Permit ELECTRICAL PERMIT
CITY OF T I G A R D:. PERMIT #: ELC2001 -00525
�i DEVELOPMENT SERVICES • DATE ISSUED: 10/25/01
'---' 13125 SW Hall Blvd., Tigard, QR 97223 (503) 639 -4171
PARCEL: 2 S 110 D C -02200
SITE ADDRESS: 15570 SW PACIFIC HWY
SUBDIVISION: WILLOW BROOK FARM ZONING: C -G
BLOCK: LOT : 011 JURISDICTION: TIG
Project Description: Tenant Improvement to produce area, stockroom, located outside of the main building. Job
No.65 -24018
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: 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: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 8 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:
TIGARD, CENTER LP CHRISTENSON ELECTRIC INC
9777 WILSHIRE BLVD #609 111 SW COLUMBIA
BEVERLY HILL, CA 90212 STE 480
PORTLAND, OR 97201
Phone: Phone: 241 -4812
Reg #: LIC 458
SUP 3289S
ELE 26 -34C
FEES Required Inspections
Type By Date Amount Receipt Elect! Final
PRMT CTR 10/25/01 $100.05 2720010000(
5PCT CTR 10/25/01 $8.00 2720010000(
Total $108.05
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 -0080. You may obtain copies of these rules or dired questions to
Permit Signature: Issued By: -
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 ' .
..,
A . Electrical PermitApp
t Date received: Permit no.: G a (,�o/ - op 52 5
a.�3, � , "RECEIVE
:.1 I , Cit o f Ti Project/appl. no.: Expire daft:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard r Date issued: By: l Receipt no.:
Phone: (503) 639 -4171 COT 2 3 ?oc
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: COMMUNITY 04 VOEtl Ali
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory XOommercial/industrial ❑ Multi- family O Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: O Partial •
Job address: 15570 PACIFIC HWY 99W (T) ' Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: (Block: (Subdivision: HOME DELIVERY DEPT. QUESTIONS? CONTACT EDD BURNS 701 -7866
Project name: SAFEWAY #1478 I Description and location of work on premises:(4) 208V 50A CIRCUITS 3P, (5) 110V 20A
Estimated date of completion/inspection: PRODUCE AREA, STOCKROOM, OUTSIDE OF BLDG CIRCUITS
. : (.,_ (ONTIL TOR. API'L1CATlO . , . - . ,.,..+ , S O :. -,-
Job no: 65 -24018 Fee Max
Business name:CHRISTENSON ELECTRIC, INC. Description Qty. (ea.) Total no. Inv
New dwelling n i t I multi per
Address:111 SW COLUMBIA, SUITE 480 rage.
dwelling tutu Includes attached garage.
City: PORTLAND I State: OR I ZIP:97201 -5886 Service included:
Phone503 2414812 I Fax5032410514E -mail: 1000sq. ft. or less 4
CCB no.:45 8 I c. bus. lic. no: 26-34C Fach additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City /metro ' o.: 5 46 Limited energy, non- residential 2
Each manufactured home or modular dwelling
Signat of supervisin ectnct (required) Date 10/ 19 /01 Service and/or feeder 2
Sup. elect. name (print): BRIAN CHRISTOPHER License no: 873S Services or feeders — installation, •
alteration or relocation:
200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - , -
which is not intended for sale, lease, rent, or exchange according to ttlation , alteration, orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2 •
Owner's signature: . Date: 401 to 600 am s 2
Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee far branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: • I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 1 46 . 3 5 2
Phone: Fax: E -mail: Each additional branch circuit: 8 53.20
PLAN REVIEW (Please check all that apply) Misc . (Service or feeder not included):
O Service over 225 amps- commercial . 0 Health -care facility Each pump or inigation circle 2
O Service over 320 amps -rating of 1&2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional Inspection over the allowable in any of the above:
❑ Egress/lightingplan 0 Other. Per inspection I I I i
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $ iUU. U5
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Plan review (at _ %) $
O Visa 0 MasterCard expires if a permit is not obtained 8.00
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires TOTAL as complete. TOTAL $108.05 /
Name of cardholder as shown on credit card •
$
Cardholder signature Amount 440-4615 (6/00 /COM)
OCT.2000 +FEES ON BACK OF FORM
Electrical Permit Fees: ' Limited Energy Fees:
•
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
/� Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. R. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00 •
Each Manuf'd Home or Modular Garage Door Opener'
Dwelling Service or Feeder $90.90 2
Services or Feeders • ❑ Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2 Vacuum Systems'
201 amps to 400 amps $106.85 2 •
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders- TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918- 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, ❑
see "b "• above. Audio and Stereo Systems
Branch Circuits ❑ Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy ❑
panel, alteration or extension $75.00 Landscape Irrigation Control'
Minor Labels (10) $125.00 ❑
Medical
Each additional inspection over
the allowable In any of the above Calls
Per inspection $62.50
Per hour $62.50
In Plant $73.75 Outdoor Landscape Lighting"
Fees: ❑ Protective Signaling
Enter total of above fees $ ❑ Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee 4 ' No licenses are required. Licenses are required for all other installations
See "Plan Review" section on $
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # .
8% Surcharge $
Total Balance Due $
i:\dsts \forms \elc- fees.doc 10/09/00 ++OVER FOR PERMIT FORM
IrroF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 -'
BUP
Date Requested . -I 1 AM PM BLD
Location 155 S 7 6 f2 / 71 Suite MEC
Contact Person `- :.Pitt -e-v.: Ph i70 6.3 PLM
Contractor Ph SWR
BUILDING Tenant/Owner - ow , ; ELC �c d/ f >� S �
Retaining Wall L. ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: a.,
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing EXI-SWI ?( G
Firewall `
Fire Spr inkler
Fire Alarm , 6
Susp'd Ceiling /el L f f ` C eJ �5/ t e1P- � 6' /
.4 /t S �'j b-cf
Roof CO E?'Wk • . i
Misc: r 7� -`. -' . _ � . W 40,„„7 =� ) .
Final
/
PAS Li S PART FAIL - --- & � p Oerp *.e. 4A / : ni+ ipp i
PLUMBING r (tXi>7 1
— s is
Post & Beam
Under Slab r / / • ®vf�sfde.
Un
Top — /� ill C foa��r�r 6 .i'�
Water Service - �/ C yt » /1 Ca-- 12 / k/
Sanitary Sewer
Rain Drains `I' IP d_ stn/ 7 4'ae le . l7
Final l
PASS PART FAIL / -.t Pa Pe>4.e-e-4 MECHANICAL
Post & Beam /.,
Rough
Gas Line In
,"
Ga , 5 _/v t �f 7 7 —f r Pc ( ry
� —f� �[ .[(
Smoke Dampers AP
Final AL � . � . ga. - ,r
PASS PART FAIL �
ELECTRICAL ,
Service
Rough In
UG /Slab ' •
Low Voltage �
Fire. arm
final
PART FAIL
S
BackfillGrading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Other oach /Sidewalk Date 1/ 4,5// Inspector
9_, Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.