Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00168
DEVELOPMENT SERVICES DATE ISSUED: 4/8/03
' II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
_ PARCEL: 1S136DB-00201
W
SITE ADDRESS: 11571 SW PACIFIC HY
SUBDIVISION: FRED MEYER ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install (2) 200 amp serv. and (1) 600amp.
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: 2 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: 1 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:
WILMINGTON TRUST CO, TRUSTEE KEC ELECTRIC INC
BY FRED MEYER, INC 1281 NE 25TH AVE UNIT K
3800 SE 22ND AVE HILLSBORO, OR 97124
PORTLAND, OR 97242
Phone: Phone: 503 - 439 - 0904
Reg #: LIC 99267
SUP 4489S
FEES ELE 34 -426c
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 3/26/03 $321.20
[TAX] 8% State Tax 3/26/03 $25.70 Elect'I Service
[ELPLCK] ELC PIn Rev 3/26/03 $80.30 Rough -
Elect'I Final
Total $427.20
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 1-800-3y-234
Issued By: ��� a,U Permit Signature: (11■ (34.o -
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: Q71 0-424ak DATE:
LICENSE NO: "I`l -S
Call 639 -4175 by 7:00pm for an inspection the next business day
. k' 4,1942003 09:09 FAX 5035981960 CITY OF TIGARD 421002
' . . .
FOR OFFICE USE ONLY
Electrical Permit Application Received , i 11 Eectrical _- • . - . ..
Date/BY:6 "r;'•61 IN Pen,* No.e-/-4..OW..0 )3 - 00/ b
Flarming Approval Si
•
City of Tigard Date/B y: gn
Perna No.:
13125 SW Hall Blvd. e GI\I ''s , Plan Review " , , ,... v Other
Tigard, Oregon 97223 , Date/By: • Permit No.: —.—
Phone: 503-639-4171 Fax: 503-A9g163 , .. , . .,,
lA; Y. ay. 1 ,. \ Post-Review
Datenily: '
,
, Land Ilse
Case No.:
Internet: www.M.tigard.or.utA la 4 I01 _14 - ::•1 I ( Contact '
Juris.: el See Page 2 for
,
24-hour Inspection Request: 503-63,9404As '''''''' Name/Method: , Supplemental Information.
arNi Or 1 ";: .
....1.0m,.:77.37c.Trattfovc.:Ii :,. ,.
.7, .....: .41,,,-„,,, .: .:. : ..:. • ..,.. ;.::,. ptim . .
rmaii ekkginithattii
Hazardous oc
\1
7v constn.iction [ Demolition . rvice over 225 arrms- Health-eare facility
D lation
v Addition/alteration/replacement Other: . ommercial 0 servicc over 320 aMps-rating of 0 Building OVer 10,000 square feet,
I ....C*TBDORSibr" ,' 0 • e cTioN...: ::;:::::::!i:.:.i:i:I..;(14 l'..' 1 & 2 family dwellings four or more residential units in
71 1 & 2-Family dwellinl II! ommercial/Industrial El System over 600 %/Ohs nominal one structure
0 B e
uilding ovr three stories El Feeders, 400 amps or more
111 Accessory Building El Multi-Family • Occupant load ovet 99 persons D Manufactumd structures or RV park
D Master Builder Ell Other: EI Egress/lighting phin in Other:
1 .i. 5 r$V.ZINEiii . .-1 1 1014.andliOeitt,T ' .0 A.,:!iiii.......:., • SubMit sets of plans with any of the abcrie.
The above are not tieable to tem ora construction senice.
1/57/ Job site address: /15 :3'- fie. /¼V/' .: :. :. -:''
Suite #: I Bldg./Apt.#: , Number of inspections per permit allowed
Project Name: At. v../ - - 7 cew 0 i c-e •-• DeScriPtim
.-11 ' Qty Fee W.) Mal
i
u / 9 609 ,4 New residential-single; or multi-family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included: .
1000 sq. ft. or less , 145.15 4
. —.
