Permit CITY OF TIGARD ELECTRICAL PERMIT
,114 ° PERMIT #: ELC2008 -00396
COMMUNITY DEVELOPMENT DATE ISSUED: 7/14/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102AB -03900
SITE ADDRESS: 12370 SW MAIN ST ZONING: CBD
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: MANILA EXPRESS
Project Description: Connect lottery sign to existing circuit.
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: 1 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:
MANILA EXPRESS CARRICK ELECTRIC
12370 SW MAIN ST 4875 NW KAHNEETA DR
TIGARD, OR 97223 PORTLAND, OR 97229
Phone: Contact #: PRI 503 - 591 -8474
FAX 503 - 645 -8273
FEES
Description Date Amount Reg #: ELE 34 -439C
[ELPRMT] ELC Permit 7/14/2008 $46.85 LIC 120169
[TAX] 12% State 7/14/2008 $5.62 SUP 2295S
Total $52.47 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 ar- - = orth in OAR 952 - 001 -0010 through OAR 952 -001 -0100. You may obtain copi these rules or direct questions to OUNC at
503.246.6.= 9 or 1.80. • i
Issued : :y: , ' .lid L4 _I Permittee Signal e:
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:
ONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: �i�.` r� ' 9 — 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
Vi
City of Tigard a Dat 7 /N a 8 Pemlit No.: gee -40396 ;� ' w 13125 S W Hall Blvd., Tigard, O 97 � Plan Review
Phone: 503.639.4171 Fax: 503.598. I � Da Other Permit:
l 1 G,\ R 1) Inspection Line: 503.639.4175 1\•\'' 41
• to Read 1aris: ® See Page 2 for
Internet: www.tigard- or.gov � t( l v $ •
c ed/Method: Supplemental Information
I' E OF WORK y G 3, PLAN REVIEW
❑ New construction [I • ddition/alteration/ 1601ent P lease c 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.
CATEGORKOF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
L _�,
❑ 1- and 2- family dwelling CommerciaUindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: 0 Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E , "1 -2 ", "I -3 ",
Job no.: 7 /' �/j C1 l OM) or more. occupancy. Job site address:
/ Z ? i T v `7 u+� i ' 1i�(t J 1 ['Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: ❑ Healthcare facilities. ❑Supply voltage for m
1 l , � ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: Jf4r, A. t:kJ 1 l ) 6 - Xpg . € . cs 0 Service or feeder 600 amps or more.
FEE SCHE I
Cross street/directions to job site: o criptbr I
New residential single- or multi- a
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.1 ,
Ea. add'( 500 sq. ft. or portion 33.40
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
t� /)M'N C-.77.4 L,irr J '/ 6—/-.) /) residential (with above sq. R.)
✓ Services or feeders installation, alteration, and/or relocation
s .� / N / 6/ g---e Ga / / 200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ 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 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
❑ APPLICANT 1 ❑ 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: first branch circuit ) 46.85x• 2
Address: Each add'( 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 2
• Signal circuit(s) or limited -
Business name: e4 4e f C / " N C energy panel, alteration, or
Address:
� -7.5 ti t%(/ l44 f-/�6Z TA- Df --
extension. Describe: Page 2 2
City/State /ZIP: 'Po i L _�., v o/L `i -� Each additional inspection over allowable in any of the above
Phone: c j / — , Fi Per inspection 62.50
4 ) 5 I ( SQ3) 3 a 3 � C9 Investigation per hour (1 hr min) 62.50
CCB Lic.: , .7_,. / . / l,' Electrical Lic 3cf e Suprv. Lic.: 7._)4,
Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: t c Subtotal: ‘, ' g
e Plan review (25% of permit fee):
Print name: `> , L'��U2 —/CZ-- Date: .7 • -L3 0 - -
State surcharge (12% of permit fee): 5 : (_ 2 '
Authorized signature: TOTAL PERMIT FEE: ?_ •
Print name: Date: This permit application expires if a permit is not obtain wi
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:t Building 'Pennits\ELC- PernitApp.doc 0521/06 440.461ST(11/051C0M/WEB
CITY OF TIGARD
.., A
l BUILDING DIVISION " PERMIT #: ELC2008.00396
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/14/2008
Phone: (503) 639 -4171 V
Inspection Requests (24 Hrs.): (503) 639 -4175 _- ,_. 1.L.
INSPECTION WORKSHEET FOR DATE: 7/21/2008 TIME: 7:01AM PAGE: 64
SITE ADDRESS: 12370 SW MAIN ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MANILA EXPRESS
DESCRIPTION: Conned lottery sign to existing circuit.
OWNER: MANILA EXPRESS, PHONE #:
CONTRACTOR: CARRICK ELECTRIC PHONE #: 503 - 591 - 8474
Inspection Request Scheduled For: Date: 7/21/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 072888.01 503 - 708-0836 N
Corrections /Comments /Instructions: el LAB L
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2 4 1Xt„D \ ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
AI ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G--• 0 to L-6 Date: 1 •2_t o1 Phone #: (503) 718- 24147
, .