Permit CITY OF TIGARD ELECTRICAL PERMIT
° 7f PERMIT #: ELC2008 -00102
1., COMMUNITY DEVELOPMENT DATE ISSUED: 2/25/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 103 D D - 01200
SITE ADDRESS: 13970 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: CHEVRON
Project Description: (6) branch circuits for signs and gas dispensers.
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:
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: 5 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:
CAIN PETROLEUM INC DOUBLE R PRODUCTS
4512 SW KELLY AVE DEL J INC
PORTLAND, OR 97239 901 NORTHWEST E
GRANTS PASS, OR 97526
Phone: 503 - 546 -3535 Contact #: PRI 541 - 476 -1387
FEES
Description Date Amount Reg #: ELE 17 -140C
[ELPRMT] ELC Permit 2/25/2008 $80.10 LIC 40432
[TAX] 12% State Surchar 2/25/2008 $9.61 SUP 3396S
Total $89.71 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 donejn..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 days. ATT ' ON: Ore. . n law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 95 01 -0010 through OA" 9 -101 011:. You may obtain copies of these rules or direct questions to OU at 503.246.6699 or 1.800.332.2344.
Issue By: Permittee Signature: - /;�!� -..sl
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:
C NTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: /` `- 1(9 DATE: A�Q
LICENSE NO: 05 / 5
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 USE ONLY
City of Tigard • Date/By: o2 ,?g Qg �, Permit No.: e� g --do/e5
. ;, Y a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T I G n It D Inspection Line: 503.639.4175 Date Ready/By: 3uri ® See Page 2 for
• Internet: www.tigard- or.gov Notified/Method: /Mi. /Mi. Supplemental Information
` 1
TYPE OF WORK PLAN REVIEW
El New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
El L �� , '
1 - and 2- family dwelling omme rci al/in du At' ial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. . ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", •
G�
100HP or more. occupancy.
Job no.: Job site address:
/3 / 7, 5€.4.) A <r , / c (- ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: (C� ❑ Health -care facilities. ❑ Supply voltage for more than
t / 7 0.4..x• ,- ? 7Z ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: / Project name: 6 p ❑ Service or feeder 600 amps or more.
D ,/rb...
rr / FEE SCHEDULE
Cross street/directiolls to job site: �v A.e ! eA Po }rc y 4 Description I Qty. I Fee. I Total I •
/ New residential single- or multi- family dwelling unit.
`/tt G l' �,Q� 3 f Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
. DESCRIPTION OF WORK (with above sq, ft.)
Limited energy, multi - family 75.00 2
y es 4 ea.«. -. `z �... . pr j „-_-_..._ c residential (with above sq. ft.)
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
Name: Co. t 00 I N
401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60% 2
Address: 4 (j 7 Z $ K .7 4 Over 1,000 amps or volts 454.65 2
City/State /ZIP: , 2 ` Temporary services or feeders installation, alteration, and/or
° ft 7 2 3 c / relocation
�
Phone: (5 ) - ' 3S 3j [ Fax: ( ) 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 599 amps 133.75 - 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: • B. Fee for branch circuits
without service or feeder fee, + 46.85 '$ .. 5 2
Contact name: first branch circuit
Address: Each add'I branch circuit J 6.65 35, 26.'•2
Miscellaneous (service or feeder not included) _
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
? /� -- - I Signal circuit(s) or limited -
Business name: DO.-.-t 6 e � \ !" e ct) (Dee_ J / , VI ) energy panel, alteration, or
Address: ,/ O / ,' f � j L W -S' JJ extension. Describe: Page 2 2
City/State /ZIP: I C`s w - tk P4-5 , CD f 9 7 c Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (5cfi ) //76 / 3 7 Fax: ( o) • .. Investigation per hour (I hr min) 62.50
CCB Lic.: , i! 3 - L Electrical Lic.: T Suprv. Lic.: 2,3 7 r<, 5 Industrial plant per hour 73.75
` Oa 7 // / 0 60 ELECTRICAL PERMIT FEES
Suprv. Electr' y stg ature, required: g L _ Subtotal: 00, ( C
Print name: �/J Q S l '� � / Date: �� �` Plan review (25% of permit fee): �—
tl' a "( o t 2 � / State surcharge (8% of permit fee): .6
Authorized signature: D ` TOTAL PERMIT FEE: q , L
Q This p application expires if a permit is not obtained w 1St
</ k
Print name: /00 stir/ c Date: r �O
� � 0 days after it has been accepted as complete.
Number of inspections allowed per permit.
I: IBuildidg \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(I1 /05 /COM/WEB L -. •-
Electrical Permit A lication • - Ci of Ti and
PP tY g ,.tsfi
Page 2 - Supplemental Information V'"
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 $75.00
system
(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
I:\ But ,IdingWermils'ELC- PermiIApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION - r PERMIT #: ELC2008 -00102
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/:42009
Phone: (503) 639-4171 . I � I i
Inspection Requests (24 Hrs.): (503) 639 -4175 _.. -..� --
INSPECTION WORKSHEET FOR DATE: 4/1/2009 TIME: 7:01AM PAGE: 27
SITE ADDRESS: 13970 SW PACIFIC HINY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CHEVRON
DESCRIPTION: (6) branch circuits for signs and gas dispensers.
OWNER: CAIN PETROLEUM INC, PHONE #: 503.516 -3535
CONTRACTOR: DOUBLE R PRODUCTS pA J L ` PHONE #: 541-476.1397
Inspection Request Scheduled For: Date: 411/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 057643-01 541- 729 -0137 \ Y
Corrections/Comments/Instructions:
d) AM .1\ 0. 2,6 "kte7t4Mir woki iNi (,Lvcd t ee 'IN
(to 'V 6 Po, .,, ,,
PASS PARTIAL APPROVAL ❑CANCEL ❑ NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: & N �ts Date: '' 1. " A Phone #: (503) 718- 7'"tt14`)
•
CITY OF TIGARD ;.
BUILDING DIVISION • . ` PERMIT #: ELC2008 00102
13125 SW Hall Blvd., Tigard, OR 97223 ISSUED: 2/25/2008
Phone: (503) 639 -4171
At �
Inspection Requests (24 Hrs.): (503) 639 -4175 _.. W °__..
INSPECTION WORKSHEET FOR DATE: 4/2/2008 TIME: 7:00AM PAGE: 17
SITE ADDRESS: 13970 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CHEVRON
DESCRIPTION: (6) branch circuits for signs and gas dispensers.
OWNER: CAIN PETROLEUM INC, PHONE #: 503- 546 -3535
CONTRACTOR: DOUBLE R PRODUCTS PHONE #: 541 - 476-1387
Inspection Request Scheduled For: Date: 4/2/2008 Pour Time:
Code # Inspection Description Eorsfirm Contact # Message
119 Electrical final 067739-01 541- 729.0137 N
Corrections /Comments /Instructions:
)
,_Q_
'.(), P /
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C) N(• Date: Y2 Phone #: (503) 718- ___AO_____