Permit CITY OF TIGARD ELECTRICAL PERMIT
71 ° PERMIT #: ELC2008 00618
° COMMUNITY DEVELOPMENT DATE ISSUED: 11/3/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 110AB -00200
SITE ADDRESS: 14363 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: CANTERBURY SQUARE LOT : 1 -3 JURISDICTION: TIG
PROJECT: LAS JARAS
Project Description: Install (1) sign lighting.
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: 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: 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:
KOLVE, G C CHANCO INC
14389 SW PACIFIC HWY 3521 SW CARSON
TIGARD, OR 97224 PORTLAND, OR 97219
Phone: Contact #: PRI 503 - 245 - 7774
FAX 503 -244 -4804
FEES
Description Date Amount Reg #: ELE C209
[ELPRMT] ELC Permit 11/3/2008 $53.40 LIC 171892
[TAX] 12% State Surchar 11/3/2008 $6.41 SUP 688S
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 181 • ays. ENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 -01 -0010 throu• ' OA • •2- 001 -0100. You may obtain copies of these rules or direct questions to NC at 503.246.6 99 0 1.800.332.2344.
/ /
Issued B : /' ! Permittee Signature:
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: i ' ' Si - A A._..__ f _ _ .A. . DATE:
LICENSE NO: I /
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 A licat' !m-, 21111ILMIXINI
p EI 4-'r Received
City Ol Tigard DateB . Permit No : -s
13125 SW Hall Blvd., Tigard, OR 91 2009 Plan Review
Phone: 503.639.4171 Fax: 503.59 DateB : Other Permit:
Inspection Line: 503.639.4175 1 Date Ready/By: lug ® See Page 2 for
Internet: www.tigard-or.gov i' ~ `E' 0!. r1{)ARD Notified/Method: Supplemental Information
TYPE 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.
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 ❑ 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: 100 HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
Z 2 r L 3 ❑ Health-care facilities. ❑ Supply voltage for more than
City/State/ZIP: '
❑ 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 Qt v. Fee. Total
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'1 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
DESCRIPTION OF WORK with above s q. ft. 67.84 2
Limited energy, multi-family 67.84 2
' ~a2 residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 1,11111,LI~~ ~g Cam, OV-1, ~ 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP:/~~~ ZZ 3 Temporary services or feeders installation, alteration, and/or
relocation
Phone: ~SD Fax: 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits wilh
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 56.18 2
first branch circuit
Address: Each add'I branch circuit 7.42 2
Miscellaneous service or feeder not included
City/State/ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRA OR Sign or outline lighting 67.84 2
Business name: Signal circuit(s) or limited-
energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State/ZIP: Each additional inspection over allowable in an of the above
Per inspection 66.25
Phone: ( ) Fax: ( )
Investigation per hour (I hr min) 66.25
CCB Lie.: Electrical Lie.: Suprv . Lie.: Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee): ,
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtai ed within 180
Print name: 4!~; Date: &41- e' days after it has been accepted as complete.
* Number of inspections allowed per permit.
:\Building\Permits\ELC-PermitApp.doc 10/01/09 4404615T(I1/05/COM/WEB
• 'Electrical Permit Application FOR OFFICE USE ONLY
Red
City of Tigard Re e ive Og Permit No.: LD G & -�Q�OI g
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
1,11 C . Phone: 503.639.4171 Fax: 503.598.1960 ceive
Dateiny: Other Permit:
T I G R D Inspection Line: 503.639.4175 Date Ready/By: to 0 See Page 2 for
Internet: www.tigard - or.gov Notified/Method: 1 6. Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction El Addition/alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: j if_Uryti1Vp r f,) S lC RL P lar 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 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: J 43r `� s� � (4 )_ Six or more e r es. R occupancy. Recreational vehicle parks.
_ `"''"" ` ❑ Six or more residential units. ❑ Recreation
City/State /ZIP: 0 ,,, ; _ x , 2 C.' ❑ Health-care za Hazardous fcation ❑ Supply voltage for more than
r ❑ Haurdous locations. 600 volts nominal.
Suite/bldg. /apt. no.: J Project name: LA6 J �6 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 0,A-MI—L-742—(b0 5 Description I Qty. I Fee. I Total I •
��� New residential single- or multi- family dwelling unit.
, OOP? t IJ C �.%NST (1--- 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. ft.)
n A Limited energy, multi - family
4 (ST(t S( ( residential (with above sq. ft.) 75.00 2
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: G p..v 1( L v Z 401 amps to 600 amps 160.60 2
I t r /� I , 601 amps to 1,000 amps 240.60 2
Address: l� � I t :c- C TW Over 1,000 amps or volts 454.65 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: 11�� O 47 ZZ relocation
Phone: 5,3 G,,Q0 g 087 Fax: w' t S8 t\ 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, a rent, or ha , 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: l / A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name: 46.85 2
first branch circuit
Address: Each add'l branch circuit 6.65 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 3. 2
Business name: !
