Permit .11 CITY OF TIGARD ELECTRICAL PERMIT
T
IL
COMMUNITY DEVELOPMENT DATE ISSUED: PERMIT #: 9/28/2007 ELC2007 00677
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S112AC
SITE`ADDRESS: 14865 SW 74TH AVE 170 ZONING: I - P
SUBDIVISION: METRO PART /MLP2002 -00007 LOT : 001 JURISDICTION: TIG
PROJECT: A & A DISTRIBUTION
Project Description: Walk in freezer power.
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: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: WISERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 4 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:
ACTION FUND RAISING ST JOHNS ELECTRIC INC
14865 SW 74TH AVE. #170 4415 NE MINNEHAHA
TIGARD, OR 97224 VANCOUVER, WA 98661
Phone: 503 - 684 - 9899 Contact #: PRI 360- 693 -5100
FAX 360- 699 -1345
FEES
Description Date Amount Reg #: ELE 37 -350C
[ELPRMT] ELC Permit 9/28/2007 $73.45 LIC 43135
[TAX] 8% State Surcharge 9/28/2007 $5.88 SUP 3024S
Total $79.33 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. Ail
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 too O at 503.246.6699 or 1.800.332.2344.
Issued By: d-J/4A_., Permittee Signature: O \ c j
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.
28. -2007 9:50AM St Johns Electric No.4492 P. 1/2
- r c21 Permit A 1 1 ,, r 5)i FC1lt -OFI 1 F. C C)�1
Y
Tigard - q
23125 SW Hall Blvd., Tiger , 0 97223 2 007 Date/By, / _ O Pemtit No.�� 7-w
Phone: 503.639-4171 Fax: 50401-1960 R _, :1. t . , I . l a �B Other Permit
Inspection Line: 503.639.4175 Li. ,,,
■ a � t Data • y
11:1"-- ae for
Internet www,ci.tigard.or.us CATY ROOD $ Notifted/Metbod: Supplemental Information
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New construction \ Addition/alteration/replacement • case eel( all that apply: w
[] Demolition ❑Other:
❑Service over 225 amps, comm'I ❑Hazardous location
m ., r . Y ,.. , r ,, 5., LA':;5774., , ,, ,. gym ❑Service over 320 amps - rating ❑Bulldog over 10,000 sq. ft
% , .; tii_,L4, s ; .,•a ' :Y.4 :C� 1�a ::; X` ._.i : : M • ' ! i ! �7 , , � '` 1 t : 1:i7 G .: r. , i.;�'.. t \V_ rl ; ; N; ,• 7 4 �; : 7 id y v
i,,... i sm. + , �,r� , •'r-� :,:�.. ks.. ; 1� ti , ;. -.� b ti „ , � z e : ?_l�i , f " ; x1 of 1 -and 2- family dwellings 4 or more new residential
yr s= sx mxrneam ^es
❑ 1- and 2 - family dwelling a. Commereial/industr Q Accessory building ['System over 600 volts nominal units in one structure
p Multi - family ❑ Master builder ❑ Other:
❑Building over three stories ['Feeders, 400 amps or more
1 r, (ti '^" 'C5 '"' 7 i C^."s 7, r a rr i tar r :a T 4 �T'"
['Occupant load over 99 persons DMnnufactured structures or
:Ft. ti x t r f.a K d 9' 1 i 0 .3 i 7� i U >* 9 i axi y
i��:�� }�� ����;.�,z �.i�: ,.� �,.��,��� ��.�T:� ����.�;�.� � °� a>;gr�snight;ng plats RV park
Job no..:5 Job site address 4/ � S ❑ Health -care facility
['Other.
�; ^ / Submit? sets of plans with any of the above.
City/Statc / (/Z1P: 6 4 / tJ,Q 9 The above arc not applicable to temporary construction service.
�.` .f l 4S, �r..s ) . F „z.. 7 ,�r ,1. 9 ,,t r
Suite/bldg. /apt. no.; /70 Project name Q4' /(/� //v6 Vii. t / :;a i" { -r;; i 7 " ,.4 ,u;
Decriptioa ... Qty ' 1 � Fee_ 1 Tat■! •
Cross street/directions to job site: 51/1 6O�rri9• D New residential single - or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or Icss 1 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Fax map /parcel 110.:
Limited energy, residential 75.00 2
Limited energy, non- residential 75.00 2
4 ; 1 ; ZetafrOM %< „ ..,,. s,, c !'r ►' . g ,r ; ' 4 *W,4.5 Each manufactured or modular
dwelling, service and/or feeder 90.90 2
1 �/
-_74/ 41 i1 J. • .4- Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
+ .. n 1r3mae a tv 201 amps to 400 amps 106.85 2
' t. it' l ;i` , +r -r - 4,c..d • ,A 401 amps to 600 amps 160 -60 2
Name: . 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /Zip: Temporary services or feeders installation, alteration, and/or
Phone: ( ) 1 Fax: ( ) relocation
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, least, rent, or exchange, according to ORS 447, 449, 670, and 701, 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extengion, per panel
Mfr )' ,t* s «, • « ^' It t" A.
