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Permit C ITY OF TI ; GARD ELECTRICAL PERMIT PERMIT #: ELC2003 -00088 140,, DEVELOPMENT SERVICES DATE ISSUED: 2/21/03 - I lll 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S136DB-00201 SITE ADDRESS: 11571 SW PACIFIC HWY ZONING: C -G SUBDIVISION: FRED MEYER BLOCK: LOT : JURISDICTION: TIG Project Descrip 'on: 4 05 • l aaa- 1 a4 ,Ah _ (.aLeL a M I T,T) 'f.I cikeit edl -tn fie. I%w to RESIDENTIAL UNIT TEMP SRVe /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: 1 W /SERVICE OR FEEDER: 6 PER INSPECTION: 201'- 400 amp: 1st W/O SRVC OR FDR: 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: 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 2/21/03 $120.20 [TAX] 8% State Tax 2/21/03 $9.62 Elect'I Service Rough -in Total $129.82 Elect'I Final This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or 1 -800-33 -23 . Issued By: j fi..irhel_ kt ,(J ) Permit Signature: U'1 a .(O.,Qi( vv---- OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: e afIliati 0_0(4._ DATE: LICENSE NO: 4 7 Li Al Call 639 -4175 by 7:00pm for an inspection the next business day r - Electrical Permit Application Ohl l t:'1: lltit : (►N I , , Date recei 'v � t 9 3 Permit no.: �.. a ".i • t� I • ,7 City of Tigard Project/appl.no.: Expire date: City of Tigard Address; 13123 SW Hull Blvd, I2I ED Date issued: 13y15 1 Receipt no,: Phone: (503) 639 -4171 Fax: (503) 598 -1960 FEB 19 2003 Case file no.: Payment type: Land use approval: I IUAI-1D & P03-co77 ❑ 1 & 2 family dwelling or accessory J Commercial/industrial 0 Multi- family enant improvement 1 New construction J Addition /alteration/replacement ❑ Other; - ❑ Partial Job addres� 51 Op) C rf- G 1/ r ,,./ Bldg. no.: Suite no.; Tax map /tax lot/account no.: - Lot: I Block: Suoui$ / Project name: ' a1jt,)al �itelp ! cription and location of work on premises: /t, $»/? I ,.d'L i ' /.u› Estimated date o4' complctionlinspection: Fee Max Job no: 3 -/ 3,z - Dsacrtpdon Qty. (cu) Total =blasts $ ssittesS name: f ���� dr C Newr cadential- sinkleormatti -family per Address: , �^ N �! e *. dwellingtmit .Includestlttachedearage. City: ti r GC S /'0 State: p ZIP: L'/ `� /,Z I. $ervic4lttclndod: 4 Phone:48 y o u Fax: Q 3y 3l I E -mail: 1000 sq. R or less / f Each additional 5011 or portion thereof CCB no.: Pt ro 7 6 -4- G I l us. e. no: bus. li j- 3y-G/,7� Limited enemy. residemial 2 - Ci metro tic. no.: L -_,__ ---- /0 -/ - 0 3 Limited Cnerj, non - residential 2 0 2 J1 /) 3 earl' manufactured home or modular dwelling Gignaturo of eupor'ici9 °Ioen'i n (rrquit."d1 Dare 0 - . O Service and/or feeder r 2 + 5 ' Services orfeedent- installation. Sup. elect. name (pr ., ,,,a, £' �a� li cense no 7 aa alteration or relneatioo: 1 F� yn 2 00 amps or less I Name (print): 201 amps to 400 amps — 2 401 amps to 600 amps Mailing address: 601 amps to 1000 amps 2 City: I Stator I ZIP: Over 1000 a to virtu 2 Phone; F ax: 1E-mail: Reconnect only - _ 1 Owner installation: The installation is being made on property I own Temporary tervieeaor feeders - installation, alteration, nr rein cetinte which is not intended for sale, lease, rent, or exchange according to 200 amps or lets 2 ORS 447, 455, 479, 670, 701. 201 snr,s to 400 sm 2 Owner's signature: 17ate: _. 4111 to 600 amps 2 LN G 1 N I R Branch circuits - new, alteration, or extension per panel: Name: . A. Fee for branch circuits with purchase of / ! , g G3. , 7 Q 0 Address: service or feeder fix, each branch circuit �v b % ( 2 City: J S tate: I ZIP: B. Fee for branch circuits without purchase w of service or feeder fcc, first branch circuit: _ 2 Phone: Fax: E-mail; • each additional brineh clrculr. MAN Ill.:VILIV (Please check all That apply) Misc . (Service or feeder not included): D Service over 225 amps-commercial 0 Health facility Each pump or ini uion circle 2 - O Service over 320 amps of 1&2 0 Hazardous location Each sign or outline lighting 2 - family dwellings 0 Building over 10,000 square feet four or Signal eircuit(s) or a limited energy panel, :] System over 600 volts nominal more residential units in one Armature alteration, or oxtension 2 D Building over three merles 0 Feeders. 400 :Irma to atuu •Ucscrlettton: _ D Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over Ike sllaysablc in any of the above: O Egress/lighting plan 0 Other. Per inspection .J I J I Stlpintt sets of plans whit airy er the above. lunatigati n roc The above are not applicable to temporary construction service. I Other A ^ Pcrmitfee $ 1Ao • . g° _ Nuty1l ,iv iylh.tinos accept credit mania. piano tall jurioliction fly , non• inr „rnurinn. riot nr This permit application Plan review (at %) $ _ DeVica 0 Master d expires if a permit is not obtained o c ' card b< r - IN 0 - l�.(D �3 - 3 /03 within 180 days after it has been State surcharge (8%) ..... $ _ 9 • ` ' t nu ri ten •,. Eapirsa accepted as complete. TOTAL $ 1P.f • 8 41'unc at cards • i cr A un credit acrd ' CardhultlCr stfnantn Amount 4404615 1M /CUM) CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST r INSPECTION DIVISION . • Business Line: (503) 639 -4171 BUP Received Date Re uested j —3 AM PM BUP Location Suite MEC Contact Person Ph (? 71) Z 1 2 - 7 6 8 • PLM Contractor Ph ( ) SWR 3 BUILDING Tenant/Owner n m. 3 ELC - 6400 g r Footing , - -- - - - -- - -- -- -- ELC Foundation Access: g Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final 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 Rough -In UG/Slab Low Voltage Fire Alarm PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date..2 Q Inspect Ext Other: Final DO NOT REMOVE this inspection record om the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4'175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST r1 BUP J Received Date Re uested — _ AM PM BUP Location iic 1+- Suite MEC Contact Person Ph ( ) q 71-;/.:2- 7t'o PLM Contractor P ( ) SWR BUILDING Tenant/Owner ~ 'Lt- �l rnal6L. ELC 3 i ' Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: Li I � SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire fy;i S• p eiling Roof • 1 r Other: Final PASS PART FAIL PLUMBING I � Post & Under Slab )� 3 Valm=4).-€1) `jl' Q / � � Rough -In �3 O P 11 4 9 l70 Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole \fr'. Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Servi 62.4 ough- U Slab Low Voltage Fir- Alarm Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SI Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Da -�. -0 Inspector 7 � r / Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL