Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00111
4 71vA DEVELOPMENT SERVICES DATE ISSUED: 3/13/03
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S136DB- 00201
SITE ADDRESS: 11571 SW PACIFIC HWY
SUBDIVISION: FRED MEYER ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Electrical tenant improvement, alteration of (16) branch circuits.
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: 15 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 MA ELECTRIC INC
BY FRED MEYER, INC 2809 NE 58TH AVE.
3800 SE 22ND AVE PORTLAND, OR 97213
PORTLAND, OR 97242
Phone: Phone: 225 - 0720
Reg #: LIC 00083526
SUP 1578S
FEES • ELE 26 -795C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 3/13/03 $146.60
[TAX] 8% State Tax 3/13/03 $11.73 Rough -in
Elect'I Final
Total $158.33
•
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 O - 9522 -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 -3 -2344. /
/ '
Issu By: r ;��.� - 11 U A Permit 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: LA 0 Q - • DATE:
LICENSE NO: / 57 S
Call 639 -4175 by 7:00pm for an inspection the next business day
•
• ( ' '.
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• '
Electrical Permit Application I
Received g /. a A Electrical f 4C 490 5 .... 06
Date/By: 01 Y' ••••" Permit Islo.:
Planning Approval Sign
City of Tigard Date/By: FermitNo.: .
13125 SW Hall Blvd. Plan Review Other .
:
Tigard, Oregon 97223 Date/By: Peanut No.: .•
Phone; 503-639-4171 Fax: 503-598-1960 , ,,,. ,, i:, Post-Review Land Use .•••
Internet: v(ww.ciiigard.or.us _ ,, 1 , miteiny: ca No.: ti H 0 .9003 -MI,/ . .
77 Contact Js.: 01 See Page 2 for •
-4..4 1JL
24-hour Inspection Request 503-639-4175 Nam/Method: -74. Supplemental Information.
• .
..'•..L11:'illiiiiiiIrlFEOrOOPIX;:'::: ii;iiii.l.r9 •• . ,,., .... i;'':!..'.;::.‘•:....,.::.;.;::-TrAISfgENALFWItiebAgii.iiiialriliiititlWi : :•.'•'...:":
El New construction j=1 Demolition El Service over 225 amps- 0 Health-me facility
commercial 0 Hazardous location .
DI Addition/alteration/replacement _ Ulli Other: 0 Service over 320 amps-rating of 0 Building over 10,000 square .feet,
,..':. '••••••• ii 1 .4' . • C.A:UPPOOPCONSMUCTION.I.'11fl:.:1' i:!:::::::V 1 & 2 family dwellings four or more residential units in
TI 1 & 2-Family dwelling D Commercial/Industrial in System over GOD volts nominal one structure
0 Building over three stories El Feeders, 400 amps or more
Accesso ry Building IU Multi-Family D Occupant load over 99 persons 0 Manufactured structures or RV park
• 0 Master Builder D Other: 0 Egresshting plea 0 Other:
i:f..t,'• ' . 0NINSOR 1V1/VPICialiiiidIt 010 ;'.• '''• '.i.:,;;;;• Th Submit sets of plans with any of the above.
e above are not applicable to tem orar, construction service.
Job site address: I 11 I ____( AC( F, r_ il.e....dy 1 : . ,: ! ..; ;; :,.;......- s :i . ,.. i §.....1...., 1 , ii ,, I ,. ins w.: . 1 . .:;. - ..i: . .:;,,,i,..,„:!..... i r::::,% . . ::..;,..,;.:iiic
Suite #: j Bldg./Aptl: Number of inspections per permit allowed
.. gect Name: f - .. ,,•,-,-j - 7 - 72.....)(k..) Ute) Description Qiy Fee (ea.) Tout
New realdentlal-single or multi-family per
Cross street/Direction-RA° jpb site: dwelling molt. Includcs attached garage.
