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Permit
CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2009 -00031 I/ 'COMMUNITY DEVELOPMENT DATE ISSUED: 1/21/2009 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 (4) 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: 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: 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 1/21/2009 $66.80 LIC 171892 [TAX] 12% State Surchar 1/21/2009 $8.02 SUP 6885 Total $74.82 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 may obtain copies of these rules or direct questions to OUNC at 503.2.6699 or 1.800.332.2344. Issued By: oA.A 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: 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 RECEIVED FOR OFFICE USE ONLY City of tigard Received q Date : t . - 0 -A Permit No.: I C aic[a . 06 03 ° 13125 SW Hall Blvd., Tigard, OR 97223 JAN 2'1 2009 Plan Review ( vT • Phone: 503.639.4171 Fax: 503.598.1960 nil Date/By: Other Permit: TI G A R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: El See Page 2 for Internet: www.tigard -or.gov BUILDING DIVISION Notified/Method: ) ( Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): nn, ❑ Service or feeder 400 amps or more ❑ Building over three stories. 1:1 ._ Demolition ,Other: 4 (LCzt 1 c V RS.) C (TS 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 R_CommerciaUindustrial ❑ 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: �, r 100HP or more. occupancy. , l CI Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: J ❑ Health -care facilities. ❑ Supply voltage for more than ty 4 L C1� L ! 2_1* ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: 1,4 kb 3 4(�' n 3 ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: v p l „ ��.4 Description I Qty I Fee. I Total I • New residential single -or multi- famiy dwelling unit. PA-C. I � C 1-601 ' —` garage. Includes attached 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 ' DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 IP Limited energy, multi - family 14 L� _1C..A -__ C ` } `"►IC residential (with above sq. ft.) 75.00 2 1 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 2 601 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 1 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 I ❑ CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: CA �ID B. Fee for branch circuits Contact name: without service or feeder fee, I 46.85 2 first branch circuit Address: Each al branch circuit 3 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 2 /^ Signal circuit(s) or limited - Business name: 1" f 0 e- -- -z .,, energy panel, alteration, or Address: 3 S(..AJ '1-60 extension. Describe: Page 2 2 City/State /ZIP: P© ( O -N 0 a 7a \ Ck Each additional inspection over allowable in any of the above } Per inspection 62.50 . Phone: (5-'65 C9•-5 7774 Fax: ( ) Investigation per hour (I hr min) 62.50 CCB Lic.: 1 Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: i e (o .8 O Print name: Date: Plan review (25% of permit fee): State surcharge (12% of permit fee): 9. Q Z Authorized signature: TOTAL PERMIT FEE: —7/4 . 52.. 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. I: \ Building \Permits\ELC- 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 I: \ BuildingWermits \ELC- PermitApp.doc 03/23/06 CITY OF TIGARD ° COMMUNITY DEVELOPMENT TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 Electrical Signature Form IMPORTANT PERMIT NOTICE CHANCO INC 3521 SW CARSON 6‘-)C at PORTLAND, OR 97219 . 2x • U Permit #: ELC2009 - 00031 Date Issued: Parcel: 2S110AB -00200 Site Address: 14363 SW PACIFIC HWY Subdivision: CANTERBURY SQUARE Lot: 1 - Jurisdiction: TIG Zoning: C -G Project Name: LAS JARAS Description: Install (4) branch circuits. 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 #: 503 - 245 - 7774 Reg #: ELE C209 LIC 171892 SUP 688S AN INK SIGNATURE IS REQUIRED ON THIS FORM X Signature of Supervising Electrician Name (printed) SUP LIC # • Ul Y OF TIGARD COMMUNITY DEVELOPMENT RECEIVED • "\ 13125 SW Hall Blvd., Tigard, OR 9722 .503 . 6 35.4171 JAN 2 2 2009 Electrical Signature Form C ITY OF TIGARD BUILDING DIVISION IMPORTANT PERMIT NOTICE CHANCO INC 3521 SW CARSON PORTLAND, OR 97219 Permit #: ELC2009 - 00031 Date Issued: Parcel: 2S 110A13-00200 Site Address: 14363 SW PACIFIC HWY Subdivision: CANTERBURY SQUARE Lot: 1 - Jurisdiction: TIG Zoning: C -G Project Name: LAS JARAS Description: Install (4) branch circuits. 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 #: s03 zds - ma Reg #: ELE C209 LTC 171892 SUP 6883 AN K ji ATURE IS REQUIRED ON THIS ORM 'aignature of Supervising Electrician (h� /•"" bM5 Name (printed) SUP LIC # I'd tP08bt OS 21311114UH0 3Aua ?JO 3)1I W da T : SO 60 T2 UeC CITY OF TIGARD 1 BUILDING DIVISION PERMIT #: ► l c ?410 4l(14)3'f 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: I/210009 Phone: (503) 639 -4171 A i u Inspection Requests (24 Hrs.): (503) 639 -4175 F'I � I INSPECTION WORKSHEET FOR DATE: /22/2009 TIME: 7_gt }AM PAGE: 1 i SITE ADDRESS: 14363 SW PACIFIC HWY CLASS OF WORK: SUBDIVISION: CANTERBURY SQUARE LOT #: 1.3 TYPE OF USE: PROJECT NAME: I A;; JARAS DESCRIPTION: Install (4) branch circuit OWNER: KOI 0 C, PHONE #: CONTRACTOR: CHANCO INC PHONE #: 503 -245 -7774 Inspection Request Scheduled For: Date: 1/2212000 Pour Time: Code # Inspection Description Co irrn -#, Contact # Message 199 Electrical final 07 920-01 503-245-7774 N Carr ions / - • ments /In- 'ins: h. :'o, k ,00 - sip •` A Z.. ��'� ∎ l .' 61tf\ t1 �l'.� tiii 1f6:70331 \ N e i _ 1 N , 1, N N (_ \\. ,\ \) \ ,.„\ ic \\\. 7 LPASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED n1�( 1� Inspector: G' Nis e 1....t- Date: 1' III Phone #: (503) 718 -