Permit •
CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
�� DEVELOPMENT SERVICES PERMIT #: ELR2003 -00150
13125. SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/2/03
SITE ADDRESS: 13090 SW PACIFIC HWY PARCEL: 2S102CB -02500
SUBDIVISION: FREWINGS ORCHARD TRACTS ZONING: C -G
BLOCK: - LOT: 007 JURISDICTION: TIG
Project Description: Installation of POS cabling for cash registers. Job No: 103026
A. RESIDENTIAL .. B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: "POS X
• TOTAL # OF SYSTEMS: 1
Owner: Contractor: '
CNL APF PARTNERS LP DYNALECTRIC
BY FOODMAKER INC 2904 SW FIRST AVE.
9330 BALBOA AVE . - PORTLAND, OR- 9720.1
SAN DIEGO, CA 92123 • Phone: Phone: 503 226 - 6771
Reg #: MET 00002545
LIC 066793
SUP 2950S
FEES ELE FUgli -ed Inspections
Description Date Amount. Low Voltage Inspection
[ELPRMT] ELR Permit 6/2/03 $75.00 Elect'l Final
[TAX] 8% State Tax 6/2/03 $6.00
Total $81.00
•
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 •
yo ollow u - adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throuc
sued by , �t /,0 - a-0/644 j Permittee Signature
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 7:00 P.M. for an inspection needed the next business day
•
•
l ` ' iin FOR OFIICE USE ONLY
Electi4ca�rPerit • Application ;ved E,eetrieal �y
Date/By: /D ; ; ,0 6 Permit No.: C ie.&®5 �/aV )
City Tigard Planning Appro l Sign
�' g Test Form Date/BY: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post- Review Land Use
/�+'na � �'� Date/BY: CaseNo.:
Internet: www.ci.tigard.or.us ■ � c•� I Contact Juris.: ❑ See Page 2 for
-
24 -hour Inspection Request: 503- 639 -4175 __ ' - Name/Method: _ Supplemental Information.
„ i.szi`'ir :T11,EE�OF'WORICX ,, #• ?; ?nr:.rr_s, .,�.: . PTAN,' REVIEW?}!'( P, leasechec `I�:all�t6at,apply.)'., .,.,. _�,,
CI New construction ❑ Demolition ❑ Service over 225 amps- • ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
l ";h;. <,:>`! =TEGORY OF <CONSTRUCTION ° "' ; . !:' ;', 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
n ❑ Building over three stories ❑ Feeders, 400 amps or more
1:1 ACCCSSO Accessory Building ❑ Multi-Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
_, , p i ,. -.. -; Submit _ sets of plans with any of the above.
70B SITE INEORMATIONfiu - '_'. F . r - The above are not applicable to temporary construction service.
Job site address: j3Da, s,.../ (`F c WW y ` ' :;.F'EE* SCHEDULE- .••:-
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed '
Project Name: 3c.c Z o - aet Nox Description Qty Fee(ea.) Total 1
Cross street/Directions to job site: New residential - single or multi- family per
l dwelling unit. Includes attached garage.
(,t -3-e-ck t , ^ . F) Service Included:
`� 1) 1000 sq. R or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1 _
Subdivision: I Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
'-`' . . �;' % ` :!•l' " ! ' : .;DESCRIPTION' OF WORK •a'.'' service and/or feeder 90.90 2
" `' `�` " ` `i <.,, Services or feeders - installation,
P 5- C"- (/It alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 , _ 2
G ®;PROPER FI OWNER; .- - ':-.1• f III . TENANT , . ,..' - . -, , 601 amps to 1000 amps 240,60 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only . 66.85 2
Address: • Temporary services or feeders - installation,
alteration, City/State /Zip: • 200 amps oroesselocation:
66.85 1
Phone: Fax: 201 amps to 400 amps • 100.30 2
IN *APPLICANT >. `_',." °7 .'® 'CONTACT . PERSON aolto60ops 133.75 2 • Branch circuits - new, alteration, or
Name: extension per panel:
Address: A Fee for branch circuits with purchase of 6.65 2
service or feeder fee, each branch circuit
City/State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included): •
::p' ;'1!CONTRACTOR' Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No:
to ?o a & Signal circuit(s) or a limited energy panel, 1
,.A [.
Business Name: , ec t c Co4.0.,,ti alteration, or extension* 1 75.00 2
*Description:
Address: a-20 Sw F1R.St 4v
City/State /Zip: Pow[ 4-u) 2 q ? ,2V( Each additional inspection over the allowable in any of the above:
r U Per inspection (per hour - min. 1 hour) 62.50
Phone: 03 —04.6 _6 X 71 Fax: s-o3 - 6 - 76 8 Investigation fee:
CCB Lie. #: C 6 7 cil Lie. #: at, — 5 - 4 C Other:
• Electrical Permit Fees* - .
Supervising electrician .. . Subtotal $ 75"
signature required: Plan Review (25% of Permit Fee) $
Print Name: 6,.., f'�i,.i.M .P I Lie. #: „2 3,35E CP State Surcharge (8% of Permit Fee) $ G to
TOTAL PERMIT FEE S R f 22
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
CITY OF TIGARD 24-Hour Line: (503) 639 -4175
BUILDING p MST
INSPECTION DIVISIO Business Line: (503) 639 -4171
BUP
Received / ' �� 14141 Date Requested AM PM BUP
Location /30 q& Suite MEC
Contact Person Ph ( ) 9 7 71 PLM
Contractor • — Ph ( / ) SWR
BUILDING Tenant/Owner N ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR 3 / sd
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing CSC/
Insulation
Drywall Nailing �� O 43
Firewall
Fire Sprinkler
Fire Alarm /' /} ; /
Susp'd Ceiling CA-7Y
Roof
Other:
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
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
<e5§.2) PART FAIL
SITE ❑ Please call for reinspection RE: Unable to in ct — no access
Fire Supply Line
ADA
Approach/Sidewalk Date /5/03 Inspector •.• _•+ i = � Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
f1 J