Permit •
' CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
- 13125
DEVELOPMENT H BMENT r S O ERV SERVICES � 639 -4171 DATE ISSUED: 10 25/2004
SITE ADDRESS: 11626 SW PACIFIC HY PARCEL: 1S136DC -00500
W
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description:
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
REGAL CINEMAS AMERICAN HEATING
BY ACT III 1339 SW GIDEON ST
7132 COMMERCIAL PARK DR PORTLAND, OR 97202
KNOXVILLE, TN 37918
Phone: Phone: 239 - 4600
Reg #: LIC 33135
ELE 26- 993CRE
SUP 2640LEP
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 10/25/2004 $75.00 Elect'I Final
[TAX] 8% State Surchart 10/25/2004 $6.00
Total $81.00
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.
Issued by d Permittee Signature Ande..5
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 7:00 P.M. for an inspection needed the next business day
Electrical Permit A lication FOR OFFICE USE ONLY
� - Received _ `,,
C of Tigard �� ® DateBy/D�S dy 4a Permit No.: 1 i �ivyi 9
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 7
Phone: 503.639.4171 Fax: 503.598.196 / asv+`G�u F• I +1 Date/By: Other Permit:
Inspection Line: 503.639.4175 �C 5 100 " ! Date Ready/By: kris: El See Page 2 for
w.
Internet: wwci.tigard.or.us Notified/Method: 1/ ( J ° Supplemental Information
!I.
EQ tJ1fICOt = . PLAN_ REVIEW • -.. ; . '< ;:` ;''"
❑ New construction Addition/alteration/replacement Please check all that apply:
ID Demolition ❑Other: ❑Service over 225 amps, comm'I ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
- - _ . _ CA OF _CONSTRUCTION _ of I - and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling 51 Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
- - ' JOB SITE INFORMATION AND LOCATION - • - '� .. ❑Egress/lighting plan RV park
Job no.: chL i Li 431 Job site address: I I (, 24 w Pace hC t4u� ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/State/ZIP: "T' n �-� ( 6a CI - 7 ?a3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: J Project name: T ( �-r1 1 i � p ri p i lon FEE *; SC Qty. ED I LE Fee. I >: Total - I '; .• I.
Cross street/directions to job site: c t ,. `�a « Q New residential single -or multi - family dwelling unit.
.YIJ� Includes attached garage.
l,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
`., : '' - , : DESCRIPTION' O F WORK' .] -' . :. = _ Each manufactured or modular
6 4 1 6 dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
Q ftjjitiP 200 amps or less I I 80.30 I 12
O'PROPERTY OWNER ❑ TENANT " _ ' 201 amps to 400 amps 106.85 2
. u - 401 amps to 600 amps 160.60 2
Name: 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
relocation
Phone: ( ) I 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 600 amps 133.75 2
Owner signature: • Date: Branch circuits - new, alteration, or extension, per panel
PLICANT : I CONTA- PERSON" A. Fee for branch circuits with
�
■ CT service or feeder fee, each
Business name: ' tI k (C�.n 1-TCid t ` branch circuit 6.65 2
Contact name: n L _ ^ B. Fee for branch circuits
'Tjte1(A,fl f , to without service or feeder fee,
3 3q $� /? i Ek _ L each branch circuit 46.85 2
Address: _ (�, ) C �C�3a
Each add'I branch circuit 6.65 2
City/State/ZIP: Toted. r_. q Miscellaneous (service or feeder not included)
t �° " Pump or irrigation circle 53.40 2
Phone: ( ) p_.Gt_ 4 a x:: ()) a`.C�,i �5
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
, - - - - .CONTRACTOR,:; • ' ' ' - energy panel, alteration, or
.6-au d C, 1 4 T n extension. Describe: 1_ Page 2 2
Business name: t w
�� Each additional inspection over allowable in any of the above
Address: t') ) C S C -: 6 . ,
Per inspection 62.50
City/State/ZIP: Pd,, l 0 Q en � �- Investigation per hour (1 hr min) 62.50
Phone: (0 �3� �� (0 oU I Fax: 69 3 �3� `7 J� Q Indust plant per hour 73.75
' {' � ' ! `� .ELECTRICAL .PERMIT FEES* "
� °
CCB Lic.: 3.8 (3 S I Electrical Lic.: (9 ' j uprv. Lic.: d� ( Per' Subtotal
Suprv. Electrician signature, required:, dF.f'A`' Al Plan review (25% of permit fee)
Print name: Date: 4/, State surcharge (8% of permit fee)
<_?'i Ut ° A ' 1 V TOTAL PERMIT FEE
Authorized signature: „/M /lil/�,Fy\ This permit application expires if a permit is not obtained within 180
JJ��J{ {{(((( �t ((((////W���������7777 ����, days after it has been accepted as complete nu
Print name: em rn a 0 ,(-Gr n n Date: 1,6_ 4 : Fee methodology set by Tri- County Building Industry Service Board
Number of inspections per permit allowed.
is\ Building \Permits\ELC- PcrmitApp.doc 12/03 440- 46tSI'(I0 /07JCOM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received S it Date Requested n_12-- AM PM BUP
Location //O Z to J Ae-141 Suite MEC
Contact Person �i(. Ph (_.) ..;?41 649' PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC Access:
' /
Ftg Drain ELR 7-0 ti --6 ' 453 3
Crawl Drain
Slab Inspection Notes: LO IA SIT
Post & Beam ti ` 1`'` 6
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
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
ELECTRICAL
Service •
Rough -In
UGUG /SI
Voltage
Fire larm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE ❑ Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date / .Z� / Inspector / Ext
Other:
Final DO NOT REMOVE this inspection record from the b site.
PASS PART FAIL