Permit IN CITY i OF TIGARD ELECTRICAL PERMIT
a ° PERMIT #: ELC2008 -00297
a COMMUNITY DEVELOPMENT
DATE ISSUED: 5/27/2008
- TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 102CC -00500
SITE ADDRESS: 13600 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: TIGARD MARKETPLACE LOT : JURISDICTION: TIG
PROJECT: H MART
Project Description: Replace T -8 ballast & lamp, (3) branch circuits.
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: 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: 2 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:
13500 PACIFIC CORP VITAL CONSTRUCTION & ELECTRIC LLC
BY CAP ADVISORS 3855 SW 153RD DR
38345 W TEN MILE RD, STE 170 BEAVERTON, OR 97006
FARMINGTON HILLS, MI 48335
Phone: Contact #: PRI 503 - 519 - 3141
FAX 503 - 636 -6139
FEES
Description Date Amount Reg #: ELE C333
ELPRMT] ELC Permit 5/27/2008 $60.15 LIC 178397
(TAX] 12% State Surchar 5/27/2008 $7.22 SUP 4490S
Total $67.37 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 b- • _ • - •• - cordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more • .n 180 days. A NTION: • egon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR •52- 001 -0010 through a A - •52 -•01 -.100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
y
Issu: d By: , ` / � /l ✓ ��`l Permittee Signature: c' - Cl..._____
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: C C � DATE: 7 7 `'I-
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.
Elect cal Permit Application FOR OFFICE USE ONLY
Received f p ,� ��
City of Tigard Date/By: / 0 D p Permit No.: j0 7
4 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
0 • Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris. ® See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below)
❑ New construction Z1 Addition /alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling A Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: Job site address: / 36 c'l t% �q C, Six or more. occupancy. �/ 0 or Recreational vehicle parks.
City/State/ZIP: / , C � / ix or more residential units. ❑ Recreatio
eati ❑ Health -care facilities. ❑ Supply voltage for more than
T' Q r� v 1' 7 Z Z 600 volts nominal.
J 0 locations.
Suite/bldg. /apt. no.: Project name: tIA cwA— ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. I Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. 11)
I L energy, multi - family 75.00 2
R n o l aC.Q.- .1- p p 13 6jj S /- a l Q vh r residential (with above sq. ft.)
'r� 3 r ^ v � � i Services or feeders installation, alteration, and/or relocation
K e .1 ) i3 rG &h C c I 1 QV 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 installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
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 ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits //j
Contact name:
without service or feeder fee, 46.85 l0• " • 2
first branch circuit
Address: Each add'I branch circuit 6.65 1 5.30 2
. Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
t } ` I t Signal circuit(s) or limited -
Business name:
U G 1 ( ' S + *r o '') 3 (� P(t Vt c G energy panel, alteration, or
Address: 3 9 f f 5 (,) / .(---3 r,01 0 extension. Describe: Page 2 2
City/State /ZIP: D ,,, {� p 9 7 -66 Each additional inspection over allowable in any of the above
`+ Per inspection 62.50
Phone: (t , (7 .-3/ Fax: ( 5 " Ei 3 ) ( S 6 — lr / ) `3 2 j Investigation per hour (1 hr min) 62.50
dza / � � a 5 Industrial plant per hour 73.75
CCB Lic. : ?O J! E Lic.: 3 �� ��� �C Suprv. Lic. : Cam` /o/d/0 ELECTRICAL PERMIT FEES
Suprv. Electrician sign �
signature, required: Subtotal: C , r
Plan review (25% of permit fee): O-L
Print name: �l h / 1 1 S t •h Date: y o State surcharge (12% of permit fee): • ? .
Authorized signature: TOTAL PERMIT FEE: 12 7
This permit application expires if a permit is not obt 180
Print name: Date: days after it has been accepted as complete.
' Number of inspections allowed per permit.
I: \Building\Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(1 I /05 /COM/WEB
Electrical Permit Application - City of Tigard
PP � �
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RE SIDENTIAL WORK ONLY:,
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \ Building \Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION , PERMIT #: ELC2008.00297
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/27 /2008
Phone: (503) 639 -4171 ly y; � i1
Inspection Requests (24 Hrs.): (503) 639 -4175 . `:_
INSPECTION WORKSHEET FOR U DATE: 6/26/2008 TIME: 7:00AM PAGE: 6
SITE ADDRESS: 13600 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: TIGARD MARKETPLACE LOT #: TYPE OF USE:
PROJECT NAME: H MART
DESCRIPTION: Replace T -8 ballast & lamp, (3) branch circuits.
OWNER: 13500 PACIFIC CORP, PHONE #:
CONTRACTOR: VITAL CONSTRUCTION & ELECTRIC LLC PHONE #: 503-519 -3141
Inspection Request Scheduled For: Date: 6/26/2608 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 071889 -01 503 - 519.3141 N
Corrections/Comments/Instructions:
\k . r ,
1 c
ii 1 1
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6 6 ,PASD ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector:. N VCA LE" Date: W' Phone #: (503) 718 -.1