Permit 1 " CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00385
DEVELOPMENT SERVICES DATE ISSUED: 6/7/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S126CA
SITE ADDRESS: 09009 SW HALL BLVD 200 ZONING: C -G
SUBDIVISION: WASHINGTON CIRCLE PLAZA LOT : JURISDICTION: TIG
Project Description: Replace exit light, add time clock to rear wall pack fixtures.
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:
HUDESMAN, DAVID + LINDA CO TRS OREGON ELECTRIC CONST /GROUP
BY THE GOOD GUYS INC 1010 SE 11TH AVE
ATTN: TED MEEHAN PORTLAND, OR 97214
BRISBANE, CA 94005
Phone: Phone: 503 - 535 - 2652
FEES Reg #: LIC 203
Description Date Amount SUP 4460S
ELE 26 -95C
[ELPRMT] ELC Permit 6/7/2005 $53.50
[TAX] 8% State Surcharge 6/7/2005 $4.28 REQUIRED ITEMS AND REPORTS
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: 122 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.
'JUN -06 -2005 04:18PM FROM -OR ELECTRIC SERVICE
i ��l® 5035352763 T -199 P.001 /002 F -830
�+,It?C1CT1Cdit �, uae rz ». EI _ q Ec G�
Received ., � _� q - �v Permit No,: t �/
City of Tigard Date/.8v; 6 1
13125 SW Hall Blvd., T Tigard, OR 9722 P1an Review Other Permit;
4i D Bi_E__ ]u0t In SeeYu -� for
Phone: SU3 ire: 03. Fax: 503.598.14fi0 luN Q 6 n 4,'� I�I� llateRendy/By: r�
Inspection Line: 503:639.4 ai Notitie eLhod: /I U Supplemental xnformnt
Internet: www,ci.tigard_er.us T.r nr: T1, ARD PLAN REVIEW
TYP s,rti��Q _ ��ISI®N Please check all that apply:
❑ New construction Adapt � teration/rep O Service over 225 amps, conntt'1 ❑Hacurdous location
Q Ddanolition ❑Cater ❑ Service over 320 amps - rating OBuildng over 10,000 sq. ft.,
of 1- and 2- family dwellings 4 or more new residential
CATEGORY OF COPiSTRTJCTION ❑ System over 600 volts nominal units in one stricture
❑ 1_ and 2- family dwelling ® Commercial/industrial ❑ Accessory building OBuilding over three stories [Weeders, 400 amps or more
❑ Multi- family ❑ M aster builder ❑ Other. []Occupant load over 99 persons (]r'l+mufacturad structures or
ess/l; ��
JOB srrE INFORMATION AND LOCATION ❑Egr g g plan park
❑ RV RV p pr:
011ealth -care facility
Job no.: 86262 I Job site Address: 9009 SW HALL BLVD. Submit 2 seta of plans with any of the above.
The above are not applicable to temporary construction service.
City/Stale/ZIP; TIGARD, OR 97223 FEE' SCHEDULE
Suite/bldg. /Apt no.: [project name: WASIDNNGTON CIRCLE PLAZA - ilo.crlpuaa Qty_ I Total
New residential single or multi - family dwelling unit_
Cross street/directions to job site: Includes attaclied gsuruge.
1,000 sq. R or less 145. , 4
Subdivision: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 _ 1
.L _ Limned energy, residential 75.00 2
Tax map/parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular 90,90 2
dwelling scrviee and/or feeder
REPLACE EXIT LIGHT; ADD TIME CLOCK TO REAR WALL-PACK Services or feeders Installation, alteration, and/or relocation
FIXTURES. 200 amps or less 80.30 2
• - loG.85 2
L • 0 TENANT 201 amps to 400 amps
❑ pAOPEIirY OWNER — 401 amps to 600 umps 160.60 2
Name: 601 amps to 1,00D amps 240.60 2
Over 1,000 amps or volts 454,65 2
Address; Reconnect only 66.85 2
City /StateJZIP: _ 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 C7 CONTACT PERSON . A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business nettle! branch circuit
B. F ee f b ranch circuits
Contact name: without service or feeder fee, 46,85 (, ,g5 2
each branch circuit
Address: . add'1 Branch circuit ( 6.65 (p ( 7 ,5 2
City /State/ZIP; _ Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Fhone: ( ) fax: : ( ) Sign or outline lighting 53.40 2
E - mail: signal circuits) or limited-
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: Oregon Electric Group —
Each additional inspection over allowable In any of the above
Address: 1010 SE 11th Ave Per inspection 62.50
City/State./ZIP: Portland, OR 97214 Investigation per hour (l he ria) 62.50
Fax; (503) 535 - 2763 Industrial plant per hour 73,75
Phone: (503) -9900 ( ) ELECTRICAL PERMIT FEES*
CCB Lie.: 203 Electrical Lic.: 26 - 95C Suprv. ' • .: 4460$ subtotal S 3 Sto
Suprv. Electrician si tature, required:
/ /� plan review (25% of permit fee)
./1./9- 0 � 1 _ . .
State surcharge (8% of permit fee) if Z IR
Print name: . i Da • 6/6/05 7 g
_ Alt • _ TOTAL PERMIT FEE ' � This p ermit applicat expires ifa permit is not obtained within 180
d signature: ��L���� 1- days of vr.It has been aeeepted as complete
Print name: • • - J
e i a : 6/6/05 • • Poe methodology set by Tri- County Building India-0y Service Board
IIII Number of oar permit allowed. ` ! ,