Permit ITY OF TIGARD ELECTRICAL PERMIT •
,, PERMIT #: ELC2003 -00092
4
. D EVELOPMENT SERVICES DATE ISSUED: 2/25/03
� J 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1 S136DB- 00201_
SITE ADDRESS: 11571 SW PACIFIC HWY
SUBDIVISION: FRED MEYER ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of lighting for one sign.
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: 1
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: 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 WALHOOD ELECTRIC SIGN •
BY FRED MEYER, INC PO BOX 395
3800 SE 22ND AVE CLACKAMAS, OR 97015
PORTLAND, OR 97242
Phone: Phone: 658 - 2083
Reg #: LIC 64007
ELE 26- 704CLS
FEES SUP 480SIG
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 2/25/03 $53.40
[TAX] 8% State Tax 2/25/03 $4 Rough -in
Elect'I Final
Total $57.68
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 ; i •ays of issuance, or if work is suspended
for more th. • - :1 days. ATTENTION: Oregon law requires you to follow rules adopted by the regon Utility ' otification Center. Those rules are set
forth i • • R 952- OO'7) through OAR 952 - 001 -0100. You may obtain copies of these rul or direct questi •ns to OUNC at (503) 246 -6699 or
1 -80! 332 - 2344.
Is - ed By: , Permit Signat - e: / j, -..W
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 639 -4175 by 7:00pm for an inspection the next business day
•
Electal Permit Application Received FOR OFFICE USE ONLY
�
�
Date/By: 9./2± 03 Permit No.`- 3
Cl of Tigard Planning Approval Sign /�,,�
`, g Date/By: Permit - 4 7
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503-598-1960 A fi Post - Review Land Use
Internet: www.ci.tigard.or.us `^ 1 Date/By:
Case No.:
I Contact Juris.: ® See Page 2 for
NI, oT 24 -hour Inspection Request: 503- 639 -4175 -- Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Plea se check all that apply)
New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
El Addition/alteration/replacement ❑ Other:
commercial ervi v ❑ Bu ilding s over 10,000 ❑ Service over 320 amps - rating of El Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
Building Multi-Family ❑ Building over three stories ❑ Feeders, 400 amps or more
ACCeSSO
❑ Accessory g ❑ ly ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder IkrOther: In G P4 ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
r The above are not applicable to temporary construction service.
Job site address: 1 5 a$ etAC tV 1 <. ti FEE* SCHEDULE
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: , • "TKOs) g aZQ Description Qty Fee (ea.) Total 1
Cross street/Directions to job site: . New residential-single uni tial-sl ud e or multi -family per
l dwelling unit. Includes attached garage.
f'14. t• 'V ill„ 5 f / f� 4T ' ' Service included:
�l _ / 9 1 sq. ft. or less 145.15 4
IAt Each ach additional 500 sq. it or portion thereof 33.40 1
Subdivision: I Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
1 t4 ST�4't. t,. r4 7; Qrt OF � • G/V alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: '1tek, Nl (ex- 'r T 542&5 I W G • Reconnect only 66.85 2
Address: 7. ) • Vim')(, 4 2.(Z i Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: Wea.'['t.`41M , On • /7242- 200 amps or less 66.85 1
Phone:5e3. 717 -3$04 Fax: 505 -717 -3595 201 amps to 400 amps 100.30 2
APPLICANT Branch n 600 circuits r uit 133.75 2
❑ CONTACT PERSON
❑ Branch circuits -new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting i 53.40 I 2
Job No: • Signal circuit(s) or a limited energy panel,
Business Name: Swag-4 ams C v"'� Description: extension Page 2 2
Address: 7.6 f - pr o apu 395
City/ State/Zip: •,t � Each additional inspection over the allowable in any of the above:
Cit
}� p: a c�4c lGra trt� en ' 170 r 5 Per inspection per hour (min. 1 hour) 62.50
Phone: 5O3 . le g'$ • 2073 Fax: ' Investigation fee:
CCB Lic. #: 44007 Lic. #: 2!o . GL.,S Other:
7' 7 o4. Electrical Permit Fees *
Supervising electricia Subtotal $ 5 . VO
_ Signatur - • • .1 :,. W D Plan Review (25% of Permit Fee) $
_ Prin 1 am:7 , , ' • - lt> Lic. #: • 0 . 5 1 State Surcharge (8% of Permit Fee) $ 1 Psi?
TOTAL PERMIT FEE S . (p O
Au t a r orized e: I ��/ N otice: This permit application expires if a permit is not obtained within
Signature: /1 c t Date: 2 • ZS • Oa 180 days after it has been accepted as complete.
�i' •Fee methodology set by Tri- County Building Industry Service Board.
�
(Please print name)
i:\Dsts\Permit Forms \ElcPetmitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
•
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
ID Audio and Stereo Systems
El Burglar Alarm
0 Garage Door Opener
0 Heating, Ventilation and Air Conditioning System
0 Vacuum Systems
0 Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00 ; .
(SEE OAR 918 - 260 -260)
6
Check Type of Work Involved:
El Audio and Stereo Systems
•
0 Boiler Controls '
Clock Systems
Ei Data Telecommunication Installation
El Fire Alarm Installation • ` . ,
n ,
HVAC ' f
Instrumentation
Intercom and Paging Systems
0 Landscape Irrigation Control
01 Medical
Nurse Calls
4
Outdoor Landscape Lighting
0 Protective Signaling
Other
. , . .1 4 • .,
Number of Systems
* No licenses are required. Licenses are required for all
other installations .
_.
ti. .
iADsts\Permit Forms'4ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
' J BUP
Received gate Requ sted 'T /bL AM PM BUP
Location 4.r r (, \ \- \ �-f I Suite MEC
Contact Person Ph ( ) PLM
Contractor \ Ph r 7 e94 SWR
BUILDING Tenant/Owner ELC
Footing ELCP.Qa;)
Foundation Access:
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 C
Post & Beam
Under Slab
Rough-In
Water Service 1
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
P $S P RRT FAIL
ECTRI,CAL )
Service
Rough -In
UG /Slab
Low Voltage
F ire Alarm
PAS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE ❑ Please call for reinspection ' E: ❑ Unable to inspect – no access
Fire Supply Line • ADA
Approach/Sidewalk Date — Inspect r ef Ext
Other:
Final DO NOT REMOVE this inspection record from th Job site.
PASS PART FAIL