Permit ' • CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00294
.���h DEVELOPMENT SERVICES DATE ISSUED: 4/29/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S136CD -00100
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SITE ADDRESS: 11705 SW PACIFIC HWY J ZONING: C -
SUBDIVISION: PACIFIC CROSSROADS LOT : JURISDICTION: TIG
Project Description: Electrical TI, (9) branch circuits.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
T000 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: 8 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREAJSPEC OCC:
Owner: Contractor:
PACIFIC CROSSROADS PROPERTIES, I TRINITY ELECTRIC
BY WYSE INVESTMENT SERVICES CO 13422 SW 128TH PL
200 SW MARKET ST STE 345 TIGARD, OR 97223
PORTLAND, OR 97201
Phone: Phone: 503 - 235 - 6481
FEES Reg #: LIC 156637
ELE 34 -653C
Description Date Amount SUP 4282S
[ELPRMT] ELC Permit 4/29/2005 $100.05
[TAX] 8% State Surcharge 4/29/2005 $8.01 REQUIRED ITEMS AND REPORTS
Total $108.06
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days ofissuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are s in 952 - 001 -0010 through OAR 952- 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503 -246 699 or 1 -800 -3 2- 4 r
Issue By: k_ , Permittee Signature: gi._Lli.•: _
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: _0 / - / DATE:
,. LICENSE NO: 4 42-8 a A. 5
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plan SE ONLY
Phone: 503.639.4171 Fax: 503.598.1960 1 ' ' y ' 1 -. - 11 - 441)(- , 1 ( DateB : Other Permit:
Inspection Line: 503.639.4175 r Date Ready/By: Jur� /,�� El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: / 1CS• Supplemental Information
Mr ' ?`� i`',,','.1. �t a>,: . -.x•�, - �..` cs ° _ . {` �- ic:. v.*J"r-"*''..`�.�,*af� -.c, 4�r a.� « o-a.- ra.T...x+ - . ,
r Pi s `„' "YP� EK6 * ,. - -$. ''. 'r" w- a",a1, >ir{ -,,a > �e;..r4IMP EW - •
ni Z.O.:�XX . xc c ,Y ;,, 1 :.cam Y _X+4:' .F� at..c, na . , ,,,,, , # x . r W ... rt,n , a.„. M . z, §..,,,,., .,MIS .x ,;,_r.�,.. , ?..m, es -,_.,, -,vy-
❑ New construction XAddition /alteration/replacement Please check all that apply,
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l ['Hazardous location
;,,z - �g! ,•, ,,,b.,, „, cniM'!A s eta,.. ° + • R , aw °., f ' -. N r,!; ac i < ; 2 ,.:- a?tesc ,T,M - , T, ;.';at � s „ +, - �.s..�, „. ., � �, , x ,,,_ . ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
IL � 4 ' C A GO OF O NSTR' '" . 1'. : . • of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling A 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
41-T e :C J6 - Wi • O ON ti O A2 lh- -- ; ' Y ' ❑E g r e ss / li g ht in g plan RV park
Job no.: . Job site address:,/ 7t,s- 5 i v 7
❑Health -care facility ['Other:
Job 119,,, Submit 2 sets of plans with any of the above.
City /State /ZIP: - 0a YJ OR The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: 'T Project name: ` J 'w ' '. F.Et,SCHEACII ::';;. +_:.�- :. _, .
r J )U� 'I � Description Qty. Fee. Total
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
a .-,-1 CRI.PT ONO ® ' ", € Each manufactured or modular
s�a�.i�. �: .�.�fii�.;:�h,,��;s�..,'• . •.,e:�s;a:.,�,i �t'u.'�a..�,- 'r`i.P?a " „��"v`� ra "'
dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
rw u � , q ���~ti�n�,, ��..: �,:.: > ^ t; =: �•f� -:u. xil• � �, ..�.�,� ,� •�,�:,•. �.., �;;�,�:� 201 amps to 400 amps 106.85 2
'S":,�ei' :e . ; ER , -, l �;. f ''` , wan . • ,gg {t e.:.
t ii , =,.a. ,si, - _ ' -� . 0) ER z ,64: Z .. - ' . ' .;`rT 1.T' , T �"r' „I '
` . ,e.
