Permit CITY OF TIGARD ELECTRICAL PERMIT
,0 1\ DEVELOPMENT SERVICES PERMIT #: ELC97 -0691
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10 / 16 / 97
PARCEL: 2S101BB -00301
SITE ADDRESS...:11834 SW PACIFIC HWY
SUBDIVISION •TIGARD ROAD GARDENS ZONING:C —G
BLOCK • LOT •001 JURISDICTION: TIG
Project Description : Add a first branch circuit to an existing couercial service
station.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD'L 500SF...: 0 201 — 400 amp • 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY • 0 401 — 600 amp • 0 SIGNAL /PANEL • 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 — 200 amp • 0 W /SERVICE OR FEEDER: 0 PER INSPECTION • 0
201 — 400 amp • 0 1st W/O SRVC OR FDR.: 1 PER HOUR • 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 0 IN PLANT • 0
601 — 1000 amp • 0 PLAN REVIEW SECTION
1000+ amp /volt • 0 > =4 RES UNITS • > 600 VOLT NOMINAL..:
Reconnect only : 0 SVC /FDR >= 225 AMPS..: CLASS AREA /SPEC OCC.:
Owner: -- FEES
TEXACO type amount by date recpt
11834 SW PACIFIC HWY PRMT $ 35.00 GEO 10/16/97 97- 300145
TIGARD OR 97223 5PCT $ 1.75 GEO 10/16/97 97- 300145
Phone #:
Contractor:
PHOENIX ELECTRIC CO $ 36.75 TOTAL
7379 SW TECH CENTER DR.
- REO!UIRED INSPECTIONS
TIGARD OR 97223 Elect'1 Service
Phone #: 684 -3600 Elect'1 Final
Reg #.. : 000522
This perait is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This pervit 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 the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952- m1- 'A10 through OAR 952 -001 -1987. You lay obtain a copy
of these rules or direct questions to OUNC by calling (503)246 -1987.
Permittee Signature: _ !•i/44„M Issued By:
OWNER INSTALLATION ONLY --
The installation is being made on property I own which is not intended for
sale, lease, or rent.
OWNER'S S I GNATU RE : DATE: 71//6/f7-
CONTRACTOR INSTALLATION ONLY - - - - - --
SIGNATURE OF SUPR. ELEC' N: 8'YLl DATE: /06/9
L I CENSE NO : 1/96'5
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an i napprt i nn npPried the next hitsi ness Hay
++++++++++++++++++++++++++- 1-+++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
- OCT,-,16-97 THU 10 :58 AM PHOENIX ELECTRIC FAX NO. 503 684 3611 P. 02/02
A CITY OF TIGARD
. 13125 SW HALL BLVD. Electrical Permit Application Pfau Check #
Reed By
TIGARD OR 97223
Phone (503) 63 9 -4171, x304 Dace Recd
Inspection (503) 639 -4175 Date to P.E.
Print or Type Date to DST
Fax (503) 684 incomplete or illegible will not be accepted Permit a t‘ ' p , 9
Called
1. Job Address:
4. Complete Fee Schedule Below:
Name of Development
Number of Inspections per permit allowed
Name (or name of business ).- LA. r, 1
Address ,- L" j \ * ( .
ill •-t c_ . t3.A, 4a. Residential -
Cfty /State/Zip i
1002 sq. ft. or fess per unit
� ` • S11 0.00 -
Commercial thereof
502 sq. ft. or 4
Re s i dential El
thereof
Limited Energy S23.00 t
Each Manuf'd Home or Modular $25.02
Dwelling service or reader
2a. Contractor installation only:
(Attach copy 68,00 2
py . 0 current licenses) - - -
Electric, o 4b services or Feeders
� , 'o�_. Installation, alteration, or relocation
Add - s a iii
r 200 amps or less
$60.00
City.' StateZjp-
201 amps to 400 amps -�- 2
Phone No. � _ ac amps to 600 amps $80.00 2
l r _� \SC ' amps p $120.00
Job No. 601 amps to 1000 amps - 2
• Over 1000 amps or volts $180.00 2
Cont Lice. No, - • Exp.Date MA,,,
Reconnect only O 00 2
OR State CCB Reg. No. - 11!>.t. - - ' t:xp Datr3 $50.00 2
Elec.
