Permit CITY OF TIGARD ELECTRICAL PERMIT
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- a' COMMUNITY DEVELOPMENT PERMIT #: ELC2008 -00662
DATE ISSUED: 12/4/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S133AD-16200
SITE ADDRESS: 12700 SW NORTH DAKOTA ST 200 ZONING: C -
SUBDIVISION: PP1995 -073 LOT : 003 JURISDICTION: TIG
PROJECT: MAGIC CLEANERS
Project Description: Installing (1) branch circuit for dry cleaning machine.
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: 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:
PACIFIC CREST PARTNERS SCHOLLS L TRINITY ELECTRIC
1430 EASTSIDE RD 13422 SW 128TH PL
HOOD RIVER, OR 97031 TIGARD, OR 97223
Phone: Contact #: PRI 503 - 235 -6481
FAX 503 -579 -3929
FEES
Description Date Amount Reg #: ELE 34 -653C
[ELPRMT] ELC Permit 12/4/2008 $46.85 LIC 156637
[TAX] 12% State Surchar 12/4/2008 $5.62 SUP 42825
Total $52.47 REQUIRED ITEMS AND REPORTS
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 co.ies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued BOPP i ` p__ •ermittee Signature: _`
j .
'� 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.
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Electrical Permit Application FOR OFFICE USE.ONLY
City of Tigard RECEIVE r , • �' I Permit No.: /1......."" _ t
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13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: •
l" I C: A It D Inspection Line: 503.639.4175 DEC 0 4 2008 Date Ready/By: kris: 0 See Page 2 for
Internet: www.tigard -or.gov Notified/Method: a Supplemental Information
TYPE OF WORKCITY PLAN REVIEW
❑ New construction XAddition/alteratiomfaaNGDivISION Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "l -3 ",
�/, , 100HP or more. occupancy.
Job no.: Job site address:
1 2, 9v t/ s�/ Norm 1 7 k 6i �/• ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: ' �� ❑ Health -care facilities. ❑ Supply voltage for more than
/
7 ' Ol'ri 0 l - ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: ,k y1 Project name: /�/J /+ ❑ Service or feeder 600 amps or more.
" "lJ M, ,, `- �Qli�� FEE SCHEDULE
Cross street/directions to job site: Description _ I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
Pr Cie A l' q 0) c %;AP - residential (with above sq. ft.)
Q� Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 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 599 amps 133.75 _ 2
Branch circuits— new, alteration, or extension, per panel
Owner signature: Date:
A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, / 46.85 2
first branch circuit ,
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included) _
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: r Signal circuit(s) or limited -
r /n r ale C /Y energy panel, alteration, or
extension. Describe: Page 2 2
Address: / 3E4_2_1_ 9 _ / /.�., /X pv_ .
City/State /ZIP: / Ii Qo re-/ O Q/� 3 Each additional inspection over allowable in any of the above
V / / Per inspection 62.50
Phone: ( ) Z / Fax:
p,� 3_( . 4, I 0 "3,:- Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: .. - ' Suprv. Lic.:4 7 Industrial plant per hour I 73.75
���? ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: , ° /' Subtotal: l,[6
/ � s
Plan review (25% of permit fee):
Print name: In !'// Date: /�? State surcharge (12% of permit fee): •
Authorized signature: �� TOTAL PERMIT FEE: �� Le7
Date: permit application expires if a permit is not obtained within 1 0
Print name:
p Tvl S, A1/3/0� days after it has been accepted as complete.
' \ • Number of inspections allowed per permit.
BBuilding\Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11 /05 /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:
El Audio and Stereo Systems*
❑ Burglar Alarm
El Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
El Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
E l Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
p Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
❑ Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
I:\ Buildin \Pamits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD t ,
BUILDING DIVISION PERMIT #: ELC2008- 00662
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/4/2009
Phone: (503) 639 -4171 Itl
Inspection Requests (24 Hrs.): (503) 639 -4175 "' L
INSPECTION WORKSHEET FOR DATE: 12/10/2008 TIME: 7:01AM PAGE: 4
SITE ADDRESS: 12700 SW NORTH DAKOTA ' 0
S1 Q CLASS OF WORK:
SUBDIVISION: pP1995.g73 LOT #: AQ3 TYPE OF USE:
PROJECT NAME: MAGIC CLEANERS
DESCRIPTION: Installing (1) branch circuit for dry cleaning machine.
OWNER: PACIFIC CREST PARTNERS SCHOLLS L, PHONE #:
CONTRACTOR: TRINITY ELECTRIC PHONE #: 503235.64W
Inspection Request Scheduled For: Date: 12/10/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 078949 -01 971 - 235.6481 R
Corrections/Comments/Instructions:
A
q
ifLPASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: V' \ 6 66 LE
Date: 111 ' Phone #: (503) 718- ViLit)