Permit rr. ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00566
DEVELOPMENT SERVICES DATE ISSUED: 9/7/2004
I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S136DC-02504
SITE ADDRESS: 07295 SW DARTMOUTH ST
• SUBDIVISION: PP1995 - 013 ZONING: C -
BLOCK: LOT : JURISDICTION: TIG
Project Description: (2) circuits for A/C unit.
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/ FOR: 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: 1 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:
SUPERVALU HOLDINGS INC BY BURKE OREGON ELECTRIC CONST /GROUP
3336 E. 32ND ST #217 1010 SE 11TH AVE
TULSA, OK 74135 PORTLAND, OR 97214
Phone: Phone: 503 - 234 - 9900
Reg #: LIC 203
SUP 4460S
FEES ELE 26 -95C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/7/2004 $53.50
[TAX] 8% State Surcharge 9/7/2004 $4 Rough -in
Elect'I Final
Total $57.78
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)
246 -6699 or 1-800-332-2344.
Issued By: Z . ci Permit Signature: _ v _ AAT
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 639 -4175 by 7:00pm for an inspection the next business day •
\ SEP -03 -04 08:29AM FROM — Oregon Electric Estimating 5032313587 T -318 P.001 /002 F -311
' tiectrlcdl rermit AppIlcauull t - "• n . • •
City of Tigard O D /B 9 --. 7 V /V Permit No.; (,Ca2 'O y O') 6
13125 SW Hal] Blvd., Tigard, OR 97 r � Plan Review Other Permit:
Phone 503.639.4171 Fax; 503.598!l9'60 sh d "c ligyi Dntcat
Inspection Line: 503.639.4175 (C
J�� O L ,,, • �l u Date Ready/By: Juris: ® See PuEe 2 for
Internet Www.ci.tigard.or,tis Notified/Ivlethod: -r1 (r Supplemental Informarion
• . TYP F�oFGWORI{ ; �y�� :: • PLAN .REVIEW
1 rt t - Please check all that apply:
❑ New construction ® Ad BUAn /�lt
El Service over 225 amps, comm'l ['Hazardous location
❑ Demolition ❑ Other; ['Service over 320 amps — rating ❑Buiidng over 10,000 sq. ft.,
CATEGORY.�OF :CONSTRUICT1lON : • of 1- and 2- family dwellings 4 or more new residential
• ❑ 1- and 2- family dwelling ® Cormnercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
['Building over three stories ❑Feeders, 400 amps or more
❑ Multi- family ❑ Master builder Q Other: _ ['Occupant load over 99 persons ❑Manufactured structures or
JOB S1i.T:E INFORMATION INFORMATION.' AND ILOCAT1ON: ['Egress/lighting plan RV park
Job no.: 51718 Job site address: 7295 SW Dartmouth St ❑ Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City /Stare /ZIP: Tigard, OR 97223 The above are not applicable to temporary construction service.
no.: Project name: Old Poppy Box Store FEE• SCHEDULE i o.riood I Qty. I Fee. I TOW I ••
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage -
1,000 sq, ft, or less 145.15 4
Subdivision: Lot no.: Ea. add'] 500 sq. fl. or portion 33.40 1
Limited energy, residential 75,00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
. • , DESCRIPTION':OF WORK • - Each manufactured or modular
Two circuits for A/C units dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocatio
200 amps or less 80.30 2
❑ ,Q.ROPERTY OVER TENAlV I • . • 201 amps to 400 antes 106.85 2
401 amps to 600 amps 160.60 2 _
Name: J % \ - \--; 0\ (K v..- t ��� s.J 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: ( ) I 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, lease, 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 extension, per panel • ..[] ,g YOAr .r :: I . !, ❑' CONTAcr PERSON .: :: A. Pee for branch circuits with
service or feeder fcc, each
6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, / '�
e ach branch circuit 46.85 Y- 2
Address:
y _ Each add'l branch circuit / _ 6.65 �j, f
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-
. •'' :CONTRACTOR: 1 " • ' energy panel, alteration, or
extension. Describe; Page 2 2
Business name: Oregon Electric Group _
Address: 1010 SE 11th Ave Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: Portland, OR 97214 Investigation per hour (1 he min) 62.50
Phone. (503) 535 - 2662 I Fax: (503) 231-3587 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lie.: 203 Electrical � i. -9 C uprv. Lic.: 44605 S u b total
Suprv. Electrician signature, required; Plan review (25% of permit fcc)
Print name: a . 44 . 1 �/ t / , Date 'A/6. State surcharge (8% of permit fee) �
y1 — TOTAL PERMIT FEE 7
Authorized signature ///��� : 7 .1 -., 14 This permit application expires if a permit is not obtained within 180
/
w C i /_ days after it has been accepted as complete
Print name: - rue methodology set by'D 'Di-County Building g Industry Service Board
1 f % / f Date; l Ci / •• Number ofinapection per permit allowed`
i tfuilding \Pcrmilt \ELC-PermitApp.doc 12/03 440- 4615T(10,02/COM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line:_ (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/ BUP
Received / D / Date Re J
sted o AM PM BUP
Location 7a
-9S ' Suite MEC
Contact Person X . . ) Ph ( 5 a z 9 -.255"/ PLM
Contractor Ph ( ) SWR /
BUILDING Tenant/Owner ELC , e , �'"10 -6 6.
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: A SIT
Post & Beam /
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall , 1 l� p D ` a[/ 5 FtA '-
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ZEI
Service
Rough -In 4/
UG /Slab
Low Voltage
Fire Alarm {,Q
J � ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART F L
S ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line l O / 1604 /�,s_ ,� ADA (1,L
Approach/Sidewalk Date I nspec t o r Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL