Permit GC!TY OF TIGARD ELECTRICAL PERMIT
..a - - PERMIT #: ELC2005 -00146
DEVELOPMENT SERVICES DATE ISSUED: 3/10/2005
°- I� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
PARCEL: 2S 110 DC -02200
SITE ADDRESS: 15532 SW PACIFIC HWY C -6 ZONING: C -G
SUBDIVISION: WILLOW BROOK FARM
BLOCK: LOT : 011 JURISDICTION: TIG
Project Description: Add sub panel & 2" conduit.
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: 1 W /SERVICE OR FEEDER: 3 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 ARENSPEC OCC:
Owner: Contractor:
TIGARD CENTER STONER ELECTRIC
9777 WILSHIRE BLVD. 1904 SE OCHOCO STREET
#609 MILWAUKIE, OR 97222
BEVERLY HILLS, CA 90212
Phone: Phone: 503 - 462 -6500
FEES Reg #: LIC 44823
3496S
Description Date Amount SUP 26.12
ELE 26 -122C
[ELPRMT] ELC Permit 3/10/2005 $100.25
[TAX] 8% State Surcharge 3/10/2005 $8.02 REQUIRED ITEMS AND REPORTS
Total $108.27
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: Permittee Signature:
OWNER INSTALLATION ONLY ` 5
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.
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.
03/10/2005 THU 12:34 FAX 5036592824 STONER SERVICE 0 002
ElectracAl1t ermit APA1ipEgEIVE D' 11 OFFICE I- SE OM
City of Tigard D / 0 '')Z._ PermitNa : 6cC)RIj O D /YC
13125 SW Hall Blvd., Tigard, OR 97223 MAR 1 0 200.: = . , Plan Review Other :
Phone: 503.639.4171 Fax 503.598.1960 I :/'' DatcJB .
Inspection Line: 503.639.4175 . . - -' I.. Date Ready /By: H See Page Z for
Internet: www.a.tigard.or.us CITY OF TIGA') Notified/Method: Sopplemattat Information
D IVISION PLAN REV �w
•
❑ New construction A /alts ration/replacement Please check all that apply
['Service over 225 amps, corning I ]Hazardous location
❑ Demolition ❑ Other. ❑ Service over 320 amps — rating I ] Buildng over 10,000 sq. ft.,
CATEGORY OF: CONSrRIIC1TON of 1- and 2- family dwellings 4 or more new residential
❑System over 600 volts nominal units one
El l - and 2- family dwelling Commercial/indusbial ID At Accessory building ['Building over three stories I ]Feeders, 400 amps or more structure
❑ Multi- family Oa Master builder ❑ Other. ❑Oca load over 99 persons I ]ldannfachu'ed structures or
JOB SITE-iiiii'OBMATIOWAND'3 OC T ION ❑ Egrenilit +g 1� RV park
s [Wealth-care facility i ]Other.
Job no.: i g 3 S/ Q I Job site address: / 5 5 W A e i', C AV Submit 2 sets of plans with any of tl a above.
City City/State/BP: 1/A / The above are not applicable to temp nary construction service. ..
G
/ j 7 k $ u O ` �Q I f't tea'
Suite/b IdgJaP t. no.: ti- h Pro ect name: 1>� a y. , i Fee. J reran
Cross street/directions to job site: New residential single- or mall -far ally dwelling twit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision. I Lot no -: Ea. Merl 500 sq. R or portion 33.40 1
limited energy, residential 75.00 2
Tax map/parcel no.: Limited energy, non-residential 75.00 2
c . DFSC ONX%F WORK . Each manufactured or modular •
a n /) t1 . 4h / ei h ce i2 4 A � e L ' �� dwelling, servi a�/or feeds 90.90 2
�K�/w(-/ �K ` / Servk� or f eedea bon. alt xatlo4 and/ relotat<oa
200 amps or less ' 8030 (0 1 G 2
201 amps to 400 amps 106.85 2
D- PROPEf TY OWNF1t . ; +0 TENANT 401 amps to 600 amps 160.60 2 •
Name: 601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts 454.65 2
Address: Reconnect only
66.85 2
City/State/LIP: Temporary services or feeders Ion auction, alteration, and/or
seloadion
Phone: ( ) I Fax ( ) less I 66.85 1 200 amps or
Owner installation: This installation is being male on property that I own whidl is not 201 armps to 400 amps 100.30 1 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 =pato 600 amps - 133.75 2
Owner signature; D ate: Brancbdrla —new, alteration, or extension, per panel
' y ify, , PFdt80N.: _ }, A. Feeforbranchcirams
service err feeder fee, ea
I , ch (G q .
..
: `:I:� ;.•.: 6.65 i ! 2
Business name: braa& circuit
B Fee for branch o r fee ■
Contact name: tvlthoat service or feeder fee, 46.83 2
each branch circuit
Address: • . Each add'l branch circuit 6.65 2
City/State/ZIP: Mboe➢aoeous (service or feeder o of inducted) -
Pump or irrigation circle 53.40 2
Phone: ( ) ,Fax : ( ) Sign or outline lighting 53.40 1 2
E -mail: Signal ci ntit(s) or limited -
CONTRACTOR energy panel, alteration, or 75.00 2
• extension_ Describe:
Business name: STa N ER e�->`GT -R i C
4 SE Q G Each additional trnpection over allowable In any of the above
9 O
Address: ! h o c. 0 Per inspection 1 62.50
q .
City/State/ZIP: M r L. 1„vA.13 K 1 e-, O IR / 7 2.. a Investigation per hour (1 Iv min) 62.50
Phone: (5C3) 4(02- (G SZ0o I Fax: (5t Co 5`9- 4-94v 8 Industrial plant per hour 7175 ELECTRICAL PI Mk= PE1iS .
CCB Lic.: 44 BZ3 Electrical Lic.:24,- j 2 i 2 c I Suprv. Lie.: 3 4940 S Subtotal 0 0. ,
Suprv. Electrician signature, required: rn,; V" Plan review (25% a f permit fee)
/ State surcharge (8% o f permit fee)
Print name: i KE �--^� Date: `2 / O D
M r `I l— N E R / TOTAL PE RMTP FEE I el g . ,
Authorized signature: This permit application apices if a hermit is not obtained within 160
- days aRer it has been a :cepad as complete
Print name: I Date: Fee methodology set by Tri- Cooney 3uilding Industry Service Board
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00146
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 3/10/2005
Phone: (503) 639 -4171 /no � t o
Inspe Requests (24 Hrs.): (503) 639 -4175 � fi'I I I.
INSPECTION WORKSHEET FOR DATE: 3/22/2005 TIME: 7:13AM PAGE: 94
SITE ADDRESS: 15532 SW PACIFIC HWY C-6 CLASS OF WORK:
SUBDIVISION: WILLOW BROOK FARM LOT #: 011 TYPE OF USE:
PROJECT NAME: SUNS UP TANNING
DESCRIPTION: Add sub panel & T conduit.
OWNER: TIGARD CENTER, PHONE #:
CONTRACTOR: STONER ELECTRIC PHONE #: 503- 462 -6500
Inspection Request Scheduled For: Date: 3/22/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 002362 -01 503 - 806-0767 Y
Corrections /Comments /Instructions:
(..7
11 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: � - .2.2— —0 Phone #: (503) 718-