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Permit
A • CITY OF ,TIGARD ELECTRICAL PERMIT PERMIT #: ELC2006 -10076 DEVELOPMENT SERVICES DATE ISSUED: 3/27/2006 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S 102 CC -00500 SITE ADDRESS: 13560 SW PACIFIC HWY ZONING: C -G SUBDIVISION: TIGARD MARKETPLACE LOT : JURISDICTION: TIG Project Description: (1) branch circuit. 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: 0 LIMITED ENERGY: 401 - 600 amp: SIGNAUPANEL: 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: 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 RELIANT ELECTRIC LLC BY CAP ADVISORS 20200 SE OLDENBURG LN 38345 W TEN MILE RD, STE 170 SANDY, OR 97055 FARMINGTON HILLS, MI 48335 Phone: Contact #: PRI 503 701 - 4562 FAX 503 - 668 -5577 FEES Description Date Amount Reg #: ELE C59 [ELPRMT] ELC Permit 4/6/2006 $46.85 LIC 162814 [TAX] 8% State Surcharge 4/6/2006 $3.75 SUP 50675 Total $50.60 REQUIRED ITEMS AND REPORTS 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: Z .. Permittee Signature: , Q1v 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. • Electrical Permit Application FOR OFFICE l'SE ONI.l l Hall Bl Ard d OR 97 RECEVED Date/B t ,`�\ - IC Tigard Plan Review Other Permit: 503.639.4171 Fax: 503.598.196 7 C i,- i Date/By Inspection Line: 503.639.4175 2. / 1006 ..-.0.4- 'I Date ReadyBy.. lulls ® See Page 2 for Internet: www.tigard - or.gov Notified/Method -` V r Supplemental Informa TeribOrWIale PLAN REVIEW El New construction U oni/replac alement Please check all that apply: El Demolition ❑ Other: ❑Service over 225 amps, comm'I 0 Hazardous location ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential ❑ 1 - and 2 family dwelling la-Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi - family ❑Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egressflighting plan RV park f ❑Health -care facility ❑der. Job no.: Job site address: '? P 1' oi I , ` Submit 2 sets of plans with any of the above. City/State/ZIP: - 11c JJ d 011 GI -- 1 2_7_, 0 The above are not applicable to temporary construction service. Suite/bldg. /apt no.: Project name: FEE* SCHEDULE Description I Qty. I Fee. I Told 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'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 • Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular �' dwelling, service and/or feeder 90.90 2 QV - - Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: 601 amps to 1,000 amps 240.60 2 Address: 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 Phone: ( ) Fax: ( ) relocation 200 amps or less 66.85 1 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 1 ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: cat Pr K-` L= L(Z-1-, branch circuit II� B. Fee for branch circuits Contact name: C l �r '�(/ _ p,�u,v� without service or feeder fee, 46.85 lite' g$ 2 Address: 20 24O 5 t: ©LL�t 3 t first branch circuit �I Each add'I branch circuit 6.65 2 City/ State/ZIP: - n jj 1 (ye_ 4) o S Miscellaneous (service or feeder not included) �) 4*� .� Pump or irrigation circle 53.40 2 Phone: (Sp? g( t:EZc E ( Fax: Sign or outline lighting 53.40 2 E - mail: Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or extension. Describe: Page 2 2 Business name: fit Address: Each additional inspection over allowable in any of the above Per inspection 62.50 City/ State/ZIP: Investigation per hour (1 hr min) 62.50 Phone: ( ) Fax: ( ) Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* CCB Lic.: 1 Le 2 1? 1 `1 Electrical Lic.: (�- 9 Suprv. Lic.: 51 L l S Subtotal .414 c 85 Suprv. Electrician signature, required: Plan review (25% of permit fee) , Print name: qd� L � Date: 3 '7- C State surcharge (8 % of permit fee) 3. 75- NA15 O TOTAL PERMIT FEE 5‘/ SC b Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: • Fee methodology set by Tri -County Building Industry Service Board •• Number of inspections per permit allowed 1:\ Building \Pemits\ELC- PamitApp.doc 12/30/05 410-4615T(10/02/COM/WEB Electrical Permit Application - City of Tigard Page 2, - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating,' Ventilation and Air Conditioning System* • ❑ Vacuum Systems* ❑ Other: • COMMERCIAL WORK ONLY: Fee for each commercial system. $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation - ❑ HVAC - - - - - _ ❑ Instrumentation ❑ Intercom and Paging Systems • ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required • for all other installations 1: UBuilding \Pmnits\ELC- PetmitApp.doc 12J30/05 CITY OF TIGARD �Z L BUILDING DIVISION .r, f PERMIT #: 2400 ( _ /a 0 7 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: �P Phone: (503) 639 -4171 j Inspection Requests (24 Hrs.): (503) 639 -4175 : �! INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: / J -2 5-4 0 6L-e--cize. CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: / / , / PHONE #: CONTRACTOR: AP'', ` • PHONE #: S Inspection Request Scheduled For: Date: 3" Z 0 — 0 Co Pour Time: p_ , di 2,:le # Inspection Description Confirm # Contact # Message •• - re m - - ments /Instructions: ----------_________ j PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED • Inspector: e, 1\i68(._ Date: 31 2 . v fj • Phone #: (503) 718- 7-" YV' CITY OF TIGARD BUILDING DIVISION PERMIT #:1E,1- C200C.,. i 0,5% 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED:', 2.n -0 b Phone: (503) 639- 4171 yi Inspection Requests (24 Hrs.): (503) 639 -4175 jilt INSPECTION WORKSHEET FOR DATE: 1 - 2.9. _ o9 TIME: PAGE: SITE ADDRESS: \ 25 (p 0 S W P A cad c. 1�V3 y CLASS OF WORK: SUBDIVISION: 1 LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: S tty N OWNER: S ( cAS PHONE #: CONTRACTOR: iket: A41 etZr(Z,• L • PHONE #: Inspection Request Scheduled For: Date: t -29.01 Pour Time: Code # Inspection Description Confirm # Contact # Message 15 FINI AL . ot`1 c- Or t orrections /Comments /Instr . tions: ., PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: G . - * � B Date: 2 d Phone #: (503) 718- 24 1 O •