Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00494
�, DEVELOPMENT SERVICES DATE ISSUED: 7/11/2005
I ; I I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2S101 DC -03700
SITE ADDRESS: 07095 SW SANDBURG ST ZONING: C -P
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: Sub -panel & circuits in kitchen area.
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: 1 W /SERVICE OR FEEDER: 6 PER INSPECTION:
201 - 400 amp: 1st WIO 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:
UNITED FOOD + COMMERICAL WORKERS CHRISTENSON VELAGIO, INC.
UNION LOCAL #555 1631 NW THURMAN ST. STE 200
PO BOX 23555 PORTLAND, OR 97209
TIGARD, OR 97281
Phone: Phone: 503 - 419 - 3600
FEES Reg #: LIC 64137
ELE 26 -1174C
Description Date Amount SUP 1994S
[ELPRMT] ELC Permit 7/11/2005 $120.20
[TAX] 8% State Surcharge 7/11/2005 $9.62 REQUIRED ITEMS AND REPORTS
Total $129.82
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: ,P, \Q \()
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.
JUL -08 -05 FRI 02 52 PM CHRISTENSON ELECTRIC FAX NO. 5034193695 P. 01
...._`, • ---
.. Eleetrical Permit i'C.at on 1,0R 0 1 . 1 , 1 ( 1 , . I si: ()NL y
City of Tigard l./ ED Received , / �Q
Date/13 : / - i __ b, /k 1 Permit No.; 6C, ' - / I y9
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone; 503.639.4171 Fax: 503.598:1960 DatcBy.
�� L "'�'Ya.0I +'• : Other Permit;
Inspection Line: 503.639.4175 -• '' •✓ 8 ?005 ; , 1 ,61,1 •I �,, Data Ready/By: tam - El Sec Page 2 for
Internet: www.ci.tigard.nr,us CITY OF 7 NoliG dmnd
ed/Me: r /� Supplemental rnformsfion
-+ BI ..... ;Mr ,•.:• •', •, • ., • % ,•.. •. , • , • 'PLAN REVIEW.' • " , .{, : ,, • ❑ New Construction 121 Addilion/alteratton/rreplacement Please check all that apply:
❑ Demolition ❑Other: QService over 225 amps, comm'1 ❑Hazardous location
' • Demolition
: }; `, i; � I#TEGO . CO .:::; ❑Service over 320 amps -• rating ❑13uildng over 10,000 sq. It,
�G�L C !s r. • °+' of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling fj Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one strucnrre
0 Multi - family ❑ Master builder ❑ Other: ❑Buildmg over three statics ❑Feeders, 400 amps or more
i ❑Occupant load over 99 persons ❑Manufactured structures or
, • :J41� SUE '�NBpR1y1(ATIO r' A1V�i:LOCA'l( . • • • • °Egress/lighting plan RV park
Job no.; W18992 j Job site address:7095 SW SANDBURG ST Cl [)I•lealeh -re facility ❑Other:
Submit,- sets of plans with any of the abnvc.
City/State/21P: TIGARD, OR. 97223 The above arc not applicable to temporary construction service.
me :UFCW 555 ;FE>g SCI EDUI,E
UESTIONS .DON BEEHLER Deurtpdoo I Qty f dwelling I Total I "
Suite/bldg• /apt. no.: 1 Project na ••
Cross strecUdirections to job site: Q (503) 419 -3631 New residential single- or multi - family dwelling unit. 1
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. R. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential 75.00 2
Limited energy, non-residential 75.00 2
• • , DF.SCRI.PI'iON OF, WORK Each manufactured or modular
60A SUB - -PANEL AND CIRCUITS IN KITCHEN AREA dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 6OA • 80.31) BU • SU 2
.0 PROkEi[iT OWNER , i . CI '1f`ENA1;Pr• ' 201 amps to 400 amps 106.85 2
Name:
- 401 amps to 600 amps 100.60 2
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
relocation
Phone: ( ) - 1 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 600 amps 133.75 �2
Owner signature: Date: Branch circuits -- new, alteration, or extension, per panel
' • • O'4PPLVCANT ' 1 " • ; ❑ :CONTACT' PERSON A. Fcc for branch circuits with i
service or feeder fee, each
Business name: branch circuit 6 6 39.90 2
B. Fcc for branch circuits
Contact name: µ without service or feeder fee,
Address:
�` each branch circuit 46.85 2
-• _ Each add branch circuit _ 6.65 2
City /State/ZIP: _ Miscellaneous (service or feeder not included) -
Pump or irrigation circle 53.40 2
Phone:
( ) I Fax: : ( ) Sign or outline lighting 53.40 2
E -mail:
Signal cimuil(s) or limited- 75.00
•5' . ',• /:" • CONTRACTOR: , • , , energy panel, alteration, or
extension, Describe: Page 2 2
Business name: CHRISTENSON VELAGIO, .INC.
Address: 1631 NW THURMAN ST 2ND FL Each additional inspection over allowable its any of the above
Per inspextion 62.50
City /State /Z1P: PORTLAND, OR 97209-2.558 Investigation per hour (I hr min) A 62.50
Phone: (503) 419 -3300 Fax: (503 ) 419 -3333 Industrial plant per hour 73.75
GCB Lic.: 64137 Electrical Lic.. - 174C i Suprv. Lic J 19945 IEL.F.CTRICAL pER1K PEES* '
Subtotal 120.20
Suprv. Electrician signature, requited; , tt 'i� f Plan review (25% of permit fee)
Print name: ROBERT AXT I DMC: 7/8/05 State surcharge (8 %ofpemdt ice)
-
9.6L
.__1
TOTAI. PERMIT FEE 129.82 • ,
Authorized Signature: This permit applicalion expleer, if • permit Is not obtained within IRO
days after it has been accepted as complete * ** l; *>E
Print name: Date: • Fee methodology oetby Tri- County Building industry Service anon
f A
•• Number of inspection,% per permit allowed.
i l 12/03 d40.dolST(1O/O2/COM/Wep
l J ` •► -
CITY OF TIGARD
RIMMING DIVISION PERMIT #: ELG2005 -00494
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/11/2005
Phone: (503) 639 -4171 i rd/f��r I�I�
Inspection Requests (24 Hrs.): (503) 639 -4175 ":
INSPECTION WORKSHEET Ft ' DATE: 9/22/2005 TIME: 7:12AM PAGE: Bry
SITE ADDRESS: ' '07095 SW S DBURG ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: LOCAL 555
DESCRIPTION: Sub-panel & cir is in kitchen area.
OWNER: UNITED HOOD + +OMMERICAL WORKERS, PHONE #:
CONTRACTOR: CHRISTENSON VE►AGIO, INC. PHONE #: 503 - 419-3600
Inspection Request Scheduled For: Date: 9/22/2005 Pour Time:
Code # Inspection Description, Confirm # Contact # Message
199 Electrical final 016291 -02 503 -887 -7098 N
Corre • • - • • - - s nstructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
I n s p e c t o r : C - - Date: 1 Phone #: (503) 718 - Q. •