12080 SW MAIN STREET-1 IS NIVW MS 08026
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12010 SW MAIN ST
a ELECTRICAL PERMIT
CITY OF TIGARD
t*1' " PERMIT 0: ELC2005-00871
DEVELOPMENT SERVICES DATE ISSUED: 11/7/2005
13125 SW Hall Blvd.,Tigard,OR 97223 503-639-4171 PARCEL: 2S102AA-00906
SITE ADDRESS: 12080 SW MAIN ST ZONING: CBD
SUBDIVISION: PAYLESS SHOPPING CENTER LOT: 002 JURISDICTION: TIG
Project Description: Rework underfloor duct electrical splices due to water flooding.Job#140605-98356.
RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS
1000 Sr OR LES:?: 0 - 200?;np: Pll /1 I ATION:
EACH ADD'L 500SF: 201 - 400 amp: S1014/OUT LINE LTG:
LIMIT ED ENERGY: 01 - 600 amp: SIGNAUPANEL:
MANF HM/SVC/FDR: 601+amps-1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSP'ECTIONS
0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION: 3
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 AREA/SPEC OCC:
Owner: Contractor:
MONTCO ASSOCIATES BROADWAY ELECTRIC-COCHRAN INC
BY THRIFTY/PAYLESS INC#5354 626 SE MAIN
PO BOX 8431 PORTLAND,OR 97214
HARRISBURG,PA 17105
Phone: Phone: 503-234-6564
FEES Roy#: LIC 72942
Desription Date Amount SUP 3447S
ELE 37-5460
[ELfRMTj ELC Permit 11/7/2005 $187.50
ITA:1 S"S,State.Surchar've 11/7/20115 $';5.00 REQUIRED ITEMS AND REPORTS
Total $202.50 i
This Permit is issued subject to the regulations contained in the Tigard Municipal Code,State of OR.Specialt•;r7c ies 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 Not rication 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
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N The installation is being made on property I own which is not intended for sale,lease,or rent.
OV%,'NER'S SIGNATURE: _— DATE:
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j CONTRACTOR INSTALLATION ONLY
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SIGNA TIJRE 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 bo 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 ins�jectlon.
• Electrical Permit Application
City of Tigard oe. Permit
13125 SW I tall 131vd.Tigard.C)R 97223 Plan Rcvww
Phone: 503.639.4171 F.: 503 598.1960 lhle/Ety. (VW i'ermik
Inspection Line: 503,619.41 15 lame Ready/By: lura 0 See Paae 2 for ^
IntentrC www.ci.ligard.or us NcmfiedNethod Sappkmenbl Informe"s
Tore bf► +Iv ;, PLAN RLVIEW_
❑New construction _ Additiotdalteration/rc;,!2_:-n ent Plcaw check all that apply,
❑Demolition ❑Other: ❑Service ever 225 amps.comm'I ❑Hazardous location
❑Service over 320 amps--rating ❑Ruildng over 10,000 sq.ft.,
CATEGORY OF CONhTMUC KM of I-and 2-family dwellings 4 or more new residential
❑ I-an,'74amily dwelling ®Commercial/industrial ❑Accessory building ❑System over 600 volts nominal units in one structure
❑Multi-family ❑Master builder Q Other: Qlluilding over three stories ❑Fecde..400 amps or more
-- ❑Occupant load over 99 persons ❑Manufactured structures of
JOIN SITE INFORMATION AND LOCATION ❑f:gress/hghting plan RV I�
Job no.: 14060983-M 1 Job site address: 12080 SW Main Street ❑►#eahh-cove facility ❑O her:.___
Submit 2 sets of plats with any of the above.
City/State/7111:Tigard,Oregon 97223 'Me above are not applicable to temporary construction service.
—
Suite/bldg./apt,
no.: name:Rit .id
_ n melpeo.e gra•
Cross street/directions to job site: New residen0el single or malWfarnlly dwelling unit.
--- Ineledes atfaehsl Bart Se.
