Permit +' A CITY O TI ARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
' I� 4, DEVELOPMENT SERVICES PERMIT #: ELR2004 -00292
Ail. 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 9/14/2004
SITE ADDRESS: 07295 SW DARTMOUTH ST PARCEL: 1S136DC-02504
SUBDIVISION: PP1995 -013 ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Limited energy for HVAC
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /1RRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: • HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SUPERVALU HOLDINGS INC AMERICAN HEATING
BY BURKE + NICKEL 1339 SW GIDEON ST
3336 E 32ND ST #217 PORTLAND, OR 97202
TULSA, OK 74135
Phone: Phone: 239 - 4600
Reg #: LIC 33135
. ELE 26- 993CRE
SUP 2640LEP
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 9/14/2004 $75.00 Elect'l Final
[TAX] 8% State Surcharl 9/14/2004 $6.00
Total $81.00
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
thro OAR 95 -911 -0100. Ye rhay obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Iss ed by , . _4l / _4;A i Permittee Signature �� e /(2
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 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application z w t �, 7 ,FOR OFFICEUSE O N L Y y } , � w ` •
City of Tigard Received
Date/By: emutNo.: E�40,• i ./"°l
/ �
13125 SW H a
Hall Blvd., Tigard, OR 97223 y (/ t
g Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 k" t ' r Date/By: Other Permit:
Inspection Line: 503.639.4175 ,� 41 I - Date Ready/By: Juris: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
._ -.. t iltg+. .. .. . ;�., <�_�....�..y -R a.. ,r . �.�g . -�`' x` „"� ` "�t3�� °ma ; , c .. .3 s`: •°� `,� K' k '.- . cf r , 3 . .� i . x..,r '�^ �- .
O '�: ' ;� • ' ,: T P.E OF.: 4.- K z tWa m : '' , , --w4, rT= PLAN. RENEW '
.
x F = ....�ia.��._ak s���ar.. fi:'aa'�;�>:�.:_.- � e ._.; ak- �r�- a�,:�,,: ,,...a �.SS ,,tz >P ..rte �, ... a- sa;�r,:`� :�•. ,- �.,a• ::fi.�,n. - .•..,.,: a �� - - a� , ,,s,��. -,r, 1-- - , '' = -��� . -, � , , .
❑ New construction Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: over amps, m' dous
Service r 225 am , s corn I ❑Nazar location
"`tp., " @' ' �t . - 3 2' c �z :- :S',� �.:.'�t=_ °���'. _ - ..�- ;x �r- s»s -
} `,_ y;y _ ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
, ' k , . ,t; - -`:€.a - CATEGORY: OTi .CQ1V$S.T , IONaw ' -.. t of 1 - and 2-family dwellings 4
„A,.�,,,,�a. „_.��' _ G "I', _� _- "i-�.�=' �_� �.,'�_'__ = - y or more new residential
s'.'^ta;;.:.�_- �: =�=:r. •.u ;..i::.,^:�w.:x-^ra.- �;z�aba s +-e -;3... .> �k: as; ^.s > €�= ��i "S:s.':�.�'�: <.,
❑ 1- and 2- family dwelling ^ › t Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family 11] Master builder 111 Other: din three stories red structures or
❑Buil g over th e sto s Feeders 4 00 amps or 0
,_ . __ ,,,; ,.,„ riF =_ __ _ =n -; DOccupant load over 99 persons ❑Manufactu
-- rA=:JO S1TE: -INS R1ySA[
TON AN OGAT ON ;, e = :'is, '' =f =:. k .. 6._ RV park
=t.,� �� . � re�� m��o-�.:e �- �a . �« : rx��- t�' �s�c7��r ,�'.�r a _a,.,_�e..s -�. � :? w :.<,�. • '. ❑Egless / lighting plan P
Job no.: Job site address: C ❑Health -care facility ❑Other:
722'-' S 1, „aer Submit 2 sets of plans with any of the above.
City /State /ZIP: " ` ri The above are not applicable to temporary construction service.
