Permit A .7 CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00066
� DEVELOPMENT SERVICES DATE ISSUED: 2/12/04
�---' 13125 SW Hall Blvd.. Tislard. OR 97223 (503) 639 -4171 PARCEL: 2S102CC -00500
SITE ADDRESS: 13600 SW PACIFIC HWY (HAGGEN
SUBDIVISION: FOODS) • ZONING: C -G
lif
BLOCK: LOT : JURISDICTION: TIG
Project Description: Sign Lighting.
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: 1
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: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
13500 PACIFIC CORP DWINELL'S VISUAL SYSTEMS
BY CAP ADVISORS 1112 E NOB HILL BLVD
38345 W TEN MILE RD, STE 170 YAKIMA, WA 98901 -3699
FARMINGTON HILLS, MI 48335
Phone: Phone: 800- 932 -8832
Reg #: LIC 157580
SUP 669SIG
FEES ELE 37- 1026CLS
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 2/12/04 $53.40
[TAX] 8% State Surcharge 2/12/04 $4 Rough -in
Elect'I Final
Total $57.67
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: AP4P Permit 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: O' 1 C:4 .p.) 1) DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
'Electrical Permit Application SGN2 " k-÷ FOR OFFICE USE ONLY
y of Tigard ® Received Permit No.:�^ ^^, '/
13125 o Hall Blvd., Tigard, ■ t1:+ �/ —�T �� �(.d�� �� ��
g EIV Plan Revie
Phone: 503.639.4171 'Fax: 5 3.. IB'.'t900 ' �II Date/By: Other Permit: [ 7
Inspection Line: 503.639.4175 A 20 �� Date Ready/By: Jurist ® for
See Page 2 for
Internet: www.ci.tigard.or.us F E 0 g 4 Notified/Method: .....t.5;
r / Kp • Supplemental Information
BT..01P PLAN REVIEW
❑ New construction AkeitiNt180111acement V CC'' �t Please check all that apply:
['Service over 225 amps, comm'l ['Hazardous location
❑ Demolition er:
['Service over 320 amps — rating ❑Bulldog over 10,000 sq. fl.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling i] Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi family 0 Master builder 0 Other:
['Occupant load over 99 persons [Manufactured structures or
JOB SITE INFORMATION AND LOCATION DEgress/lighting plan RV park
DHealth facility ❑Other:
Job no.: Job site address: 1 > (000 SW PaU4I e 14V5 Submit 2 sets of plans with any of the above.
City/State /ZIP: Ti 5O Cl 6 la The above are not applicable to temporary construction service.
I FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name:
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 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I
5 Limited energy, non dl 75.00 2
Tax map /parcel no.:.S102C C — 00 5
Limited energy, non - resi 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I 0 TENANT 201 amps to 400 amps 106.85 2
Foot 1,000 am
401 amps to 600 amps 160.60 2
� (3, j
Name: 601 amps to 1,000 amps 240.60 2
Address: s ,_ Y--e-, Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT ("CONTACT PERSON A. Fee for branch circuits with
` service or feeder fee, each 6.65 2
Business name: a JW I y . e I Is S \I iSU1l c «S N^!.J branch circuit
Contact name: pa�` La+ASh B. Fee for service circuits
l without service or feeder fee, 46.85 2
Address: D I� tOyti /f Q -S each branch circuit
`v — Each add'1 branch circuit 6.65 2
City/State /ZIP: StdM K 1 (AI; 981 VA Miscellaneous (service or feeder not included)
( 2(510) 2_92 -�� S ( tee ) b gal�l�� Pump or irrigation circle 53.40 2
Phone: Fax:
Sign or outline lighting / 53.40 53. +7lD 2
E -mail: p is vs hc c14.')i\.,e as- co-N. Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
" extension. Describe: Page 2 2
Business name: �� 1 ae, I IS V (S\Ac∎ Sy 5
Address: 0 m ( �v.� S � (O 0 ^ L� Each additional inspection over allowable in any of the above —
(./L Per inspection 62.50
City/State /ZIP: j lac ' WIN ei& t. 9 o' � Investigation per hour (I hr min) 62.50
Phone: ( 'l 2./2.,._ 8 g 49 S I Fax: (?kb ) . 8a. -49-Q I Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 15 ts go- Electrical Lic.: 1 O 1 Sf I Suprv. Lic.5 g ' ' & Subto
_ A 40
Suprv. Electrician signature, required: `p— "'CID Plan review (25% of permit fee)
Print name: ra I G . . I Date: State surcharge (8% of permit fee) Li a,7
g_ TOTAL PERMIT FEE S 7 (, 7
Authorized signature: — This permit application expires if a permit is not obtained within 180
'y
days after it has been accepted as complete
Print na . tttt: en- Date: -3 0 -0 • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Permits'ELC- PermitApp.doc 12/03 I .h% / (10/02/ M/WEB
CITY OF MR. Mg 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
g //
d' // `�� AM PM BUP
Receive � � � �b Date Regy�;ted
Location /36OD "/ Suite MEC
Contact Person Q.r l� Ph ( c? 22 Pf , 5LM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner
Footing v �'
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear •
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
gA
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
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire m
'r- PART FAIL El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SI ❑ Please call for reinspection RE: 1=1 Unable to inspect — no access
Fire Supply Line
ADA Approach/Sidewalk Date /� G Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from th ob site.
PASS PART FAIL