Permit CITY OF TIGARD ELECTRICAL PERMIT
1 2 . COMMUNITY DEVELOPMENT Permit #: ELC2012 -00147
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/16/2012
Parcel: 1 S126CA01000
Jurisdiction: Tigard
Site address: 9009 SW HALL BLVD 115
Project: Sport Clips Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: (1) service and (5) branch circuits.
Contractor: HALE -STONE ELECTRIC Owner: CAFARO NORTHWEST PARTNERSHIP
1814 NE BRYANT PO BOX 422
PORTLAND, OR 97211 FLORHAM PARK, NJ 07932
PHONE: 971 - 227 -1272 PHONE:
FAX: 503 - 289 -7816
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 03/16/2012 $100.70
Specifics: amps or less
5 crt Branch Circuits w /Purchase 03/16/2012 $37.10
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 03/16/2012 $16.54
Electrical
Type of Const:
Occupancy Grp:
Total $154.34
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules questions to OUNC by calling 503.2 .1987 or 1.800.332.2344.
Issued By: - ii 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' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
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.
Mar 151212:15p Daniel Hale 503-289-7816 p.1
—
En
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Electrical Permit ADDli vIliait` :LIVE[) FOR OFFICE USE ONLY
City of Tigard Received
. 13125 SW Hall Bled.. Tigard, ORMAR3 1 5 2012 "pat 7
en ': .1 MAIT
Plan Review
Phone: 503.718.2439 F WC 503.598.1960 . Date/By: Other PemaiV(3140 l ...r )(1,2 Ca
i.. GA au , Inspection Lino: 503.639.4175 OF TIGAPO Dale Rcorly/3y: la Sec Page 2 for
Internet: www.td niNn ordfs NotifieSIMethod: 1j............-& Supplemental information
,:: 0.6.1*;:.:-f. ':1:.;. ..: '..,..,..:... :...:., ...,, ...:] ..„-;;; :#1;:iii
El New construction 0 Additirmialteration/rqilacement Please check all that apply (submit 2 sets of plans w/itana checked below):
0 Service or feeder 400 amps or mote 0 Building over three stories.
El Demolition 0 Other where the a‘ai I ablo fault current. 0 Marinas and boatyards
. .
.:'?::.-:.:::,.',..:... '..;•: - :".:.".'.. ,... ..::,:.... ', . :. : H.: : : ..::•".: exceeds 10.000 amps at 150 volts or 0 Floating buildings
lce, tn ground, or =Ace& 14.000 0 Corarnmcial agricultural
0 1 - and 2-family dwelling El Commercial/industrial 0 Accaisory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Firs pump. 0 Installation of 75 KVA or
. .. _ . . . . . . . . . .. . . . . 0 Emergency system. larger separately derived svasm
: • :: :..:".- :,. :•:: ..' • • - 4.011'SITIE AND. LOatTIO1 : r...." • . . : ' • • • • '.,... 0 Addition at new mater load of 0 "A", nr, "1-2 - I - 3 - ,
Job no.: 12-010 Job site address: 9009 SW Ball Blvd 10011P or more. occupancy.
0 Six or MOTE reSideraial tlilLS. 0 Recreational vehicle parka.
City/State/ZIP: Tigard, OR 97223 0 Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt no.: 115 I Project name: Sports Clips 0 Service or feeder 603 __I' A cmps 01'1110re.
i : , .....: !. '.:'. . • ::.. ...... .. FEt.SCIFF-Plitic : •-:. i' .." .......-..:-"•'.
Cross sired/directions to job site: in Washington Cir next to Target Store i Description I Qiv. I Foe. I Told I •
New residential single- or multi-family dwelling unit.
■ Includes attached garage.
,
Subdivision: Lot no 1,000 sq. 0. or less 168.54 4
Ea. add'i 500 sg. IL or portion 33.92 1
Tax map/parcel no.: Limited energy, residential . -
75.00 2
.:......... : ,1 ' ; ':..' - ...:,.,;. - -- : .: ' .., IV,SPRIP TR* . OF V.V0111: • • : " • ' ::" ' (with above sq. IL)
. Limited energy, roniti
75.00 2
200A, 3ph Service residential (with above sq. R.)
' Services or feeders installadoiksdtersition, and/or relocation _
200 amps or less 1 100.70 100.70 2
1 0 , o*Nfat: :- -... ..: Cl ' TENANT . ".,... :. ,..-...".•:: 201 amps to 400 amps 133.56 2
I
401 amps to 600 amps 200.34 2
Name:
I ; 601 amps to 1,000 amps ... 301.04 2
Address: I Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation. alteration. and/or
' City/Stater/1P: relocation
Phone: ( ) Fax: ( ) i 200 =VS or less 5936 1
201 a 400
Owner installation: 11iis installation is being made on property that I own which is not mps to amps 125.08 2
401 amps to 599 amps 16834 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670., and 701.
Branch circuits — mew. alteration, or extension, per panel
Owner signature: Date: ; A. Fee for branch circuits with
. . . .... . _.. . . . . above service or feeder fee, 5 37.10
- A1!PLICANT .„. - . ... '. :. ' 1 ... - '' 0 CONTACT 0E0800 - .". • " • :: each branch circuit 7.42 2
Business name: Hale Stone Electric n.. 'Fee for branch tircuita without
service or feeder fee, first
56.18 2
Contact name: OFFICE branch circuit
Each addl branch circuit 7.42 2
Address: 1814 NE Bryant Street Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/Z1P: Portland, OR 97211 dwelling, nervicc audios feed 67.84 2 er
Phone: (971) 227-1272 I Fax: : (503) 289-7816 i Reamed only
! 67.84 2
Pomp or inigation circle 67.84 2
R-mail: .. Sign or outline lighting 67.84 2
: • . . .:::!:.....; - -: ...".7...."...- ...• ..• t.: ..... -:- .. .::: ... ..,.....-: .-.,... . -:;. - : .-::.": - _ si i - - or limi ed
pa c 1 -energy
panel, altcrition or extension. Page 2 2
Business name: Hale Stone Electric
Rads additional inspection over allowable in any of the above
Address: 1814 NE Bryant Street Additional inspection (l lir min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
CitylStateiZIP: Portland, OR 97211 Indusuiai piaxi (l hr irlio) 78.18/ hr
Phone: (971) 227-1272 Fax: (503)289-7816 Inspections for which no foe is
90.00/ hr
imeifteatly listed ts.. In min)
CCB Lic.: 160458 I Electrical Lic.: C ti.. Suprv. Lie.: 4240S .--: ::., ,.:- r...:' :.;:.. f.i
7 Subtotal: 137.80
r .
Suprv. Electrician signature, nxiuired: 7) /,,
14 e4.1 - 2-0/ ". • Plan reviow (25% of permit
Print name: Mary Jennings ../ Dater State surcharge (12% of permit fee): ....... ).615r .. ko t 5 .4 1
! TOTAL PER.MIT FEE: 1 . 151(311
Authorized signature: &'aL4 le 714,4: ,
This permit application capires if a permit is not obtal ed within ISO
days after it has been accepted us complete.
Print name: Daniel Hale I Date: 3-15-2012 * Number of inspections ii eel per permit.
IMiuildinit.PmniW.ELC-PermiLappdoc OM 010 440 lioscostAtrat