Permit 1 ,
• CITY OF TIGARD F ELECTRICAL PERMIT
PERMIT #: ELC2007 -00779
COMMUNITY DEVELOPMENT ' DATE ISSUED: 11/19/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 136AD -05800
SITE ADDRESS: 11465 SW PACIFIC HWY ZONING:
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: SHELL
Project Description: Install conduit for sign. 1 branch circuit.
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: SIGNAUPANEL:
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:
EQUILON ENTERPRISES LLC NORTHWEST PUMP & EQUIPMENT
PO BOX 4453 2800 NW 31ST
HOUSTON, TX 77221 PORTLAND, OR 97210
Phone: , Contact #: PRI 503 519 - 6056
FAX 503 - 205 -1465
FEES
Description Date Amount Reg #: ELE 26 -852C
CITY OF TIGARD MENU 11/19/200' $46.85 LIC 64567
[ELPLCK] ELC Pln Rev 11/19/200' $11.71 SUP 4884S
[TAX] 8% State Surcharge 11/19/200" $3.75
(additional fees not listed here) REQUIRED ITEMS AND REPORTS
Total $62.31
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: 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.
Electrical Permit Applic `�I � '�y FOR OFFICE USE ONLY
City of Tigard Date/By: C/10 I-, Permit Q0 �/��
U PI
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review (�
1 7 . Phone: 503.639.4171 Fax: 503.59 I 1 q 200? Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready /By: luris. / la See Page 2 for
T I G A It D
Internet: www.tigard CITY OF TIGARD Notified/Method: /l1 Sa pp Supplemental Information
TYPEW Malta DIVISION PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction Et] Addition/alteration/replacement
❑ 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
❑ 1- 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.
El A Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "f -3 ",
Job no.: Job site address: y ( • �• 100HP or more. occupancy.
11(0 6 j p�i I a ( 4 ❑ S or more residential units. 0 Recreational vehicle parks.
I t ai(d , OP ( MP 1 ❑ Hazardous locations. ❑ Supply voltage for more than
City/State /ZIP: /
600 volts nominal.
Suite/bldg. /apt. no.: Project name: 5. L J ❑ Service or feeder 600 amps or more.
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
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: _
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
II v `t () ( 6(3).) Limited energy, multi - family
1 residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ 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: ( ) I Fax: ( ) 200 amps or less 66.85 l
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
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
in APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
� each branch circuit
Business name: /vr) Mt wt�+ pi l e t f Mt - B. Fee for branch circuits
Contact name: ��� Jt C�o� v �" }I without service or feeder fee, 46.85 �� 2
first branch circuit
Address: 0 1) No 'a' 6 de_ Each add'I branch circuit 6.65 2
r/ Miscellaneous (service or feeder not included)
City /State /ZIP: ( iota t o oQ g7'' iC Each manufactured or modular 90.90 2
l b' dwelling, service and/or feeder
Phone: (6p3) s ig to 06 ( I Fax: : (bD3 )apt p1,1 f 6 Reconnect only 66.85 2
CA—L4 "'�'l ` Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
�J Signal circuit(s) or limited -
Business name: it b ffk LAiefri � � 3 E � `� "' , ! tV - energy panel, alteration, or
Address: iv") • 1 �j I' r t2 extension. Describe: Page 2 2
City/State/ZIP. r, (1 I6 vr i d a P I O Each additional inspection over allowable in any of the above
I
P Per inspection 62.50
Phone: ( ) Fax: ( ) i0 11
Investigation per hour (I hr min) 62.50
CCB Li *` 4 1, 0 Electrical Lic.: CXbt Suprv. Lic.: tieR175 Industrial plant per hour 73.75
1 i� -• ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 'iii, ♦ Subtotal: pi
Print name: l Date: Plan review (25% of permit fee): " ]
State surcharge (8% of permit fee): 1 %; a 75
Authorized signature: TOTAL PERMIT FEE: 60
Print name: Date: This permit application expires if a permit is not obtained within 80
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I: Building \Permits'ELC- PernitApp.doc 05/23/06 440- 4615T(I1/05 /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:
❑ Audio and Stereo Systems*
•
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ In'strumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other •
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 03/23106
CITY OF TIGARD
BUILDING DIVISION P E RMIT #: ELG2007 00779
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/1B/2007
Phone: (503) 639- 4171 ��
Inspection Requests (24 Hrs.): (503) 639 -4175 "' L.
INSPECTION WORKSHEET FOR DATE: 11/21/2007 TIME: 7:00AM PAGE: 32
SITE ADDRESS: C HWY CLASS OF WORK:
11�i65SlNPA_IFICF4NY
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: SHELL
DESCRIPTION: Install conduit for sign. 1 branch circuit.
OWNER: EQUILON ENTERPRISES LLC, PHONE #:
CONTRACTOR: NORTHWEST PUMP & EQUIPMENT v 04\ PHONE #: 503- 519 -6056
Inspection Request Scheduled For: Date: 11/21/2007 Pour Time:
Code # Inspection Description - - G nfirr - # Contact # Message
199 Electrical final 060110 -01 503. 519 -4018 N Y
Corrections /Comments /Instructions:
a._
PAS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G T (R) 1.� Date: II \ 1-li 01 Phone #: (503) 718- _1_44.b.___
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2OO7.00779
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/19/2007
Phone: (503) 639 -4171 W • '�hI
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/20/2007 TIME: 7 :00AM PAGE: 31
SITE ADDRESS: 11465 SW PACIFIC I CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: SHELL
DESCRIPTION: Inslall conduit for sign. 1 branch circuit.
OWNER: EQUILON ENTERPRISES LLC, PHONE #:
CONTRACTOR: NORTHWEST PUMP & EQUIPMENT PHONE #: 503 - 519
Inspection Request Scheduled For: Date: 11/20/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
. 105 Underground/slab cover 060007 -01 503- 519-6056 N
Corrections /Comments /Instructions:
k`fRtoc2 "10 PVC wnt?X.S ® 10 %5S ANM
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G W L Date: \tk VI(V) Phone #: (503) 718 -