Permit ' C OF TIGAR® ELECTRICAL PERMIT
� '" ' `° 1 PERMIT #: ELC2008 00455
COMMUNITY DEVELOPMENT
D ATE ISSUED: 8/7/2008
,TIGA}iP: 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 110DC -02300
SITE ADDRESS: 11555 SW DURHAM RD A -1 ZONING: C -G
SUBDIVISION: WILLOWBROOK BUSINESS PARK LOT : JURISDICTION: TIG
PROJECT: JB OBRIEN'S PUB
Project Description: Sign lighting for wall sign.
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: 1
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: 0 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:
HIP WILLOWBROOK LLC PETERSON ELECTRIC INC
PO BOX 2708 2220 KELLI BLVD
PORTLAND, OR 97208 HERMISTON, OR 97838
Phone: Contact #: PRI 541 - 567 -0228
FAX 541 - 567 -9216
FEES
Description Date Amount Reg #: ELE 30 -68C
[ELPRMT] ELC Permit 8/7/2008 $53.40 LIC 29350
[TAX] 12% State Surchar 8/7/2008 $6.41 SUP 2283S
Total $59.81 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952- 001 -0010 through OAR 952 - 001 -0100. You ma obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By % / Permittee Signature: ec-P /,�'']'S�jyj/
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OFFICE USE ONLY
' ' • • City and E Received
7 ea L ET/€.966J ' y� ^
`J Of Tigard CF • Date /By: C17 Permit No: V`���
11 l
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
I . ' • Phone: 503.639.4171 Fax: 503.598.1960 Q Date/By: Other Permit:
2p0$ Y
T l G A R D Inspection Line: 503.639.4175 n `,G ' � Date Ready /By: turfs: ® See Page 2 for
Internet: www.tigard- or.gov N RI Notified/Method: '7 7 Supplemental Information
TYPE OF WORK ( l �Y Q G�i�1S PLAN REVIEW
❑ New construction ❑ Addition /alteration/l� a Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other:
where the available fault current ❑Marinas and boatyards.
CA EGORY 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 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 ", '1 -2 ", "1 -3 ",
Job no.: Job site address: 10OHP or more. occupancy.
�� S S� S !/4° /f�/n "' ❑Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: / 9 .,7 Project name: d 0BiPi�„./1- G o v ,, ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 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] 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
//t/S 7 /1 SO - " X Go '' ,r G - L 6 7 residential (with above sq. ft.)
�'
. J Services or feeders installation, alteration, and /or relocation
CU /' // J - / t) C7444, TEN A scfr 200 amps or less 80.30 2
❑ PROPERTY OWNER AN 201 amps to 400 amps 106.85 2
Name: _ 401 amps to 600 amps 160.60 2
`s /'c /7''4ti.J/6 _ Gc.J O L /' L 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: £50s 6 2 7 g y/ 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
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT J2- PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: /�,9 y without service or feeder fee,
first branch circuit 46.85 2
Address: / ��� ��y Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /Slate /ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) :: ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting / 53.40 ,"3, 2
Business name: , C • ,,j Signal circuit(s) or limited -
��C�PSd energy panel, alteration, or
Address: 2 2 2 V A—E Z ' QL v� extension. Describe: Page 2 2
City /State /ZIP: ,/7 f y / f') - v / .D7/� , . ____?-6 Each additional inspection over allowable in any of the above
Per inspection 62.50
, S - A . . . . _ 5 - ‘ P h o n e : � 7 2 Z e Fax: L a , f.6 2 e /-, Investigation per hour (1 hr min) 62.50
CCB Lic.:2 9j$,$2 Electrical Lic. 6 6 4 Suprv. Lic.: 2 e, - s Industrial plant per hour 73.75
�j ELECTRICAL PERMIT FEES
Suprv. Electrician n atltre, required: /� '10/t to
p Subtotal: SLY y - 0
.., J Date: O S d Plan revi (25% of permit fee):
Print name:
��� � ��� —� a // State surcharge (12% of permit fee): ‘ , 51/
Authorized signature: TOTAL PERMIT FEE:
sy. 8 /
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.dos 05/23/06 440- 4615T(1 l /05 /COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2008004f,5
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/7/2008
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 Vit
.
INSPECTION WORKSHEET FOR DATE: 8/22/2008 TIME: 7:01AM PAGE: 20
SITE ADDRESS: 11555 SW DURHAM RD Al • CLASS OF WORK:
SUBDIVISION: WILLOWBROOK BUSINESS PARK LOT #: TYPE OF USE:
PROJECT NAME: JI3 OI3RIEN'S PUB
DESCRIPTION: Sign lighting for wall sign.
OWNER: HIP W1LLOWBROOK LLC, PHONE #:
CONTRACTOR: PETERSON ELECTRIC INC PHONE #: 541 - 567-0228
Inspection Request Scheduled For: Date: 8/22/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 074514.0 541.567 -0228 N
Corrections /Comments /Instructions:
• CLoS f)• TiYYAE — "r.(1 AAA,
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS
) FAIL 'CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Cr— • N 6e) LE
Date: A Phone #: (503) 718- lif%