - 535 - 2652 Reg #: LIC 203 SUP 4460S FEES ELE 26 -95C Description Date Amount Required Inspections [ELPRMT] ELC Permit 11/4/2004 $53.50 [TAX] 8% State Surcharge 11/4/2004 $4.28 Rough -in Elect'I Final Total $57.78 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: r � Permit 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 639 -4175 by 7:00pm for an inspection the next business day NOV -01 -04 12:25PM FROM — Oregon Electric Estimating 5032313587 T—B81 P.001 /002 F -892 ,,. LiG .ILa,.41 1 10 1lu1L l�pp 4 - City of Ti and ItUER1,7Et ba // J a7 /2Z Permit No.: `4 C 7 0 5 --- 13125 S' Hall Blvd., Tigard, OR 97223 Plan Review Phone: 563,639.4171 Fax: 503.598.1960 NOV 0 �"x� M"'� {'�i�'� Pate/By: Other Permit; Inspection Line' 503.639.4175 ' VO !! 0 1 a F ' "•'1 I, Date ReadyBy: )urin //` ® Sec Page 2 for Internet: www.ci.tigard_or.us N 1/ t,7 S upple mental Information CITYOFir . ,RICal•Ftio-i ' PLAN REVIEW ❑ New construction ® Addition /alteration/replacement Please check all that apply: ❑ Demolition ❑ Other: ©Service over 225 amps, comm'l ❑I a7 rdous location . ❑Service over 320 amps – rating © Buildng over 10,000 sq. ft", • • : C.T"EGORY OF: CONSTRIJCTION • _ „ • , . , 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 El Multi family El Master builder ❑ Other: DBui]ding over three stories ❑Feeders, 400 amps or more El Occupant load over 99 persons ❑Manufactured structures or ' JOU' S1rC'E A`ND. LOCATION, " DEgress/lighling plan RV park Job no.: 82718 Job site address: 7295 SW dartmouth ❑ Health -care facility ❑Other: Submit 2 sets of plans with any of the above. City /State /ZIP: Tigard, OR 97223 The above are not applicable to temporary construction service. Suite/bldg. /apt no.: Project name: Jeffery Allen Home and Garden SCFII DULE Description I Qty. I Fee. I Taal I— Cross street/directions to job site: New residential single -or multi - family dwelling unit. Includes attached garage. 1,000 sq. fi. or less 145.15 4 Subdivision: Lot no.: Ea. add'] 500 sq. ft. or portion 33.40 l Tax map /parcel no.: Limited energy, residential 75.00 2 • liESCRIPTION "O�'' \YORK: . limited energy, non - residential 75,00 2 : i .. � • . Each manufactured or modular (2) circuits for heaters dwelling, service and/or f 90 _ 2 Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 • .❑ .rROPER rY. OWNER T : • ❑`TENANT ' • • • 201 amps to 400 amps 106.85 2 ' 401 amps to G00 amps 160.60 2 Name: Jeffery Allen Home and Garden 601 amps to 1,000 amps 240.60 2 Address: same as Job site 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: (503)968 -7799 Fax: ( ) 200 amps or less 66.85 1 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 • 0 APPLICANII'.• .' , * . ' . . : : , I T : . . - El ''CONTACT :PERSON'.; ::.; `:: A A. Fee for branch circuits with service or feeder fee, each Business name: branch circuit 6.65 2 B. Fee for branch circuits Contact name: without service or feeder fee, / 46.85 y. each branch circuit Address: Each add'] branch circuit 1 6.65 City /State /ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) Fes; ( ) Sign or outline lighting 53.40 2 E -mail: Signal circuit(S) or limited- • . • energy panel, alteration, or • extension. Describe: Page 2 2 Business name: Oregon Electric Croup Address: 1010 SE lltll Ave Each additional inspection over allowable in any of the above . . — Per inspection 62.50 City /State/ZIP: Portland, OR 97214 Investigation per hour (1 hr min) 62.50 Phone: (503) 535 - 2652 Fax: (503) 231 -3587 Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* CCB Lic_: 203 Electrical Li t5rv. Lie.: 44605 Subtotal ��3,. Suprv. Electrician signature, required: , I Plan review (25% of permit fcc) Print name: • Date: State surcharge (8% of permit fee) , ag o TOTAL ?EMIT FEE 5 7 -7 Authorized signature �4n This permit application expires if a permit ix not obtained within ]80 � J days after it has been accepted :e, complete A.../f1V 1 / � Print name: A t �// r✓ Date: f/ / /6, y ' Fee methodology set by Tti - County Building Industry Service Board " Number of inspections per permit allowed. Riau' 12/03 440.4615T(10/O?/COM/WPa CITY OF TIGARD 24 -Hour BUILDING Inspection Liner503))639 -4175 MST INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested / / • AM PM BUP Location 7 S • Suite MEC Contact Person x-c) -- Ph ( ) L f c l - „Ts-re' PLM Contractor Ph ( ) SWR BUILDING Tenant/OwnerH ELC aoo Footing ELC Foundation Access: - Ftg Drain ELR Crawl Drain Slab Inspection Notes: G . Post & Beam Shear Anchors /J A AIM Ext Sheath /Shear Cz�¢-�l D/) Int Sheath/Shear U Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post•& Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL _ • �.' 4 :ou•h- UG/Slab Low Voltage Fire arm • a Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. BASS PART FAIL SITE El Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA /l �� y� Inspector ` ~� / /% Approach/Sidewalk Date / Ext Other: Final DO NOT REMOVE this inspection record from th ob site. PASS PART FAIL