Jl t.'eC�',�'�. �f
.. "` £ er, �j r ".. E;` aFE'S'GIitDLILE :
E* ° '.x: :
Suite/bldg. /apt. no.: Project name: tl s .a✓°.o WI, iu p ,.,.... =_ . :.:
� De scription I I Fee. Total
f .„, f
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'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
g' .,, ��.,, , ``° r p � ■ �, ,� �, „- Limited energy, non - residential 75.00 2
4 RZ `- "` c,.. h DSCItI- ' .4,. �) "' �°••"4_,g � . g,4? Each manufactured or modular
dwelling, service and /or feeder 90.90 2
,
2H
� � �,� �; � - ,�, � ,�,,
1 7,-;41 Vv
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
_x >�'uw r,: r z �K• .. r <° a3:_ .tea „,,:� 201 am s to 400 am s 106.85 2
ac.' ' ,,PRO)'ERT OW itkt ,I g ,;d t € A T, . , ..� `( P P
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 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
yam v
1 . A�P PT:I AITg 4 a r . i tnCONTt1 * ERSOI A A. Fee for branch circuits with
, �_. x_ N. -.«. 1 x� . _., ; try. : ;w,n.�, TM : -.:..-. .. ,. . _ . ,w.. service or feeder fee, each •
Business name: . -•• s f e . - _ . :;.?.A.- branch circuit 6.65 2
��nn
Contact name~ �C l B. Fee for branch circuits
�J.'�"r,/ ,, 7 j-y)",�j•: e-74.7 without service or feeder fee,
each branch circuit 46.85 2
Address: /3 a r ,. ,: J.04 S
Each add'I branch circuit 6.65 2
City/State/ZIP: -,�,�. •, 6,,<1 a e 97,:::;:,<22.-, Miscellaneous (service or feeder not included)
Phone:S" ?..?-:% ) ?-j - ' Fax: : (�'y; �e)
Pump or irrigation circle 53.40 2
-�'`-� 233-26'3'0 Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
'-'Witai ,c ` T Werli W, F arCONTRMCTOR : 7 a MIRE VE ,ini energy panel, alteration, or
extension. Describe: Page 2 2
Business name: 4 ,,.,•. rr ,, ;,T „^ t
r _ / Each additional inspection over allowable in any of the above
Address:
46 ` - "" L` f e'�da -54-• Per inspection 62.50
City /State /ZIP:)- ,,.- 1:4!",i ., eyes 5 ° Investigation per hour (I hr min) 62.50
=, M, h Industrial plant per hour 73.75
Phone: (a, .a) 2'.3� . ', r ' e i t Fax: ) 0 °- 7e3
�- ;a� -): EL�EC'iCRCAL. PERIVIITF , =f t a
CCB Lic.: . 23 /.a �; - Electrical Lic. «e Suprv. Lic.: y,/._0 _ a4r�'° Subtotal
Suprv. Electrician signature, required -. , _ °_ /...: r Plan review (25% of permit fee)
Print name: 1 . ' F E State surcharge (8% of permit fee)
x c. c_...,,, € 4, ,..,,,,, Date: C .-. _ 6„/
TOTAL PERMIT FEE
Authorized signature: , -
JL • - � = This permit application expires if a permit is not obtained within 180
J days after it has been accepted as complete
Print name: s: ° y • L „ .. 7 4 , 1`- Date: !. 2.. e",? * Fee methodology set by Tri- County Building Industry Service Board
'° Number of inspections per permit allowed
i.\ Building \Permits \ELC- PernutApp.doe 12/03 440- 4615T(10 /O2/COM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
' g BUP
Received Date R uested ` -� AM PM BUP
72
Location 15 - d�i6? -�-L Suite MEC
Contact Person Ph ( ) 57;R " Sci 77 PLM
Contractor Ph ( ) a3 Z - 'tt 00 SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access: cg e" g_ ap a ?e%. Ftg Drain ELR 7
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam a . \
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear vi
Framing
Insulation f ' A 35 � Drywall Nailing �
Fire wall
Fire Sprinkler
Fire Alarm i
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 Cfprifim rr 577(4 Nor P'$ 6 A✓Ly t) is)
PASS PART FAIL /
MECHANICAL
Post & Beam •
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRIC AL
Service „ A
Rough -In r 4) f C '
UG /Slab �f
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
dairalp PART FAIL
Please call for reinspection RE: EI Unable to to iinspect — no access
Fire Supply Line
ADA D 19 V ✓ 16N L4 L ` ���' Ext
Approach/Sidewalk Inspector
Other:
Final DO NOT REMOVE this inspection record from the Job site.
• PASS PART FAIL