C�� Signal circuit(s) or limited -
T C e, energy panel, alteration, or
Address: ` G aa-� extension. Describe: Page 2 2
City/State /ZIP: K 1) 0e- qua Iq Each additional inspection over allowable in any of the above
3 � l� Fax: /aG.3) Per inspection 62.50
Phone: ( ) at
�� � 14/50.1 Investigation per hour (I hr min) 62.50
CCB Lic.: 171ppg_ Electrical Lic.ege:pi Suprv. Lic.:7 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: .`J 7, etb
Print name: T)hll ,A-()D LG9- Date:
Plan review (25% of permit fee): $-
State surcharge (12% of permit fee): ee , Vi
Authorized signature: TOTAL PERMIT FEE:
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
t:\ Building \Permits\EL.C- PermitApp.doc 05/23/06 440-4615T(11/05/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*
❑ 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
1:\ Building \Permits\ELC- PermitApp..doc 03/23/06
Nov 03 08 04:57p MIKE OR DAVE CHANDLER 5032444804 p.
CITY OF TIGARD
COMMUNITY DEVELOPMENT •
' .' K ° 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
•
Electrical Signature Form
IMPORTANT PERMIT NOTICE
CHANCO INC •
3521 SW CARSON
PORTLAND, OR 97219 •
Permit #: ELC2008 - 00618
Date Issued: 11/312008
Parcel: 2S110AB -00200
Site Address: 14363 SW PACIFIC HWY
Subdivision: CANTERBURY SQUARE
Lot: 1 - 3
Jurisdiction: TIG
Zoning: C - G
Project Name: LAS JARAS
Description: install (1) sign lighting.
Your company has been indicated as the electrical contractor for the permit referenced above. In order for the electrical
permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from
your company sign below and return this Electrical Signature Form prior to the start of the work. Please mail the form to:
City of Tigard, Building Division, 13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681.
if you have any questions please call 503.718.2433.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR;
KOLVE, G C CHANCO INC
14389 SW PACIFIC HWY 3521 SW CARSON • TIGARD, OR 97224 PORTLAND, OR 97219
Phone #: Phone #: 603 245 - 7774
Reg #: ELE C209
ix 171892
SUP 688S
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Lk) c1 L✓ Mkt u r( 1,0 C` La 14 c I.l
Signature of Supervising - Electrician Name (printed) SUP LIC #
•
•
CITY, OF TIGARD
BUNG DIVISION PERMIT #: fit..:?OO -() i€
1312 Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11f`3;2o(.I;;
Phone: (503) 639 -4171 • ill
Inspection Requests (24 Hrs.): (503) 639 -4175 "_.-.
INSPECTION WORKSHEET FOR DATE: 1/7/2009 TIME: 7:01AM PAGE: 32
SITE ADDRESS: 11363 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: CANTERBURY SQUARE LOT #: 1 - 3 TYPE OF USE:
PROJECT NAME: LAS JARAS
DESCRIPTION: Insla!! (1) sign lighting.
OWNER: KOLVF, G C, PHONE #:
CONTRACTOR: L'.p IANC+ INC
#: 503-245-7774
Inspection Request Scheduled For: Date: 1/7/20021 Pour Time:
Code # Inspection Description (omi€; onfirm # Contact # Message
'193 Electrical fins.! 01 503-793-3336 - Y
Corrections /Comments /Instructions: 1/2_ P
io`Q : b - P c� N0\11 a $ uA3 (poi
bil (C. „k, 4 4 ,_. -_ - . KC,__cA .
a ,.. --
. ,4,1, r►L f 1 0 6t) 'i
1 1 _ Ps. LL L' ,.../ 1 \ ' 1i '
106kLS . A -
1--0)1 E LL'''QII d a tP iilL.
w P
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
U CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 5 N 6(6 Date: 1,' 1 ' C t Phone #: (503) 718 - .10)______
CITY -OF TIGARD
. BU ,DING DIVISION PERMIT #: El ..C
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 111302()011
Phone: (503) 639 -4171 ill a
Inspection Requests (24 Hrs.): (503) 639 -4175 . ' .-
INSPECTION WORKSHEET FOR DATE: 12/12/2008 TIME: 7:00AM PAGE: 30
SITE ADDRESS: 14363 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: CANTERBURY SQUARE LOT #: 1 -3 TYPE OF USE:
PROJECT NAME: LAS JARAS
DESCRIPTION: Insiall (1) sign lighting.
OWNER: KOLVE, (3 C PHONE #:
CONTRACTOR: CHANCO INC, PHONE #: 503 - 245 - 7774
Inspection Request Scheduled For: Date: 12/12/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 070971 -02 503 - 793 -3336 Y
Corrections /Comments /Instructions: A LPN - 3i 02-8
i• a tsj Vacx_vv:iit- . 41W(.-4§.... ? (0 Attiv
A,4r3 ctst.lopsirN ril-Lt`V4 Zi-
ook.
n PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL _7,, CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: uV la-G Date: 1141 1 411 Phone #: (503) 718- _ f o