Permit ,CITY OF TIGARD ELECTRICAL PERMIT
DE VELOPMENT SERVICES DATE ISSUIED; 8/ Co20202 -00403
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S135DD-03301
SITE ADDRESS: 11945 SW PACIFIC HWY 250
SUBDIVISION: HOFFARBER TRACTS NO.1 ZONING: C -G
BLOCK: LOT : 002 JURISDICTION: TIG
Project Description: Install 3 branch circuits to beverage bar.
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: 2 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 STONER ELECTRIC
2106 SE OCHOCO ST 1904 SE OCHOCO STREET
MILWAUKIE, OR 97222 MILWAUKIE, OR 97222
Phone: Phone:
Reg #: 605-46236FAM3
SUP 4025S
ELE 26 -122C
FEES Required Inspections
Type By Date Amount Receipt Elect Final
PRMT CTR 8/20/02 $60.15 2720020000(
5PCT CTR 8/20/02 $4.81 2720020000(
Total $64.96
This Permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Spedalty 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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
/ .. / .4..i 7 Permit Signature: I ssued By: , , � 1 ,4 0 / •
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: l��
E®le6
CONTRACTOR INSTALLATION ONLY !!T� ��
SIGNATURE OF SUPR. ELEC'N: (F) L o - DATE:
LICENSE NO: g{O / 2 C ziOa -5 S
Call 639 -4175 by 7:00pm for an inspection the next business day
08/15/2002 THU 12:30 FAX 5036592824 STONER SERVICE lj002
Electrical Permit Application
� . Date received: g j �Z Permit no.:- ,/�
..,41 It City of Tigard h Project/appl. no.: / Expire date: ' � r�3
City Address: 13125 SW Hall Blvd, Tigard, OR 97223
. Date issued: By Receipt no.:
AUG hone: (503) 639 -4171 AUG -: LtU2 Recei P
Fax: (503) 598 -1960 U l7 Case file no.: Payment type:
Land use approval: ,T + t� {t1 � ,'i,s i
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ,,ommercial/industrial ❑ Multi - family O Tenant improvement
O New construction ❑ Addition/alteration/replacement ❑ Other. _ - 0 Parti
.JOB SITE INFOR11MATlON
Job address: , Si p . 'r o ° ' ., ' Bldg. no.. Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision: /1 c,. Iij -
Project name: 579.ruc 4-y 4/3.g), I Description and location of work on premises: /4.)//...E. Fop_ 9Ge 04
- Estimated date of completion/inspection:
_._... , _ , ..- ,CONTRAC TOR_ APPLIC_ 1TION... ...__.,._._.,_:::- _..._..._..._ -FEE SCI1[D LL •_. -- .....- . - - -.. _....._.. - -. ...
Job no: ‘13.A qj 5 Fee Max
Business name: S/e wrFte.. 4* Tte Description • Qty. (ea.) Total no. Imp New residential -single or muld-familY Per ,.. Och o c-0 dwelliogtadt Includes attachedgarage .
City: M - • I State:pe I ZIP:, 72 zz Serviceincluded:
Phone b3- S/(„2_4.so 0'Fax:h559 -4'90 IE -mail: WOO sq. ft. orless 4
CCB no.: el449, 3 - - I Elec. bus. lic. no: 210 — 2-2-- Each additional 500 sq. ft or portion thereof
Limited energy, residential 2
City /metro lic. no.: 44/ Sib / Limited energy, non- residential 2
S' n �J d or Each manufactured home or modular dwelling •
ectrici Date Service and/or feeder 2
•
Sup. elect name (print): Mt tee" ev,v6r,„,_ License no: 3494, S Set••dtxx or feeders installation,
alteration or relocation:
200 amps or less 2
Name (print): 201 amps to 400 amps 2
Mailing address: 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: 'State: I ZIP: Over 1000 amps or volts • 2
Phone: 1Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on proper} I own Temporary senicesor feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or les 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am • s 2
•
ENGINEER Branch circuits - new, alteration,
Name: or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase /
Phone: Fax: E-mail: service or feeder fee, first branch circuit 1 467 16. ( 2
Each additional branch circuit: I . 6.6 ( "
PLAN REVIEW (Please cltcck all that apply) . Misc. (Service or feeder not Included):
O Service over 225 amps - commercial O Health -care facility Each pump or irrigation circle 2
O Service over 320 amps-rating of18c2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories 0 Feeders, 400ampsormore *Description:
O Occupant load over 99 persons Cl Manufactured structures or RV part Each additional Inspection over the allowable in any e:
of the abov
O Egress/lightingplan O Other. I I I I
Per inspection
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other f
'Not all jurisdictions accept aedit cards, please call Juristiction for more information' Notice: This permit application Permit fee $ lQO' ( '
D Visa MasterCard expires if a permit is not obtained Plan review (at �! %) $
e i Ott TOn(um� 91741—/6.9/-9J/414 r ` - s / / within 180 da s after it has n State surcharge (8%) $ l
Name of cardholder as shown on cmdit card ' acce E TOTAL $
$ h !o E/� RRAA
l Cardholder signature - A mount � �!
440-4615 (wooicoM)