Permit 11 ' CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00085
COMMUNITY DEVELOPMENT DATE ISSUED: 2/7/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S135DD
SITE ADDRESS: 11993 SW PACIFIC HWY ZONING: C - G
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: Sub panel and 4 branch circuits.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
' EACH ADD'L 500SF: 201 - 400 amp: SIGNIOUT 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: 4 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:
GLADSTONE, HELENE D TRUSTEE SCOTT ELECTRIC INC.
150 IRON MTN BLVD PO BOX 2231
LAKE OSWEGO, OR 97034 SALEM, OR 97308
Phone: Contact #: PRI 1- 503 - 581 -1192
FAX 1- 503 - 391 -8393
FEES
Description Date Amount Reg #: ELE 24 -1 15C
[ELPRMT] ELC Permit 2/7/2007 $93.45 LIC 157142
[ ELPRMT] Investigation F 2/7/2007 $93.45 SUP 2381S
[TAX] 8% State Surcharge 2/7/2007 $7.48
REQUIRED ITEMS AND REPORTS
Total $194.38
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 1.800.332.2344.
Issued By: Permittee Signature: t7h °`'0"'' , CG�.Y�t-
8 S'1'_.
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.
Feb 06 07 02:13p 5033918393 p.2
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Electrical Permit ApplieatidjCEIVED r crrFicr. 1'sr o`1.1
City of Tigard , , n Remind - 6 , Pusan Ne : • e7 - oh
13125 SW Hall SW., Tigers, OR 97231 yam ail
Phone: 503.639.4171 Fax: 503.549 0 Ocrter Fermis
T i G "■ s; n
Inspection � s03. 39.44 7S 10 OF TIGARD Date aa�iB (S! See tPasei Nr
� BUILDING DIVIQlrN I sapplemennitarornadon
=MAY WOR PLAN RBVIEW
❑ New construction E;1' ition /alteraconfreplaceemeat Pau Meek ail dtm apply (submit a sae of plans winced checked below):
t.
0 Demolition 0 Other. L3 Smiee or feeder 400 amps or trove ❑ Sanding over Owe* swim.
.fine the available Dub cum= Q Marl= and baatyatdt
CATEGORY ortoreraUGTION =vends 10,000ampea l50 volts or ❑Fload agbulldut�.
❑ 1- and 2 family dwelling 121- nrxterciaUstdustrial In Accessory building e°" , o a .meXe� to ooa ❑ l.0 ag4e 1smat
ems fared other immlletlona. bi Idlsgt.
o Multi - mil r _ ❑ Master builder ❑ Other: ❑ Fire guru ❑ luttaIladon of 75 KVA or
JOB SITE INFORMATION AND •faOCATION • ❑ y n. lagerseparaWyderivednorm
OMd:epon sync. Waco. mar er 0 `w r,-1.3
lob no.: , Job t ire address: Q 100/0) or mom. apsoey.
!� ! I ��iC //A0..,1 f r Grp ❑ six oc more =idealist unite. ❑ Reaeadonel vehicle pada
CitylState/ZIP: Q ( /C . 7 ? ❑H ci niiier. ❑Supplyvohege far mete than
_ ! ❑ Hued= toesdone 600 volts etna nal.
Sudte/bidglapt no.: I Project name . / „/_ ) � r 0 Service ce feeder 600 SCHEDULE r EDUCE
Cross street/directions to job site `s - ! veannc « I Orr. I p.. 1 'Gbi t •
New residential single- or multi -fam4y dwelling unit.
. "ILA • ..! 4 Ii • Q Itrdades attached garage.
Subdivision: /fj, Su, nit ;, •., ,„ l,O0osq. ft or less 144.15 4
`:i - s Ea. addi 500 sq. ft or portion 33.40 1
Tax map/parcel no.: Limited enemy, resideetial 75.00 2 • DESCRD?'ITON OF WORK. 1 (with above raR.)
Limited energy, twill -Family 75.00 2
,i_S 7.,a 0 . ., ' L A / ' , residential (with taboo eq. I!.) .
