Permit • t .CITY OF TIGARD • ELECTRICAL PERMIT
PERMIT #: ELC2006 -00137
� DEVELOPMENT SERVICES DATE ISSUED: 2/17/2006
`- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S135DD-03301
SITE ADDRESS: 11945 SW PACIFIC HWY 228 ZONING: C -G
SUBDIVISION: HOFFARBER TRACTS NO.1 LOT : 002 JURISDICTION: TIG
Project Description: 10 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: 9 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:
TIGARD PROPERTIES INC
2106 SE OCHOCO ST
MILWAUKIE, OR 97222
Phone: Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 2/17/2006 $106.70
[TAX] 8% State Surcharge 2/17/2006 $8.54
Total $115.24 REQUIRED ITEMS AND REPORTS
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 r es or direct questions to OUNC at
503 - 246 -6699 or 1 -8 332 - 1
Issued By: 1 ��� Permittee Signatureer
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 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project
Approved plans are required on the job site at the time of each inspection.
t_j '`.- 1 • H k ...
Electrical h FOR OFFICE USE ONLY
h g Dat / veed ,.( /V r 6� 7 e,. b - tro 13 r
1 0 TI and Per mit No.:
13125 SW Hall Blvd., Tig 7 3 1o% Plan Review
Phone: 503.639.4171 Fax: 3 . 8. 96 �J i �� ��� Date/By: Other Permit:
Inspection Line: 593,63M175 ,�_4„ CI I Date Ready/By: - HI See Page 2 for
Internet: www.ci.ti 44 O T11UA Notified/Method: Supplemental Information
BUILDING W PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'I ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ I - and 2 - family dwelling ® Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑ Other: ❑Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: 11945 SW PACIFIC HWY, SUITE 228 ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: TIGARD, OR The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: TIGARD PIZZA KITCHEN FEE* SCHEDULE
Description I Qty. I Fee. I Total I **
Cross street/directions to job site: New residential single or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 0.00 4
Subdivision: `- Lot no.: Ea. add'l 500 sq. R. or portion 33.40 0.00
Limited energy, residential 75.00 0.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 0.00 2
DESCRIPTION OF WORK Each manufactured or modular
MISCELLANEOUS RECEPTACLES dwelling, service and/or feeder 90.90 0.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 0.00 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 0.00 2
401 amps to 600 amps 160.60 0.00 2
Name: 601 amps to 1,000 amps 240.60 0,00 2
Address: Over 1,000 amps or volts 454.65 0.00 2
Reconnect only 66.85 0.00 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: Fax: 200 amps or less 66.85 0.00 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 0.00 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 0.00 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
Business name: branch circuit 6.65 0.00 2
Contact name: B. Fec for branch circuits
without service or feeder fee,
Address: each branch circuit 1 46.85 46.85 2
Each add'l branch circuit 9 6.65 59.85 2
City/ State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) FBx :: ( ) Pump or irrigation circle 53.40 0.00 2
Sign or outline lighting 53.40 0.00 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: Greenway Electric Company 0.00
Address: 9460 SW Tigard St., Ste. 104 Each additional inspection over allowable in any of the above
Per inspection 62.50 0.00
City/State/ZIP: Tigard, Oregon 97223 Investigation per hour (1 hr min) 62.50 0.00
Phone: (503) 620 - 6020 I Fax: i (503) 620 - 6124 Industrial plant per hour 73.75 0.00
ELECTRICAL PERMIT FEES*
CCB Lie.: 153421 Electrical L' : 34 - 617C I Suprv. Lie.: 5025S Subtotal $106.70
/ Suprv. Electrician signature, required: 1 1 Plan review (25% of permit fee)
-`,„
Print name: James V. Rooney Date: State surcharge (8% of permit fee) $8.54
TOTAL PERMIT FEE $115.24
Authorized signature: This permit application expires If a permit Is not obtained within 180
Print days after It has been accepted as complete
rint name: Mark Short I Date:
Fe e methodology set by Tri-County Building Industry Service Board
** Number of inspections per permit allowed.
is\ Bui Wing \Pennits\ELC- PermitApp.doc 12/03 440-4615T(10/02/COM/WEB
CITY OF TIGARD . A l\
BUILDING DIVISION PERMIT #: Ll.Cx00E.i.00137
13125 SW Hall Blvd. 9 Ti and , :11712�G:y OR 97223 DATE ISSUED: �. Phone: (503) 639 -4171 I
Inspection Requests (24 Hrs.): (503) 639 -4175 ,'.� "'' I
INSPECTION WORKSHEET FOR DATE: 2/21/2006 TIME: 7:02Am PAGE: 34
SITE ADDRESS: 1194 SO/ 'ACIFIC HWY 228 CLASS OF WORK:
SUBDIVISION: t1OFFARBE• TRACTS NO.1 LOT #: 002 TYPE OF USE:
PROJECT NAME: TIGARD PIZZ KITCHEN
DESCRIPTION: 10 branch circui :-.
OWNER: TIGARD PROPER ES INC, PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date 2/21/2006 Pour Time:
Code # Inspe ' escription Confirm # Contact # Message
199 Electrical final 027229-01 ?,03 -539-5447 Y
Corrections /Comments Mons:
] PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: t N66 1
v Date: 2 `- 4 ' a Phone #: (503) 718- 2 1 `f 0