Permit CITY OF TIGARD- ELECTRICAL PERMIT
r ° PERMIT #: ELC2007 -00140
COMMUNITY DEVELOPMENT DATE ISSUED: 3/8/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S135BD-01200
SITE ADDRESS: 09802 SW SHADY LN ZONING: C -G
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: NEW YORK DELI
Project Description: (2) branch circuits for storeroom.
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: 1 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:
FORBES, DONALD CAROLYN PHOENIX ELECTRIC
BURDICK, DONALD LINDA PO BOX 14037
434 RIDGEWAY RD PORTLAND, OR 97293
LAKE OSWEGO, OR 97034
Phone: Contact #: PRI 503- 231 -8006
FAX 503 - 235 -4300
FEES
Description Date Amount Reg #: ELE C89
[ELPRMT] ELC Permit 3/8/2007 $53.50 LIC 162753
[TAX] 8% State Surcharge 3/8/2007 $4.28 SUP 5154S
Total $57.78 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: . 1 � _ 1 ' ` Permittee Signature: �� P ,
OWNER INSTALLATION ONLY 6 6
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.
T
Mar 08 07 10:03a Terry Koch 503 -266 -8394 p.1
.
iC' Electrical Permit Application --- _ FOR OFFICE l SE ONLY
r i , - 9 Received City of Tigard � DateB.r.✓ "7 ul Z G 7 - Permit No. / /r 7 -op O
1 111 1 13125 SW Hall Blvd., Tigard, OR. 97223 Plan Review ���n^ JA°�r�v 9/yl /�
O Phone: 503.639.4171 Fax: 503.598.1960 `i 1 Daze/g Other Permit
T I G A R D Inspection Line: 503 Vt 0 ( - 1 001 Date ReadyB ha
is: 7: la See Page 2 for
Internet: www.tigard or.gov Notified/Mcthod: Supplemental information
TYPE QF,KO'ItKy) Y lt °l PLAN REVIEW
1:1 New construction L ddlti 1 fiS�aC eID tC tt ilIc 6 � ' Please check all that apply (submit a acts of plans w /items checked below):
❑ etilO oast ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 750 volts or ❑ Floating buildings.
El 1- and 2-family dwelling Commercial/industrial El Accessory building less to erotmd, or exceeds 14,000 ❑ Commercial-use agricultural
Y gB amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fare pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ - A ", "L ", ' 1 - ", "l - 3".
Job no.: 304 ' Job site address: 9�0a vr/ � fiN� Six I0OHP
or more Recreational ' t /" S! r 0 err morn residential omits. ❑ R vehicle parks.
City /State/ZIP: % V 0 2 el 7,a. 3 ❑ Health -care facilities. 0 Supply voltage for more than i
13 Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Vau y 2)a,/ ❑ Service or feeder 600 amps or more.
/ FEE SCHEDULE
Cross street/directions to job site: Description l Qty.) Fea t Total I • I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no 1,000 sq. It. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.44) 1
Tax map/parcel no.:
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
`_ Limited energy, multi - family
/ 1 J , i , t L L ( e ) � 4 al.& t i s / O J,` oiebeoo Nt._ residential (with above sq. R.) 75.00 2
Services or feeders installation, alteration, and /or relocation
I 200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders in'd,.11..tion, alteration, and/or
relocation
Phone: ( ) 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 feedtx fee,
Contact name: 46.85 5 2
first branch circuit
Address: Each add'l branch circuit / 6.65 (y •r 67 2
Miscellaneous (service or (ceder not included) _
City/State/LE': Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
.(t! SL � Ti'tc'/ P energy panel, alteration, or
Address: p 0 . ax /4 7 exterttion. Describe: Page 2 2
City/State/ZIP: /9 Q7 /4�- f o . 9 7. $ 3 Each additional Inspection over allowable in any of the above
! x L� Per inspection 62.50
Phone:
To 3) tt� - Y J Fax (5-03)_}6 -T . J 9 T Investigation per hour (I hr min) 62.50
-. CCB Lic.: /4 I Electrical Lic.: C Suprv. Lich: S /(o y5 Industrial plant per hour 73.75
Su Electrician signature,
ELECTRICAL PERMIT FEES
pry gnature, required: `� � 6. Subtotal:
, 4, KOG. Da te: Plan review (25% of permit fee): 3. O
.
! - �
Print name: z 7 _ 0 7
/ State surcharge (8% of permit fee): �
Authorized signature: TOTAL PERMIT FEE: 5-n, 7 b
7 _ This permit application aspires If a permit is not obtained within 180
Print name: /�� /6„ � - Date: J O7 days atter it has been accepted as complete.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: FLC2007- 00140
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3l8 /2iiij1 •
Phone: (503) 639 -4171 4.4 i
Inspection Requests (24 Hrs.): (503) 639 -4175 1 L
INSPECTION WORKSHEET FOR DATE: 3/23/2007 TIME: 7:03AM PAGE: T(i
SITE ADDRESS: 09802 SW SHADY LN CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: NI :W YORK DELI
DESCRIPTION: (2) branch circuits for storeroom.
Job #3068.
OWNER: FORBES, DONALD CAROLYN, PHONE #:
CONTRACTOR: PHOENIX ELECTRIC PHONE #: 503 2`,R'1 1300CA
Inspection Request Scheduled For: Date: 3/23/2007 Pour Time:
Code # Inspection Description der # Contact # Message
199 Electrical final 045261 -01 503-8869930 N
Corrections /Comments /Instructions:
9 - C 'I
Rwm,q6 FR-0N u: E r CA L
AZi Flo . E N ��G•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
2 Inspector: `T N 6e Date: 3'Z3 o 1 Phone #: (503) 718 - 'F4)