_ 1,000 sq.P.o less 145.15 4
Subdivision: I.of no.: -_-_ I:a.add'l 500 sq.ft.or portion 33.40 :—:1]2 e
Limited energy,residential 75.00
1 ax snap/parcel no.: Limited energy,non-residential 75.00 _ 2
DESCRIM014 OF WORK_ _ Each manufactur,.d or modular
Rework Underfloor Duct Electrical Splices Due 7'o Water Flooding
dwelling,servrr-a-"d/cx feeder 911'90 2
-—_ ----e----�--- -_-___...-- --- Services or kerien installation,alteration,and/or reloeatiou
200 temps or less 80.30 2
❑ PROPERTY OWNER (3 TEI4ANT 201 Pmps to 400 amps 10(,.85 2
401 amps to 600 amps 160.60 2
Name: --`
-----_---_-- _ �__-�_. ._— 601 amps, to 1,000 arrrpa 240.60 2
Address: Over 1,000 amps or volts 454.63 2
-_- - - — - — Reconnect only 66.85 1 2
City/Stale/7111: Temporary services or feeders Installation,alteration,and/or
Phone:( ) Fax.( ) relocation
200 amps or less 66,85 I
Owner installation:This installation is being made on property that 1 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 turps to 600 amps 133.75 2
Owncr signatu-c: -Date: Branch circuits-new,alteration,or extension,per panel
❑ APPLICANT ��-- ❑ (ONTACr It'6R80N A Fee for branch circuits with
service or feeder fee,each 6 65 2
Business name:Broadway Electric branch circuit
- —`- --- A.Fox for branch circuits
Contact,tulle:Jeff Holmes _ withimr service or feeder fee, 46.85 2
each branch circuit
Addi:3s:626 SE Main Street Each add'I branch circuit 6.65 2
City/State/ZIP:Portland,OR 97214 Miscelbaeen(seryke or feeder not Included)
`a-- Pump or irrigation circle-�T 53.40 2
Phone:(503)2.'i4-6364 --— Fax::(303-23&Z048)
a -_— `. Sign or online lighting 53.40 2
�
P-mail: holm eochraninc.com _ _j � Signnl circuit(s)or limited-
CONTRACTOR energy panel,alteration,or
13nsiness name:Broadway Electric extension.[ksceifte- Page��1l 2
J Address:626 SE Main Street Each additional Inspection over allowable In way of the above
- Per inspection 62.50
City/Statd7.IP:Portland,OR 97214 Investigation per hour(I la min) REPO 62.50
W Phone:(303)234-b3W Fax:(503)231!-2098 Industrial plant per hour 73.75
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CCB Lic.: 37-546C Electrical Lic.: 72942 Supry. ELECRiCALE
.Lic.: � Subtotal
Suprv.Electrician Agnatum.required: Plan review(25%of permit fee)
Print name: _ ? Date:
State surcharge(8%of permit fee)
_1<-�• TOTAL PERMIT FEEZ&2�7
Authorized signature: TLB permit applkadoa expires if a permit h not obtained within 100
— — clays after k Yas been se epk.i as complete
Print name: Date: — Fos:methodology". by Tri-County Building Industry,%rvice Board
Numfxr of%^ texYicmt ver permit allowed
CITY OF TIG,ARD 0
BUILDING DIVISION PERMIT#: ELC200r..r00d71
13125 SW gall Blvd., Tigard, OR 97223 DATE ISSUED: 11/7/2005
Phone: (50;;) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 1'111(?!:!)(?ii TIME: T02AM PAGE: 1
SITE ADDRESS: 121#80 SW MA114 IS I CLASS OF WORK:
SUBDIVISION: PAYLESI, SHt►PPING (,UNIF,R LOT #: 002 TYPE OF USE:
PROJECT NAME: RITE AID
DESCRIPTION: Rework underfloor dur.t electrical splicer,due to water flooding. Job 0140605-90356.
OWNER: MONTGO A S!'iOCIATES, PHONE #:
CONTRACTOR: BROADWAY ELECTRIC-COCHRAN INC PHONE #: •6564
Inspection Request Scheduled For: Date: III 101200r, Pour Time:
Code # Inspection Description Confirm k Contact if Message
P11) Aisr insper.bon/F . 020902 01 503260.7.412 Y
Corrections/Comments/Instructions:
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A-P-A S S ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: -__ _ __._ __ _� Date: i,� =��` Phone #: (503) 718- _
CITY OF TIGARD
BUILDING DIVISION PERMIT#: ELC200500871
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 111/%1005
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 117H/200!) TIME: 7.00AM PAGE: 6
SITE ADDRESS: 12080 SW MAIN S1 CLASS OF WORK:
SUBDIVISION: PAYLEl)S,SHOPPING CENTER LOT #: 002 TYPE OF USE:
PROJECT NAME: RITE AID
DESCRIPTION: Rewoxk underfloor duct electrical splices due to wate♦ flooding. Jot,#140605 98356.
OWNER: MONTCO AS.,:'OCIATES, PHONE #:
CONTRACTOR: BROADWAY ELECTRIC-COCHRAN INC; PHONE #: 503.234.6564
Inspection Request Scheduled For- Date: 1 10200ri Pour Time:
Code # Inspection Description Confirm # Contact # Message
1% Mita inspe(tion 0106)3_01 !J0 )60-7917 Y
Corrections/Comments/Instructions: �y
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❑ PASS VPARTIAL APPROVAL ❑ CANCEL [] NO ACCESS
❑ FAIL VCALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: —L—[ �S Phone #: (503) 718-