,( Services or feeders hutallatina. alteration. and/or relocation
- ti/ I P ,P0 :11 eG� & A'.4 + GI/O/ 200 snaps or less 1 80.30 2
. PRO > Ovim'. • I . • , 201 amps to 400 snpa 106.85 2
Name; e , 401 ratter to 600 amps 160.60 2
r �/ /1 Old/ 2e� 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 Z
City /State/ZIP: Temporary services or feeders iweralation, situation, and/or
retapton
Phone: C-5.43)-3 7 ' C 0 / V 7 1 Fax ( ) 200 amps or less I / I 66.65 46 pi 1
- Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps I I 100.30 2
intended for sale, lease, 9a according 701. lease or exchange, to OILS 447 449 670, and 701 401 ampa to 599 amps I 133.75 2
Owner signature: Branch circuits - now. situation, or extenson, r pond
A. Fee for branch circuits wird
❑ APPLICANT I • ❑; cONTACr .PERSON above service or feeder 6x,
each branch circuit 665 2
Business nattae��C'e /it < 7, p /// /;, (/ ' 8. Foe for blush circuits •
r widrout service or feeder fee,
Contact name: e -�PdL / ow branch circuit 46.95 2
Address: 7 P6 / /J D_/ / � { ^r , 3 / Each midi branch circuit 6.65 2
r Y / 1Y / ? ri GC(( / 9 7_507 40! � 1t red (orrice sr feeder nut included)
Ciry /StateJtlp Each rmpnutaenned or modular
) , C / F ax : , dwell., service end/or feeder
Phone: 90.90 2
(2 ].7/ - 19l 1 - Z3 - 5'3 Reconnect 66.65 2 •
E•n1a11: ®' Pump or inigenem circle 53.40 2
CONTRACTOR • • . • ' . Sign or outline fighting 53.40 2
Business name: Signal cireuh(s) or limited -
A energy panel, alteration. or
Address: (J xtension. describe Page 2 2
City /State/ZIP: / Each addldonal inspection over allewat4e 1a as of the above
Per inspection 62.50
Phone: ( ) V-2,6.. I Fax: (AA)A
/1A / O Investigation per hour (I hr min) 62.50
CCB Lir.: /57 4/ I Electrical Lic, ,p ri CI S 7iv. L.ic.: �3�/ Industrial plant pa hour 73.75
�� ELECTRICAL PERMIT FEES • •
Super. Electrician signature, required: /, - ."'41111BeirF: subtotal: c3. 445 - V15.4t
Print acme: -�Sn Datc:�_� _ �7 Stare macrame ew (25 o af Cper»r ;tr peewit fee): 7. Ye
Authorized signature: /l , � /. , .��f `` TOTAI, PERMIT FEE: MO . 3
Print snare: I Date: days p •ppotatisu rapine We permit Is no trainload wiMin too
Rays after It has been incepted ■■ complete( ,
• Number erutspections allowed per powult.
MOO ou25/06 s10.rstyrpttcs' pw1WEa / 94.
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007- 000115
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 717/2007
Phone: (503) 639 -4171 ;4
Inspection Requests (24 Hrs.): (503) 639 -4175 r I �
INSPECTION WORKSHEET FOR DATE: 3/5/2007 TIME: 7 :00AM PAGE: 51
SITE ADDRESS: 11993 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: ALL AMERICAN TIRE & SUNI
DESCRIPTION: Sub panel and 4 branch circuits.
OWNER: GLADSTONE, HELENE D TRUSTEE, PHONE #:
CONTRACTOR: SCOTT ELECTRIC INC. PHONE #: 1- 503 - 581 -1192
Inspection Request Scheduled For: Date: 315/2007 Pour Time:
Code # Inspection Description .. • Contact # Message
199 Electrical final 044272 -01 503- 581 -1192 Y
Corrections /Comments /Instructions: K
SCZT
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: & • N Date: 1'1/45 Phone #: (503) 718- 1-4410