Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
-- t , COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00178
T I G A R b 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/27/2008
PARCEL: 1 S136AD -06504
SITE ADDRESS: 11462 SW PACIFIC HWY ZONING: C - G
SUBDIVISION: AMERICAS TIRE COMPANY LOT: 003 JURISDICTION: TIG
PROJECT: DISCOUNT TIRE COMPANY
Project Description: Installing (1) low voltage data system.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
• HVAC:
•
DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: .
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
DISCOUNT TIRE COMMWORLD OF PORTLAND
4026 W. WHITTON 5711 SW ARCTIC DRIVE
PHOENIX, AZ 85019 PO BOX 3675
BEAVERTON, OR 97005
Phone: 602 - 272 -9356 Contact #: PRI 503 -520 -1220
FAX 503- 646 -0235
FEES Reg #: ELE 26- 890CLE • LIC 103916
Description Date . Amount SUP 3043LEA
•
[ELPRMT] ELR Permit 6/27/2008 $75.00
[TAX] 12% State Surch 6/27/2008 $9.00 REQUIRED ITEMS AND REPORTS -
Total $84.00
,
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. Y. may obtain copies of these
rules or direct question to OUNC at 503.246.6699 or 1.800.332.2344. - ,
Issued = /�`,. _ � ermi'ee ignature: �4 L....- A--
• 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 Application �� FOR OFFICE USE ONLY
■ g
City of Tigard Received 0 f p
. City DDate/13 `y /� ' ermit No.: ` r �/
" a 13125 SW Hall Blvd., Tigard, O Plan Review Q
M Phone: 503.639.4171. Fax: 503 � ^*(?) Date/By: Other Permit: zeaGrl r .-- -r
T I G A R D Inspection Line: 503.639.4175 `` \\t,\ 1 L Date Ready/By: kris: 65 ee Page 2 for
Internet: www.tigard - or.gov Jv ^ A � Q Notified/Method: Supplemental Information
TYPE OF WOR O. ,v, C j , ® PLAN REVIEW
lew construction El Addition/alterat T 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 ❑Odle[: SO 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
• ❑ 1- and 2- family dwelling [Z - mmercial /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
El Emergency system. larger separately derived system.
• ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
I ix or or a more. R occupancy. Recreational Job no.: 18050 I Job site address: 11462 S W Pacific Hwy
❑ Six or more residential units. ❑Recreational vehicle parks.
City /State /ZIP: Tigard, OR 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: Arne s Tire Co. ❑ Service or feeder 600 amps or more.
s c r-1 .� FEE SCHEDULE
Cross street/directions to job site: 0 E 7 � 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
Data /Telecommunications Cabling residential (with above sq. ft.)
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: I Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
• relocation
Phone: ( ) ■ I 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, er panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ 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'l 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
Signal
Business name: CommWorld of Portland energ on,ed-
rgy p panel, alteration, or
Address: 5711 SW Arctic Drive extension. Describe: 1 Paget 75.0 2
City/State /ZIP: Beaverton, OR 97005 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: 603)520-1220 Fax: (5 0 3) 6 4 6 - 0 2 3 5 Investigation per hour (1 hr min) 62.50
CCB Lie.: Electri Lic.: _ . - dustrial plant per hour 73.75
1 0 3 91 � -r= a �' _ a
ELECTRICAL PERMIT FEES
Suprv. Elec c ignature, required: �` CI 1 e) Subtotal: 75.0 0
, ^ Plan review (25% of permit fee):
lUl ' �
Print name: ■ 0 Date: 2 a
State surcharge (12% of permit fee): 9.00 _ _
Authorized signature: TOTAL PERMIT FEE: 84.00
r — / This permit application expires if a permit is not obtained within 180
Print name: Robert Olsen Date:
bll days after it has been accepted as complete.
t • Number of inspections allowed per permit.
I:\Building\Permits\ELC- PermitApp.doc 05/23/06 440-4615T(11/05/COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #
ELR200B 00178
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
eb, 6/27/2008 Phone: (503) 639 - 4171 . 1;�'�I
Inspection Requests (24 Hrs.): (503) 639 - 4175! -. ;y__
INSPECTION WORKSHEET FOR DATE: 8/8/2008 TIME: 7:O0AM PAGE: 36
SITE ADDRESS: 11462 SW PACIFIC I1WY CLASS OF WORK:
SUBDIVISION: AMERICAS TIRE COMPANY LOT #: 0 TYPE OF USE:
PROJECT NAME: DISCOUNT TIRE COMPANY
DESCRIPTION: Installing (1) low voltage data system.
OWNER: DISCOUNT TIRE, PHONE #: 602 -272 -9356
CONTRACTOR: COMMWORLD OF PORTLAND PHONE #: 503520 -1220
Inspection Request Scheduled For: Date: 818/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 073925-01 509-294-6073 ' Y
Corrections /Comments /Instructions:
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$PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
ii . ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G 1 1 L Date: dt1 1 Phone #: (503) 718 - VI*
...
CITY OF TIGARD
Ei
BUILDING DIVISION PERMIT #: ELR2008 -00178
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED 6/27/2009
Phone: (503) 639 -4171 / u
Inspection Requests (24 Hrs.): (503) 639 -4175 `_
INSPECTION WORKSHEET FOR DATE: 7/31/2008 TIME: 7 :00AM PAGE: Q6
SITE ADDRESS: 11462 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: AMERICAS TIRE COMPANY LOT #: R03 TYPE OF USE:
PROJECT NAME: DISCOUNT TIRE COMPANY
DESCRIPTION: Installing (1) low voltage data system.
OWNER: DISCOUNT TIRE. PHONE #: 602-272-9356
CONTRACTOR: COMMWORLD OF PORTLAND PHONE #: 503 -520 -1220
Inspection Request Scheduled For: Date: 7/31/2008 Pour Time:
Code # Inspection Description Cn -# Contact # Message
199 Electrical final (073493 -01 509 -294 -6073 N
Corrections /Comments /Instructions:
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❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
X FAIL XCALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
N 66 L� Phon #: (503) __
Inspector: c Date: `� � l� 4 � ( ) 718-
I