Permit , ELECTRICAL PERMIT
�r' ,,. CITY OF TIGARD
IN
�` PERMIT #: ELC2007 -00788
COMMUNITY DEVELOPMENT
,,, „, z D ATE ISSUED: 11/21/2007
; TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 102 BA - 00304
SITE ADDRESS: 09826 SW TIGARD ST ZONING: I -
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. LOT : 021 JURISDICTION: TIG
PROJECT: FRY ELECTRONICS
Project Description: Reconnect.
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: 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:
TIGARD INDUSTRIAL LLC WILLAMETTE HVAC
11336 SW BULL MOUNTAIN RD #103 PO BOX 23334
TIGARD, OR 97224 TIGARD, OR 97281
Phone: Contact #: PRI 503 - 628 -6841
FAX 503 - 848 -2597
FEES
Description Date Amount Reg #: ELE 34- 346CRE
ELPRMTI ELC Permit 11/21/200' $66.85 LIC 56951
1
(TAXI 8% State Surcharge 11/21/200' $5.35 SUP 4025LEB
Total $72.20 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 thro gh OAR 952 - 001 - 0100. You may obtain copies of these rules or direct questions to OUN.0 at 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature; {VX -e--c �
i
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 _ ' B ' F ' I ` `` r` 0 � ,''
FOR OFFIC IJSE'O . 716, - f `' e R
a t-i Y,: or,tks9 -s ' . 4 -4±: iintir " ar ,ai l- '
C ity o Tigard � � i Received I permit No s
r f K 23"� Date
II
/By: 0 9 B6
Plan Review 11 J G��- �tJ07 ��
13125 SW Hall Blvd., Tiga O 9 I
C Other Permit:
Ph one: 503.639.4171 Fax: 503.59
� 21 10U1 Date/By: DT I - '- It D. Inspection Line: 503.639.4175 Date Ready /By: Inns: ® See Page 2 for
# Internet: www.tigard - or gov
CITY of- IUD Notified/Method: Supplemental Information
TYPE 'rrl l 9 TH' `TdGDIVIIgtS ON PLAN. REVIEW,
❑ New construction [Addition /alteration /replacement 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.
` .
C 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: , F' 0 G 4to � e c T'' occupancy.
❑
❑ Six or more residential units. Recreational vehicle parks.
City/State /ZIP: — 0/c 9 7 0 ' 3 ❑ Health -care facilities. ❑ Supply voltage for more than
�� ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE' SCHEDULE
Cross street/directions to job site: Description 1 Qty. I Fee. 1 Total I •
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'l 500 sq. ft or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
' DESCRIPTION OF WORK . (with above sq. ft.)
y �J Limited energy, multi- family 75.00 2
_,) S C ec�:.1 1. o,N �` Re_ cc: AA- e c residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
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 ■
Address: 9 �� S w T..e ` r`" r ia T Over 1,000 amps or volts 454.65 2
City/State /ZIP: _ Q �� V 4 Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
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 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 1 ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: I ` . Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: ( ) I Fax ( I) Reconnect only f 66.85 l 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR .4 ,," ,; / Sign or outline lighting 53.40 2
Busi name: 44.14.0.,,A AI Ua e l i0 � e energY pane al (r limited -
energy panel, alteration, or
Address: rd /70 X D 3 3 74/ Al , l ,,,/- A extension. Describe: Page 2 2
,
City /State /ZIP: 7 O 7 4r/ !' � Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (R,3 ) 6%7 _ K - ,‘ Fax: (S03 )" 7 —'L S 2 q -7 Investigation per hour (1 hr min) 62.50
CCB Lic.: .... 6 9S/ ,\.• Electrical Lic.: Q Q prv. Lic.: L/02 Industrial plant per hour 73.75
, ELECTRICAL PERMIT FEES'.
Suprv. Electrician signature, required: • �- JQ I t/" Subtotal:
Date: // - 2 f —CJ Plan review (25% of permit fee)
Print name:
.711(i/e„._ < cA� State surcharge (8% of permit fee): � �
Authorized signature: TOTAL PERMIT FEE: `7 .e 9
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.doc 05/23/06 440- 4615T(1I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information •
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
n 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:
n Audio and Stereo Systems
❑ Boiler Controls .
