Permit CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00139
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- 13125 DEVE
1639 -4171 DATE ISSUED: 3/9/01
PARCEL: 2S115BA-00100
SITE ADDRESS: 16200 SW PACIFIC HWY Z
SUBDIVISION: ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Wire New Ice Machine
Job No. 89944S
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: 3 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:
ALBERTSONS INC #565 STONER ELECTRIC
BOISE, ID 83726 1904 SE OCHOCO STREET
MILWAUKIE, OR 97222
Phone: Phone:
503 - 462 -6500
Reg #: LIC 00044823
SUP 4025S
ELE 26 -122C
FEES Required Inspections
Type By Date Amount Receipt
Ceiling Cover
PRMT CTR 3/9/01 $66.80 2720010000( Wall Cover
5PCT CTR 3/9/01 $5.34 2720010000( Elect'I Service
Elect'I Final
Total $72.14
This Permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Spedalty 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 direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S 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
Electrical Permit Application f,49.. -'1 � e ?}` r: y ; .
I r . Date received: Permit no.:fizg /, / 3
d > I I
�, ,._�� City of Tigard Project /appl.no.: Expire date:
- 'City of gard ` Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT .
❑ I & 2 family dwelling or accessory XCommercial/industrial 0 Multi- family 0 Tenant improvement
❑ New construction , Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION .
Job address: /l Zep ..J ,f-eie /c X Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: 'Subdivision:
Project name: j�gitJS .�Cas I Description and location of work on premises: u)/,P. AIL /C 9�aX a- -
Estimated date of completion/inspection:
_ CQNTRACTORAPPLLCATION __;__. -.. - - - - - - -.;� ...:r_.... . E SCIIED
Job no: 399 44/ Description Qty. (e a.) Total no. p
Business name: ,,,,, �e� -7-we,
Address: New residential -single or multi-family per
1904 , OeA0c - dwelling unit. Includes attachedgarage. •
City: /vj, ,_ free, e - I State:pe I ZIP:' 72 22— Service included:
Phone;so3- ih.z_L,so0 I Fax:(,59 -4968 I E -mail: 1000 sq. ft. or less 4
CCB no.: y41 3 I Elec. bus. lic. no: 24, — t2 Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City /metro li . no.: 4/ t, Limited energy, non - residential 2
3/-1p1 Each manufactured home or modular dwelling
Signature o supervising e trici (required) Date / [ Service and/or feeder 2
Sup. elect. name (print): Me r< e - License no: 3494, $
Sen�ces or feeders - installation,
alteration or relocation:
PROPERTY OWNER 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: 'State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only I
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 installation, alteration, or relocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
' ENGINEER Branch circuits - new, alteration,
Name: or extension per panel:
. ._ A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: ZIP: B. Fee for branch circuits without purchase
Phone: Fax: Email: of service or feeder fee, first branch circuit: / 4,5 44( 2
Each additional branch circuit: ,g Z ,5 /9,9J-
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 irrigation circle 2
0 Service over 320 amps - rating of I &2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel.
O System over600 volts nominal more residential units in one structure alteration, or extension' 2
O Building over three stories 0 Feeders. 400 amps or more •Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lighting plan 0 Other. Per inspection 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 $ 46.1
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ g 3
Expires accepted as complete. TOTAL $ 72, /
Name of cardholder as shown on credit card
S
Cardholder signature A mount �. 440 -4615 (NW /COM)
2919
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
22 BUP
Date Requested —/ 7 AM PM BLD '
i
Location / w Z GG Sc„ AC, c', c AL / Suite MEC
Contact Person Q /6, f Ph 5Zj 206 G AG7 PLM
Contractor 9___, Ph SWR
BUILDING Tenant/Owner ELC a940/—G U /51
Retaining Wall ELR
Footing Access:
Foundation '' 1I11 FPS
•
Ftg Drain � 1 re ettetJ Z? ° ,414 `/ / Jr'. SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler / . ice,
Fire Alarm
Susp'd Ceiling
----------
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
1 Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
Service
Rough In
UG /Slab ,
Low Voltage
F ' Alarm
1 Fi
S PART FAIL
Backfill /Grading
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
Approach /Sidewalk Date ,� /y /a Inspector Other t Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.