Permit •
IN CITY OF TIGARD ELECTRICAL PERMIT
RN
PERMIT # : ELC2008 -00572
COMMUNITY DEVELOPMENT DATE ISSUED: 10/7/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 126CA -01000
SITE ADDRESS: 09009 SW HALL BLVD 142 ZONING: C - G
SUBDIVISION: WASHINGTON CIRCLE PLAZA LOT : JURISDICTION: TIG
PROJECT: SUSHI HANA
Project Description: Reconnect only.
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: 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: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
WASHINGTON SQUARE PLAZA
BY THE CAFARO COMPANY
P 0 BOX 422
FLORHAM PARK, NJ 07932
Phone: Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 10/7/2008 $66.85
[TAX] 12% State Surchar 10/7/2008 $8.02
Total $74.87 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 • - . ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 -4: -0010 throu• 0 r 952- 001 -0100. You may obtain copies of these rules or direct questions to OUNC a 0 .26.6699 or 1.800.332.2344.
Issued ,,y: �L :, Permittee Signature: �� %, /,�
OWNER INSTALLATION ONLY if
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.
Elec Permit Application FOR OFFICE USE O NL Y
City of Tigard Received
Dctr,(13y .. Permit No.: e.„/„C az- 06- -CO 97Z
lig
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C ; ' Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit.
TI G A R D inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for
Internet: www.tigard or.gov 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):
❑ 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
.� .�o,. t ❑Emergency system larger separately derived system.
:=
r, . * ; ,. JOB' SITE INTORMATION M ANI LOCATION -',,, >, �
.. .. _. ' ID Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: Job site address: 9 9 4f 6 100HP or more. occupancy.
"----� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ' / ( � , -7 v
/ �j ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: 5( 0 (4 ❑ Service or feeder 600 amps or more.
.'''T E E,SCHEDI E�,: : _ ° :.>w ;',:;,','''
Cross street/directions to job site: Descriptio I Description I Fee. I 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
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
y DESCRIPIIO , OF,: W,ORK,,. ; ', (with above sq ft.)
�� Limited energy, multi- family
�A /d E� l Q L residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
' » 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
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
" 4 i'*. ;": j :T n ,, ..,, N CONT PERSON°: b. -,,
rvr ,
APPLICANT�� �, r _ s 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: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only ,d 66.85 2
E -mail: Pump or irrigation circle 53.40 2
W , .7 ,, " ,NO 'C OR i w '' * ;`' ' " , ,, . - - , Sign or outline lighting 53.40 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 any of the above
Per inspection 62.50
Phone: ( ) Fax: ( )
Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
-" ` ELECTRICAL ,PERMIT„ FEES " "> , : ; G - `
Suprv. Electrician signature, required: Subtotal: 6 ,. O
Print name: Date: Plan review (25% of permit fee): - &---
State surcharge (12% of permit fee): $• p 2-,
Authorized signature - j � TOTAL PERMIT FEE: 71..1. s7
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(1 1 /05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other:
V COMMERCIA> WORK CiNI;X:- "'
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
n HVAC
n Instrumentation
❑ Intercom and Paging Systems
n 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 \Building \Permits \ELC- PermitApp doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #:
ELt..2008 U05 2
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1017/2008
Phone: (503) 639 -4171 km� l����
Inspection Requests (24 Hrs.): (503) 639 -4175 rIxl■
INSPECTION WORKSHEET FOR DATE: 10/80008 TIME: 7:tItAM PAGE 13
SITE ADDRESS: 09009 SW HALL BLVD 142 CLASS OF WORK:
SUBDIVISION: I�IA'i
WASHINGTON CIRCLE PLAZA
#: TYPE OF USE:
PROJECT NAME:
SUSHI 1Ir'iNa
DESCRIPTION: Reconnect only.
OWNER: WASHING
WASHINGTON SQUARE PLAZA, PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 1f11i31f�tE Pour Time:
Code # Inspection Description Confirm # • Contact # Message
199 Elect.iical final „' 076417-0 503 -M2 -7600 \ Y
Corrections /Comments /Instructions: 0 3 ' 4 1 $ I .39,5
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PASS I I PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
X FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: G---- N6e L Date: 10 _ Phone #: (503) 718 -