Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: 424441
DEVELOPMENT SERVICES DATE ISSUED: 8/25/2004
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171
PARCEL: 2S 102AA -01100
SITE ADDRESS: 12035 SW PACIFIC HWY A
SUBDIVISION: KINGSTON ZONING: C -G
BLOCK: LOT : 1 -7 JURISDICTION: TIG
Project Description: Reconnect only.
RESIDENTIAL UNIT TEMP SRVCIFEEDERS 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: 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: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
TIGARD AUTO STOP PARTNERS
300 ADMIRAL WAY #200
EDMONDS, WA 98020
Phone: Phone:
Reg #:
FEES
Description Date Amount Required Inspections
[ELPRMT] ELC Permit 8/25/2004 $66.85
[TAX] 8% State Surcharge 8/25/2004 $5.35 Elect'I Service
Total $72.20
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 accordahce 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:' ) Permit Signature: , e, p, \eR
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
Sent By: #; 619 563 7878; Aug -25 -04 12:27PM; Page 2/2
08/25/2004 11;58 FAX 5035981880 VE D CITY OF TIGARD X1001
Electrical Permit App i r FOR OFFICE USE ONLY
2 � 5 SW Hall B lvd Tigard. OR 97223 1\ 2, 5 L�� Roeatved �� CY (� i 0d • 0) . /
... ,_ • , Ninth No.: Pla Revi • Phone. 503.639.4171 Fax 503.598.1960 , _, i • , ri �. oar:Perna
d o h [ w w .cistO .us WI OF �I! N i&diMethod -. IM
(1_7. ` - G p 1 G!.J , ;� >r.,.t: i, �1,• - ur'C
D New construction ❑ Additioa/alteratiodteplaceme Please cheek all that apply; .
❑ Demolition 0 Other: ❑Service over 225 amps, conrn'1 014a2ardeus location
^ z,: -- _ _ . 1 .-,.. : - . ..., rt SeMCn over 20 amps �, •��. _'. _ _ _ _ -- _ ,,. , - ., -� , 3 a:np -rating �Bdnldagaver !0,000 eq. ft,
,
.., i.._ _ _ _. _.�"- �3 } {l }Q+.' L' aft - and 2- farm!, dwelling n or more new rosidentisl
13 1- and 2-family dwelling f 0 ial/industriel ❑ Accessory building ❑ Systssm over 600 vatts nominal wits inane structure
❑ Multi- flunily • ['Master builder ❑ Other ❑Building over three stories ❑Faodea, 400 amps or m
❑Oootpent load over 99 persons OManufaaaaed stiucttuas du •
- i _ r _ J 1 dr. _ r 1! .,=. + '1 ti • 1 l I . RV. park ■
IE l b l i Job site address: 1, - � e • I ., _ • - ❑ Health a titoility 00ther. ■ Submit j sets of plans with any of the above_
City /Stste/ZYP: - 71 G D , OR- 9 1) as j 0 The e above ere not applicable to temporary construction service.
Suite/bldg. /apt no.i/ A I Prgiect name: ~ J: , i:: r' I .-. 2.21 • ,vM „. ;� u:::. • •
14toisttea Qty. B . Total
Cross street/directions to job site: New residential single. or multi - family dwelling unit
Includes attached garage.
1,000 eq. ft. or less 145.15 4
Stlbdivii7011' I L no Pa. addl 500 sq. ft. or portion 33.40 1
Tax map /parcel •
United anew, residential 75.00 2
on - r Limited energy, non-residential 75.00 2
r _ i r. ' .Si j - t.� 4•. t �-,jt, 1 .i J1 ,r'�,' r ' - , • . .L _ .t . • ., _ - _ L. Bach manufactured or modabr
C►( ¢ dwelling, service and/or ti eder . 90.90 , 2
-� - Services or feeders installation, alteration, and/or relocation
A 1 J 260 amps a' leas 80.30 2
f'i ,. E-7:7;---,,-:-,..;-.7--.-..:-,.,:,-77:7 , '..: 201 a
: mps to 400 amps 106 .85 2
` — - - _ter... _. ... .� ... _:. - .. �_ -lave_. e.J° {: - • 4012ntpsta600at[Ips 160.60 2
Name: a■ • - i 2-1=4/1.-a- a /i C E. IN C. 601 neaps os 1,000 1171ips G 240.60 2
Ama sS: a 4 t^Almi bM kit So *.31.c... Ovvr amps orvolts
/ 4 6.85 1 2
f ty /state/ZlP: 5 A (s► -hi E ( s C A I a' 1 v 8 Temporary services or feeders tel altetatlon, and/or
Phase (6 cj) Vol goo C • F ((o f q) 3— relocation less
Owner installation: This installation is being ade on B property that X own which is wails ar 66.85 1
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.. 201 amps to 400 amps 100 30 2
401 amps to 600 amps 133.75 2
Owner signature: Data: Branch circuits -new, alteration, or ettanll per pane(
' '.4 i ' 1 _. _ .r - 1 A. Foe (Or branch cimrits with
__ -- J �_ _ . _ . _ . - service or fewer fee, welt
Business names branch circuit 6.65 2
B. Fee for trench circuits
Contact DMA: without service or feeder fee. 46.85 2
Address: each branch circuit
Each add 1 branch circuit f 6.65 t 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) I Fax : ( ) Pump or it igadon circle 53.40 2
Sign or outline ring 53.40 2
B-mail• ff Signal circuit(s) or tirnited• .
•. ,'-'4":”7 - 9 - ,J — r , , ) _.. !., r 1 ; ;. 7f eaet'gy panel, alteration. Or .
_ •- -- _ extension. Describe Page 2 2
Business name:
.4441[33: Each additional inspection over allowable In any of the above
Pe on 62.50
City/State/ZIP: Investigation pa hour (1 la ann) 62.50
Phone: ( ) Fax ( Industrial pleat • bola 73.73
..i . `::.:i:_' »" t:T: 1:i;:`:�',�7:.r.. ,- ,.. - 1T_. , ,,42:1 7 7:1. --
CCB Lic.: Blechical Lic.: Suprv. Lic.: subtotal ,1„. J r
Suprv. Electrician Hahne, required: . • Plan review (25% of permit fee)
.: t name ` / Dare: State surcharge (8% ofpertrdi fee) . 3.5
TOTAL PERivJIT FEZ 7a. as
Authorized signature: dafriiLii u This perwr t npptiaaoa ntplres It a permit Is not obtained within too
i c-- days Rehr II h.a been aotepted as ministate
Print name: A R_ 1 .< 'R fti E L 1) Data: g -- a QCif • Fee m6tee ataxy set by Td.Gadmty Building indton) aeMee Bond
to Number ber of isspeedoa• pot p.amit allowed
tl.otd(nPt+amdalffi.C•9ntatApp.dec 12105 44o.e615r(Icu2IWb IWEB
♦ r 17 6LW4/11-A-d
A /v_ 4f
CITY OF TIGARD 24 -Hour
BUILDING • Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line (503) 639 -4171 MST
BUP
Received Date Requested g-30 AM PM BUP
Location / 2 35 Pi i F - / Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 220 y -00 59Y
Footing
Foundation Access: ELC
Ftg Drain ELR �7
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam .MS,
Ext Shear Sheath/Shear
ea th /Sh
Ext eah/hear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fire wall L
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
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
PASS PART FAIL
T
Service •
-In
UG/Slab
Low Voltage
larm
PASS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
E 0 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line � / 4 �LFi
- o r
Approach/Sidewalk Date r � Inspector E7rt
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL