Permit L/ /9 4? ' • h frrr) It -to ;Ak -
CITY OF TIGARD ELECTRICAL PERMIT
0 • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00145
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: (22) branch circuits for TI.
4/19/12: REPRINTED permit to include (2) low voltage systems for audio and data telecommunications.
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
22 crt Branch Circuits wo /Purchase 03/16/2012 $212.00
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/16/2012 $25.44
Type of Use: COM Electrical
Class of Work: ALT 2 ea Limited Energy 04 /19/2012 $150.00
Type of Const: 18 12% State Surcharge - 04/19/2012 $18.00
Occupancy Grp: Electrical (manual)
Total $405.44
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 OA • - 001 -0090. You ma ' f the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
�I
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 protect
Approved plans are required on the Job site at the time of each Inspection.
CITY OF TIGARD ELECTRICAL PERMIT
114 a . ' COMMUNITY DEVELOPMENT Permit #: ELC2012 -00145
T [ G A R D 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: (22) branch circuits for TI
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
22 crt Branch Circuits wo /Purchase 03/16/2012 $212.00
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/16/2012 $25.44
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
• Total $237.44
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 r direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 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 603.639.4176 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.
•
Apr 17 12 11:06a Daniel Hale 503- 289 -7816 2
Electrical Permit Applicatio FOR OFFICE ['SE ONLY
APR 17 201
City of Tigard 2 Received Persil (,C
l'it
13125 SW Hall Blvd., Tigard, OR 97223 �`� - t���,�a'
- Phone: 503.718.2439 Fax: 503.598.11ge OF TIGA'D Review alter Permit
Inspection
71 G .4 tt D ection Line: 503.639.4175
D Rea
Internet: www.tigard or.gov BUILDING DIVISION Notified/Method: od t� Supplemental See Page 2 for
supplemental Information
TYPE OF WORK PLAN REVIEW
0 New construction ❑ Addition /alleratiomheplaccment Please check all that apply (submit 2 sets of plum w /items checked below):
❑ Demolition ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Other: where the available fault current - ❑ Minas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at ISO wilts or ❑ Floating buildings.
❑ 1 and 2 less to ground, or exceeds 14,000 ❑ Commercial�oagricultural
y dwcllin g ® Commercial /industrial ndustrial ❑ Accessory building amps for all other installations. bmldin1.
❑ Multi- family . ❑ Master builder ❑ Other. ❑ Fire pump. ❑ tnstallalian of 75 KVA or
JOB SITE INFORMATIO1( AND LOCATION ❑FmaBC°�system large: separately derived system.
`9 ❑ Addition of new motor load of ❑ "A",13 "1 -2 "1-3",
Job no.: 12 - 010 I Job site address: SW HALL BLVD IoOap or more °ce'tpaacy.
eb ❑ Six or mote residential emits ❑ Recreational vehicle parks.
City/State/ZIP: TIGARD �y�A 97223 ❑ limlthearc f acilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suitclbldg.tapt no.: 0115 I Project name: SPORTS CLIPS ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: IN WASHINGTON CIR onnipm 1 Qtr I Pea I Total 1 •
BY THE TARGUIT STORE • New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: L Lot no.: 1.000 sq. ft or less 168.54 14
Tax map/parcel no.: Ea. midi 500 sq. ft. or portion 33.92 , 1
Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi-family
LIHGTS AND PLUGS 7) fb M i7 residential (with above sq. ft) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 - 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 55226 2
City/State/VP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36
Owner installation: This installation is being made on property 201 amps to 400 amps I 125.08 1 I
2
g p petty that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 i 2
Branch circuits— new, alteration, or extension, Qer panel
Owner signature: Date: A Fee for bran cu
ds cirits with - .
® APPLICANT 1 ❑ CONTACT PERSON 'each circuit eeder fee, 7.42 2 ,
Business name: HaleStone Electric . B. Fee for branch circuits without
service or feeder fee, first 1 56.18
Contact name: branch circuit 56.18 2
Address:
Each add'I branch circuit 21 7.42 155.82 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each dwelling, and/or feeder
67.84 i 2
Phone: ( ) I Fax :: ( ) Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited energy
Business name: HaleStone Electric panelothaation, or extension. Z Page 2 f p- 2
. Each additional inspection over allowable in any of the above
Address: 1814 NE Bryant Additional inspection,(1 hr min) 66.25/ In-
.
City/State /ZIP: PTLD Or 97211
Investigation (1 hr min) 66251 hr
Indusmial plant (I hr min) 78.18/ hr
Phone: (971)227. 1272 I Fax: (503) 289.7816 Inspections for which no fee is
CCB Lic.: 160458 I Electrical Lie.: C-63 1 Su rv. Lic. 42405 specifically listed (Yzhrmin)
90.00/ hr
p ELECTRICAL PERMIT FEES
Sunni. Electrician signature, ` Subtotal: �2.UU 1
,
g required: li
' 'Y���� " °"
' Plan review (25% of permit fee):
• Print name: Mary Jennings 1 1 15/12 State surd arge (12% of permit fee): / 1
Authorized signature:
PERMIT FEE: i �9'ah .1( , �
•
fj This permit application expires If a permit is not obtained within 180
Print name: Daniel hale f e' - _ j/ re 7,41 �' r Date: 3/15/12 days after It has been accepted as complete.
�`s� ^^rlr y r ZZ-- • Number of inspections allowed per permit.