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical •
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ P rotective Signaling
n O ther
Total number of commercial systems:
*No licenses are required. Licenses are required
for'all other installations
1: \ Building 'Permits\ELC- PermitApp.doc 03/23/06
r �
Community Development
Request for Permit Action
TI GARD - 3
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor f rK City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual)
V 0 �� ( Mailing Address:
( �'✓ City /State /Zip:
0:0Le eorrri
Phone No.:
PLEASE, T A CTION FOR THE ITEM(S) CHECKED (1):
C ERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: L C t D s /— D 6 7!5 d 1 (.Q jed w L`= L/ZOI f -b 7
Site Address or Parcel #: 9f24 5 s
Project Name: r- y /L'S
Subdivision Name: Lot #:
EXPLANATION: (p, 4 hv' / / G2rj 4r ��/ / ?� G
Gi� Date: 3/1/ / S/
Signature: d
Print Name: eeli /L/s 5
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fcc when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fcc when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
sFO OFFICE USE:ONLY'e . ° ," . . gYa-y y;
Rte to Sys Admin: Date B Rte to Bld. Admin: Date e'er ® By _
Refund Processed: Date 4'AIIIII B ' _t %j Invoice Processed: Date B
Permit Canceled: Date , / dfr " B ' � _.Parcel Tat Added: Date By
Recei t # Date Met od Amount $
1: Building \ Forms \RcgPcrmitAction.doc Rev 07/26/07
CITY OF TIGARD
BUILDING DIVISION PERMIT #: LLC20r17 007F18
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/2112007
Phone: (503) 639 -4171 _. Vait
Inspection Requests (24 Hrs.): (503) 639 -4175 _:.
INSPECTION WORKSHEET FOR DATE 81002000 TIME: 7 :00AM PAGE: 22
SITE ADDRESS: 09826 SW TIGARD ST CLASS OF WORK:
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. LOT #: 021 TYPE OF USE:
PROJECT NAME: FRY ELECTRONICS
DESCRIPTION: Reconnect
OWNER: I GARD INDUSTRIAL. 1.1C, PHONE #:
`
CONTRACTOR: WILLAMETTE AMETTE I..IVAC PHONE #: 503 - - 6841
Inspection Request Scheduled For: Date 8/B/2008 Pour Time:
Code # Inspection Description i Confirm. Contact # Message
1`x'8 Electrical final 073962 -02 `� 603 -422 -1991 Y
Corrections /Comments /Instructions:
.� ) t
/ 'PA .
\\I \J
0
..._________________________,
Riro_Ac.e war\ E. LC, 2c 00213 I
G-, NOB CE S.$. $
.
PASS ❑ PARTIAL APPROVAL rA CANCEL n NO ACCESS
n FAIL n CALL FOR INSPECTION ❑ ADDITIO■• ' L FEES ASSESSED
Inspector: G---- N 6e (-� -- Date: D' li Phone #: (503) 718- 2 446 . 4ty
CITY OF TIGARD
BUILDING DIVISION PERMIT #: FL C 007 0,17138
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11 /21 /2fl )7
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 71: •1/20f18 TIME: 7:00AM PAGE: 47
SITE ADDRESS: O982( SW TIGARD ST CLASS OF WORK:
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. LOT #: 021 TYPE OF USE:
PROJECT NAME: FRY ELECTRONICS
DESCRIPTION: Reconnect
OWNER: TIGARD INDUSTRIAL. LI PHONE #:
CONTRACTOR: WILLAMETTE HVAC PHONE #: 603
Inspection Request Scheduled For: Date: 2J21/2000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 0€345.01 503.970 -9.277 N
Corrections /Comments /Instructions:
�i
Oil E fv ► ALbN a,dO fleetZz\
'QCL t, s E A 'Cbti \ teQ1`N ► ell 411 0IS<_661 C. >
P(4 6-f 2w IA-01k
n PASS n PARTIAL APPROVAL ❑ CANCEL fl NO ACCESS
FAIL CALL FOR INSPECTION L i ADDITIONAL FEES ASSESSED
Inspector: G ' C-G Date: 12 'O1 Phone #: (503) 718 - 1.4