Each additional 500 sq: ft. or portion thereof 33.40 1
Limited enew, residential 75.00 2
—Subdivision: Lot #: Limited energy. non reaidential 75.00 2
Tax map/parcel #: . Each manufactured hor,ne or modular dwelling
•-"....: ..• ...'?'• ; i''.1-'1,I AkESCRaftilioN.OrWORX:119,:;. ............ f ,;,.: ; !.1 service and/or feeder i 90-90 . 2
. .. . . . .. , . . .
Services or feeders - installation,
if, smte C' 00 A P./ f ` ArroArrAirt /h alteration or relocation:
200 amps or less I c 80.30 I Ca (.0 2
A.2,75 201 amps to 400 amps I 106.85 2
401 amps to 600 amps • , / 160.60 i 60.60 2
.iftgOr 0 - Tle OWNSIV.!: !::: :::' i' rim :a;r1 ,.' r.. I': :';: .1::: 601 ar "P g t° 1000 arnrs 240,60 - 2
•
Over 1000 amps or volts 454_65 • 2
Name: J irc,./ ,4 ( N-e 0 - e A Y 5 / Reconnect only - • 66.85 2
Address: 1 coo 5 C (1 ,2 ...xl A ti
Temporary services or feeders - Installation,
- alteration, or relocation
■.. City/State/Zip: Po..- 200 amps or less , 66.85 1
sZl 100,30 I 2
201 Omps to 400 am_ps I
Phone: 55 3 7c(7 34 Fax
. ,.... .„., .. 401 to 600 amps ; 133.75 , 2
N Q jall'PPLACANIVIII:111:i1::::M•1 .:Ii.'..;.alaiNTACT:inutsorr... .,:...:-;::!,:...! Branch circuits . ariv, alteration,
Name: extension per panel;
‘-c Address: A. Fee for branch circuit 4 with purchase of
service or feeder fee. each branch circuit 6.65 2
■ City/State/Zip: B. Fee for branch eiretiits without purchase of
- service or feeder fee. fast branch circuit 46.85 2
`-‘ Phone: I Fax; Each additional branch circuit 6.65 2
.. .
- E-mail: Mise(Service or feeder not included):
N ' OEF:!'iiIi'li...7:171:!;.; . ■:: I. :1:.: !.'..:!':?:!; ';'"q '.11 :;:. Each imir" °r in4R4ti°6 circle . 53.40 2
Each sign or outline lighting 53.40 2
f Job No: / circuit(s) or a limited energy panel,
aheration. or extension Page 2 2
4 Business Name: irC i 1 - 7 ..3.7 : e (...e. Description:
Address: fi( # 2 5 ' ..0 x 1 a vi-jr Z( 1 i _
City/State/Zip: . /./1 «5 0 erO 0 r .17 .2 141 Each additional inspection over the allowable in any of the above:
Per inspection per haul (min. 1 hour) I 62.50 I
Phone: 4 Li 745 (95,9q ax: co3 4 yo 3 c IA- j ion fee: 1
.,.. _CCB Lic. #: c-147,iC.. - 7 L 4 ic. #: 3, - qac C Other: . I " I "
...,', :''i '' .
.: :: ..:....:Eittaiikatge . . ' , ,Cd4e 1: ;. : .•! - ..P:; ial i..: i'MF:J1::-:;.":'
Supervising electrician/ - I Subtotal
nature re 1 ,4%._ /-- Plan Review(25% of Permit Pee) $ :0.30
Print Name: r v4.4y I Lic. #: 1-( 7( S'' State Surcharge (8% of Permit Poe) S
, TOTAL PERMIT FEE S
th _44g
• Auorized -
e.. Notice: This permit application expires if a permit is not ob
Signature: 4- _ , .,111 - _ -;--...........r . Date: R/03 180 days after it has been accepted as complete. ned flig " / , .°
*Fee methodology set by 'Fri-County Building Industry Se cc Board.
(Please print name)
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i:\Dsts 1 Permit Forms\EIcPennitApp.doc' 01/03 I
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