11Building\Pero itsrELC•Pemmit App.doe 07/01/10 440 ST(11/OS/COM/WEB
•
Mar 1512 10:38a Daniel Hale 503 - 289 -7816 p.1
Electrical Permit Application , ' �
City of Tigard See Page Z for
Ct.;.'' Reed 2w .3125.SW Hal1131vd.,Tigard,OR ✓r•.• / /S /02 Permit No.:LCLC�!/���D /y�j
'� Phone: 503.718.2439 Fax: 503. 1960 C 1 ® p ie "�`"
Ot Pam' '''' nn�
T I G .A I. D inspection
Line: : 503.639.4175 R K/"o Q�o�'Q Q �3Q
Internet: ww'w_figardor. ov �~ Date Ready/By: is,._
g Z�G Ng) Noti6e&Method: , / /6.--. f Supplemental Information
TYPE OF Week_ l OF 0 J \S,o
• ® New construction ❑ Addition/alt PLAN REVIEW
ant Plea , all that apply (submit a suds of plans w/items checked below):
❑ Demolition 0 Oth ❑w
sioe feeder 400 amps amp more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings
❑ 1 -and 2- family dwelling Commercial/industrial [] Accessory building ' less to ground. or exceed, 14,000 ❑ Commercial -use agricultural
❑ Multi- family ❑ Master builder
amps all other installations. buildings,
❑ Other: ❑ Fire pinup' ❑ Iaslallatian of 75 KVA or
❑ Emery system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION
Job no.: 12 ❑ Additionnf new mouvload of ❑ "A E ^,wt -2" °1 -3"
es,5A8fSW HALL BLVD t 001iPOrmore. =valley •
Job site add
City/State/ZIP: TIGARD 0 121 Six or morn residential units. ❑ Recreational vehicle parks.
97223
9 0 Health - care facilities. ❑ Supply voltage for more than
Suite/bldg. /apt r�tt1I5 I Project name: SPORTS CLIPS ❑ Service feeder 6 s 600 volts nominal.
O Susvicc or feeder 600 mops or more.
Cross strect/direetions to job site: IN WASHINGTON CIR FEE SCHEDULE
°e°iodom 1 OM 1 1 Total 1 •
BY THE TARGUIT STORE New residential singe- or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1.000 sq. R or less
r I f 68 . 54 4
Tax map/parcel no.: Fa add'[ 500 sq. R or portion I 3392 1
DESCRIPTION OF WORK Limited a bove gy, residential
(with above sq. ft.) 75.00 2
LIHGTS AND PLUGS Limited energy, multi- family
residential (with above sq. ft.) 7 5.00 I 2
Services or feeders installation, alteration, and/or relocation
❑ PROPERTY OWNER 00 mops or less 100.70 2
❑ TENANT' 201 amps to 400 amps 133.56 2
NamC: 401 amps to 600 amps 200.34 2
Address: 601 mops to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( )
q Fax: ( ) 200 amps or less 59.36 i I 1
0 Owner installation: This installation is being made on property that I own which is not 201 am to 400 amps 12s.o
intended for sale, lease rent, or exchange, according to ORS 447, 449, 670, and 701. 40l amps to 599 amps 168 54 i 2
t r Owner signature Branch circuits new, alteration. or extension, per panel
t } A. Fee for branch circuits with
® APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: HaleStone Electric ' B. Fee for branch circuits without
Contact name: service or feeder fee, first 1 56.18
branch circuit
56.18 2
br
Address: Each add'I branch circuit 21 7.42 155.82 2 '
Miscdleneons (service or feeder not included)
Cily/State/Zip: Each manufactured or modular
dwelling, service and/or feeder
Phone: ( ) 67.84 2
q Fax:: ( ) RecotlnetY only 67.84 2
—.[ E -mail:
Pump or irrigation circle 67.84 2
CONTRACTOR • Sign or outline lighting 67.84 2
2 2
Business name: HaleStone Electric Signal alteration. or or le x t ension. P ionergy
-re
panel, aheration extension. 1
Pa
Address: 1814 NE Bryant Each additioeat inspection over allowable in any of the above
Additional inspection (1 hr min) _
66.25/ hr
City /Slate/LIP: PTLD Or 97211 Investigation (1 hr min) 6625/ hr
I
Phone: (971) 227 12 Industrial plant (1 hr min) 78.18/ hr
Fax (503) 289.7816 Inspections for which no fee is
B Lic.: 160458 Electrical Lie.: G63 / / specifically listed (y, br min) 40.001 hr
7 / Suprv. Lic.: 42405 ✓ ELECTRICAL PERMIT FEES
• ii.../et.,
Suprv. Electrician signature, required: �yf / Subtotal: I 212.00
3 Print name: Mary tannings X61 Plan review (25%ofpermit fee):
D e: 3/15/12 State surcharge (12%ofpetmilfee): 25.44 /
Authorized signature: TOTAL PERMIT FEE: 237.44 ✓
+ Print name: Daniel hale 1 This permit application expires if a permit is Got obtained witbin 180
/cQ j t 7 / I Date: 3/15/12 days after it has been accepted as complete.
I' 1 , Lf • 'Amber of inspections allowed per permit.
r,' Inuirdingtrarrcit eELC- AcmitApp.doe 07/01/10
440- 4615TO 1 /05/COM/w E 9
Apr 1712 11:07a Daniel Hale 503 - 289 -7816 p.4
Electrical Permit Application - City of Tigard ADD To "Le
Page 2 - Supplemental Information
ph real`. Fi.C 2012 - 001415
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for a residential systems combined ... $75.00 `7 5
Check Type of Work Involved: • 7 5
❑ Audio and Stereo Systems*
Sf4f'B
❑ Burglar Alarm C k do J m 1 6
❑ Garage Door Opener*
ref � 6 g —�
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
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
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 2.
*No licenses are required. Licenses are required
for all other installations
l:\ Building \Pumit5 \E4C- PamilApp.doc 07'01110