9 74.-c-c, rfs..0 M y.,4 7-- Service Included:
A).t z 4-0 I.S e_C —C 6A a.' AL 1000 sq. ft_ or less 145.15 4
Each additional 500 sq. ft. or portion thereof
33.40
1
_I #: Limited marry. residential
75.00
Limited energy. nonresidential
75.00 2
Subdivision: Lot
2
Tax map/parcel #: Each manufactured homc or modular dwelling
i tifor feeder 90.90 2
• . °.17fOrN.KIREts!:11 g erv reed= . installation,
alteration or relocation:
200 amps or less R0.30 2
201 amps to 400 raoPs 106.85 2
401 amps to 600 amps 160.60 2
'
...,,.„,,. , 7. , ..OMEtC • : IT , : E.,12,wory..:.• ,.., : i; !:.:1.I... : :f , ...... 601 amps to 1000 amps 240.60 2
• . .
' Over 1000 amps or volts 454.65 2
Name: _ . Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or rdocatioo:
City/State/Zip: 200 amps or less 66.85 I
Phone: Fax: 201 =PS to 400 man . 100.30 2
401 ro 600 amps 133.75 2
....111 :APMCANT. !;.: : ;•';:l - new, alteration or
a!!!:;•,;'? Si l!COST : s -: -a
...r......ts ,
Name: extension per panel:
A. Fcc for branch circuits with rnachasc of •
Address: service or feeder fee, each branch circuit 6.65 2
—
City/Statea.ik B. Fee for branch circuits without purchase of
or feeder fee.
Phone: -Fax: service first branch circuit
Each additional branch circuit 6.55 ye ----_,... 2
/ c" 6.65
E-mail: Misc.(Service or feeder not included):
• ',.. '!•',i.:iii :ii .:'•!;"
• 4 "Ji: - .i ., :;:ii. , i: •:...Ci&ERAICITOIV.11:1::: ' :.: . E or o
a Eacki ch :7 111P " ilTiga " c!rcie 53.40 2
- . go outline lighting 53.40 2
Job No: AAA-Electric Inc. Signal circuit(s) or a limited energy panel,
-
Business Name: ( 4445 SE Stark St. alteration. or extension Page 2 2
Description:
Address: Portland, OR 97233
- Each additional inspection over the allowable in an of the abovc
City/State/Zip: / , per inspection ter hour (min. I hour) 6 2.5 0
Phone: ,A'„,43 3 7 4 : 2 6
C: Fax: , erf,'44 . Tnvestigation fee:
CCB Lic. #: 5 Lic. #: ,-1‘.7q5".--e other: 1 1 1
.,,- .:;. . ?:........i.Aliiv!;i:i , :.:' I.: 7 :;
Supervising electrician •s. 0 Subtotal $ 1 ---
signature required: fr, Plan Review (25% of Permit Fee) $
Print Name: Pi174 ' / /2 gk' Lic. #: , 6 10 S State Surcharge (8% of Permit Fee) S
TOTAL PERMIT FEE $
Authorized . NoticNotice: This permit application expires if a permit boot obtained within
Signature: • Date: 180 days otter It has been accepted as complete. •
*Fee methodology set by Tri-County Building Industry Service Board.
(Please print name) •
i:XDsta \Permit PorrneElcPerrnitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST •
INSPECTION DIVISION' Business Line: (503) 639 -4171
BUP
Received Date Requ sted ( AM PM BUP
Location � 1( 7 1 r Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 3 - 0 / / 1
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes- ��,� , ,,,� rn SIT
Post & Beam 1 l
Shear Anchors 1
Ext Sheath/Shear /
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler •
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
cr
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post& Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In e G �� S
L olt I I
Low Voltage
Fire larm
AIM
S PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for r- nspectio ' E: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector ift
� . f Ext
Other:
Final DO NOT REMOVE this inspection record om the Job s e.
PASS PART FAIL