Q 401 amps to 600 amps 160.60 2
Name: A , Ct � `C C OSS 120 4I P¢ � f / f 601 amps to 1,000 amps 240.60 2
Address: g o(' !) 6 r �� t 3e/5-- Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: L� . 9 7 A I 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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
, ` rar i t . •, t ` .. "" "`" " ""-�`` At ' ' A. Fee for branch circuits with
� �� 't :Xwa : ` T I c A e 00 . k� rCO4 T`j 4,, ER � i» ;i = „,
'� ""' """" service or feeder fee, each
Business name: branch circuit 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit i 46.85 �� 2
Address:
Each add'l branch circuit 6.65 0 153 . v 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
s a:r... Y " f . "" q s x . energy panel, alteration, or
,-' w, �� , sad" w dim, O 1 F � e r t" ,, s • - o . <. i --
extension. Describe: Page 2 2
Business name: ' 7 ; ;/ /' /€ e fr; G
Each additional inspection over allowable in any of the above
Address: /3U -�
_ 5 - ii) /...),E>71/ pZ Per inspection 62.50 .
Cit /State /ZIP: / Investigation per hour (1 hr min 62.50
y / A8a'P -- 4 P 9.9...)_2_3 g p c >
Phone: ( , / ) . . : , . . . 3 _ 5 - - 1 4 4C / Fax: (D3)Q5' -..37.17 Industrial plant per hour 73.75 ,
> � r'E��E:�TR;r'/�'���'� : i iI r- +t';it:;,t: ,:
CCB Lic.: / � 1 � 3 7 1 \ 4 • L ic . : 3 (�_�14 - d Suprv. Lic.: 4_,...43.s Subtotal loo .o5
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Suprv. Electrician signature, required: o / 4 /o 7 Plan review (25% of permit fee)
Date: State surcharge (8% of permit fee) S ,D
Print name:
v �� TOTAL PERMIT FEE / p g .00
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
1:\ Building 1Permits\ELC- PermitApp.doc 12/03 440 -461 ST(10/02/COM/wEB
r
Electrical Permit Application — City of Tigard '
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
p�. c r�u�s�cr±m�x �>.xuxu�a<�^ �•" ���v��^�.x c,g's 4�d�. T..'s?v aA "
iit. IY W. m. O ,.. kfrW1V!11 �'' 'u' a -at' r �, t ' y c
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
R''w�, °' "�,z�� �* rw�'�e°'F^"^�'"e^'� -�
.0011IMERG1AL R'O ITQ r; .
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
El 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:
*No licenses are required. Licenses are required
for all other installations
is\ Building \Permits\ELC- PermitApp.doc 04/03
CITY OF TIGARD
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BUILDING DIVISION PERMIT #: ELC2005-00294
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/29/2005
Phone: (503) 639-4171 Jappilt
Inspection Requests (24 Hrs.): (503) 639-4175
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INSPECTION WORKSHEET FOR DATE: 6/24/2006 TIME: 7:09AM PAGE: 13
SITE ADDRESS: 11705 SW PACIFIC HWY J CLASS OF WORK:
SUBDIVISION: PACIFIC CROSSROADS LOT #: TYPE OF USE:
PROJECT NAME: SUSHI HANA
DESCRIPTION: Electrical TI, (9) branch circuits.
OWNER: PACIFIC CROSSROADS PROPERTIES, I, PHONE #:
CONTRACTOR: TRINITY ELECTRIC PHONE #: 503-235-6481
Inspection Request Scheduled For: Date: 6/24/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 010119-01 971-236-6481
Corrections/Comments/Instructions:
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•
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..k6;kSS r7 PARTIAL APPROVAL El CANCEL NO ACCESS
LI FAIL III CALL FOR INSPECTION LI ADDITIONAL FEES ASSESSED
Inspector: ML(t4- - Date: C 'Or Phone #: (503) 718-