COT Business Tax or Metro No. S Installation, Temporary Services
Lion o or relocation
or Feeders
- t Exp.Date q Iruta(tation, alteration, or relocation
Signature of Supr. Elec'n 'SS 200 amps or less $50 .00
1 201 amps to 400 amps $75.00 2
401 amps to 600 amps 2
License No. C.! C
Over 600 amps to 1000 volts, $100.00 2
Phone No. . 41:0M Exp see "b'• above.
2b. For Own 44- Branch Circuits
er installations: New. alteration or extension per panel
a) The fee for branch circuits with
Print Owners Name purchase of service or
Address feeder fee
Ad Each branch circuit $500
State Zi b) The fee for branch circuits 2
Phone No without
purchase of
service or feeder fee.
The installation is being made on property First branch circuit __1 _. $35.00 Sc CD intended for sale, lease or rent p l own which is not Each additional branch circu 2
it $5.p0 2
Owner's Signature 4e. Miscellaneous
(Service or feeder riot included)
Each pump or irrigation circle $40.00
3. Plan Review section if r Each sign or outline listing $40.00 2
( equired): * Signal circuit(s) or a limited energy 2
panel, alteration or extension $40.00
Please check appropriate item and enter fee in section 58.
Minor IBbets (f 0) $100.00 ' 2
4 or more residential unit;; in one structure
nominal volts and feeder 225 amps or more 41. Each additional
any inspection over
System over 600 ;; the allowable in any of the above
Classified area or structure containing special Per inspection $35.00
as described in N.E.C. Chapter 5 occupancy Per hour $ 00 ---
In Plant $55.00
Submit 2 sets of plans with application where any of the above apply. 5. Fees:
.it
Not required for temporary construction services.
Sa. Enter total of above fees $ t
1‘10:m
Subtotal 5 o Surcharge (.125 X total fees) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS 5b. Enter 25% of line 5a for Pla $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Su n Rewew h requ,red (Sec.3) $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY Subtotal $ � -
TIME AFTER WORK IS COMMENCED.
21 Trust Account # -5:a
Total balance Due $ 1
04/07/2000 Activities for Case #: ELC97 -00691
2:53:06 PM
Assigned Hold Updated •
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 10/16/1997 GEO RECD GEO 10/16/1997
ELCC003 Permit created 10/16/1997 GEO PASS GEO 10/16/1997
ELCC799 Elect'I Final 10/16/1997 02/10/1998 BRP PASS J'H 02/10/1998 Canopy lighting - pass final.
ELCC500 (F)Issue permit 10/16/1997 GEO PASS GEO 10/16/1997
ELCC800 Case Finaled 02/10/1998 BRP PASS J'H 02/10/1998
•
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O
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171 .10 , IP 8
Date Requested: 2 I � A.M. P.M. MST:
p
Location: // O 3 S -/ / �o � /..., BUP:
Tenant: t.�� 4.
� Suite: Bldg: MEC:
Contractor: ■ // � 7// / . Phone: 6g � - 3600 PLM: // •
Owner: Phone: ELC: "-O /lj �/
rw.r) C ELR:
U SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ELEC SITE
Site Post/Beam Post/Beam Post/Beam Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service • MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approvee Approved
Appr /Sdwlk Not Approved Not Approved Not Approved , . _ . oved Not Approved
FINAL FINAL FINAL FINAL
i . if _ j . - / /
-
C
O Call for reinspec '.n a. ' Reinspection fee of $ required before next inspection O Unable to inspect
II
Inspector: / Date: Page of