h � . •�� . �, ��� b � �z , « '
'' 3 •'�` `�'' " '`' i ' ' �� " °` r �� ® v. Fee for branch circuits with
service or feeder fee, each
Business name: branch circuit 6.65 2
Contact name: B. Fee for branch circuits
without service or feeder fee, / 46.85q , g' ' 2
each branch circuit
Address: , Each ;Mtn branch circuit !Si 6,650 ( 2
City /State /ZIP: _Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
r. r �. '°: ? x ,- ; . F4�+ "• energy panel, alteration, ' �bk. �''�d��i�,a�f^ �; %i'���lsz r� `- -'�a �. �� �1i�S:t�;�'r;...'$i`s'-, •'�� , �' gyP r
0 0
n'I ,, / � ' extension. Describe: Page 2 2
Business name: s OH/V SV 0 & C
Address: L/ / q / v G iv j � /p� //77 i4 (577-. Each additional inspection over allowable In any of the above
T Per inspection 62.50
City /State/ZIP: / a A . w., 9ffi!'/l� Investigation per hour (1 hr min) 62.50
Phone: ( U4/' 6 93 .500 Fax :( ',) , •do Industrial plant per hour 73.75
L +v .'. 5h'i?!t:�.'..'a7 �ir'« $ ,t d7••. �Sii'�r 9-4:1 R
CCB Lic.: / d Electri r ic.: y� uprv. Lic.: 35( S ubtotal ' 16, T
�
Suprv. Electrician signature, requi •: ♦41•111 Plan review (25 %ofpermit fee) ‘.7. � `�
■ State surcharge (8% of permit fee)
Print name: 'jam AR t Date: • a.7 . 3
TOTAL PERMIT FEE �� s. Authorized signature permit application expires if a permit is not obta of ed within 1811
days after it has been accepted as complete
Print name: *) Date: �,
,4 v Fen methodology set by Tri -County Building Industry Service Boar]
r' Number of inspections per permit allowed.
is�8uitding \ Permits \ELC•PermitApp. 11103 410- {615T(10 /02/COM4Vta �4 e_ F 4)( Porn miineER
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CITY OF TIGARD
BUILDING DIVISION
PERMIT #: ELC2007-00677
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: R'78/2007
Phone: (503) 639-4171 1.
INSPECTION Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 10/2612007 TIME: 7:01AM PAGE: 38
SITE ADDRESS: 14866 SW 74TH AVE 170 CLASS OF WORK:
SUBDIVISION: METRO PART/MLP2002 LOT #: 001 TYPE OF USE:
PROJECT NAME: A & A DISTRIBUTION
DESCRIPTION: Walk in freezer povver.
OWNER: ACTION FUND RAISING, PHONE #: 50-684-9999
CONTRACTOR: ST JOHNS ELECTRIC INC PHONE #: 360-693-5100
Inspection Request Scheduled For: Date: 10125/2007 Pour Time:
Code # Inspection Description 9:infirm-# Contact # Message
199 Electrical final frE 0683211 360-693-6100 > Y
Corrections/Comments/Instructions:
1 30 N c)? $.
\,1\
PASS PARTIAL APPROVAL 0 CANCEL n NO ACCESS
fl FAIL El CALL FOR INSPECTION P1 ADDITIONAL FEES ASSESSED
Inspector: CY s kse L4 Date: 1 611.9 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC20( }7 -00577
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/28/2007
Phone: (503) 639 -4171 iv/ ∎
Inspection Requests (24 Hrs.): (503) 639 -4175 __
INSPECTION WORKSHEET FOR DATE: 10117/2007 TIME: 7 :02AM PAGE: 45
SITE ADDRESS: 14865 SV1! 74TH AVE 170 CLASS OF WORK:
SUBDIVISION: METRO PART /MLP2002 -00007 LOT #: 001 TYPE OF USE:
PROJECT NAME: A & A DISTRIBUTION
DESCRIPTION: Walk in freezer power.
OWNER: ACTION FUND RAISING, PHONE #: 583. 8849899
CONTRACTOR: .5"1" JOHNS ELECTRIC INC PHONE #: 360.893 -5100
Inspection Request Scheduled For: D 10/1 7/2007 Pour Time:
Code # Inspection Description , Confirm # Contact # Message
199 Electrical final 057734 -01 1 360.693 -5100 N
Corrections /Comments /Instructions:
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Pam`$ ► 411• It. 6l - 4 k v
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10 Pct.56vAbE N ails leo co 6Aati .
i bi te-a (st._ .
PASS n PARTIAL APPROVAL CANCEL ❑ NO ACCESS
FAIL X CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: G NS E• l-E Date: lb I Phone #: (503) 718- MO0