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Permit ELECTRICAL. PERMIT -� CITY OF TIGARD PERMIT #: ELC2005 -00406 404,00 DEVELOPMENT SERVICES DATE ISSUED: 6/13/2005 °� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171 PARCEL: 1S136CD SITE ADDRESS: 11745 SW PACIFIC HWY ZONING: C - G SUBDIVISION: LOT : JURISDICTION: TIG Project Description: (3) branch circuits for sign & outlets. 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: 2 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: MONOGHAN FARMS, INC ROCKY MOUNTAIN ELECTRIC 14120 E EVANS AVE 8615 SE 257TH AVE GRESHAM, OR 97080 Phone: Phone: 503 - 618 - 9379 FEES Reg #: ELE 26-748S Description Date Amount LIC 75210 SUP 3103S [ELPRMT] ELC Permit 6/13/2005 $60.15 • [TAX] 8% State Surcharge 6/13/2005 $4.81 REQUIRED ITEMS AND REPORTS Total $64.96 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 or 1- 800 - 332 -2344. Issued By: L5_;7 Permittee Signature: s j._Q 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 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 Q l;oR OFFICE USE ONLY City of Tigard 3 C EVED DateBy' OJ / ✓ )( ) Permit No.: aQQ\lOby6t 13125 SW Hall Blvd., Tigard, O Plan Review Phone: 503.639.4171 Fax: 503.598.1960 G,. ' `S?11� Other Permit: � ' DateBy Inspection Line: 503.639.4175 " ",. ni t 1 3 200,5 '! I Date Ready/By. It :/f Ill See Page 2 for Internet www.ci.tigard.or.us Notified/Method: -r / V I Supplemental Information OAP F TiGAR® IN V ON PLAN REVIEW ID New construction t tton/ /alteration/replacement Please check all that apply: ❑ Demolition ❑Other: ❑Service over 225 amps, conun'I ['Hazardous location ❑ Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., CATE OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential 13 1 and 2 family dwelling m mercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑Buildin over three stories ❑Feeders, 400 amps or more ❑ Multi - family 0 Master builder 0 Other: ['Occupant load over 99 persons ❑Manulhctured structures or JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park Job no.: I Job site address! V '�c.160,W�, ❑Healthcare facility ❑ Other: 7 Submit 2 sets of plans with any of the above. City/State/ZIP: / 42 • ,9..D. 3 The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: Project name: S r -� oo '� \ p FEE* SCHEDULE •, 1 Y \ (/l 1( LJ�J Description I Qty. I Fee. I 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: I Lot no.: Ea. add'I 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 DESCRIPTION OF WORK Each manufactured or modular 1 0 CtOcD�i ere A — _ dwelling, service and/or feeder 90.90 2 f� %, Services or r feeders installation, alteration, and/or relocation 200 amps or less ' 80.30 _ 2 OPROPERTY OWNER I ❑ TENANT _ 201 amps to 400 amps 106.85 m 2 � 401 amps to 600 amps 160.60 2 Name: \_ ^ dNNh J ■,.. cs m 5 , .. .>.r,Ci 601 amps to 1,000 amps 240.60 2 Address: /q /.Z © V . 6v A r~ T v - t - ■ Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State./ZIP: 0 1,r-c-0 C ® Temporary services or feeders installation, alteration, and/or Phone: ( ) I Fax: ( ) relocation 200 amps or less 66.85 I 1 Owner installation: This installation is being made on property that I own which is not ' 201 amps to 400 amps 100.30 1 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 1 133.75 2 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel ❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, ) 46.85 g 2 Address: each branch circuit ( (p — ° Each add'I branch circuit a 6.65 / 2 City/State/ZIP: Miscellaneous (service or feeder not included) Phone: ( ) I Fax: : ( ) Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E - mail: Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or extension Describe: Page 2 2 � Business name: k AyjnZl/l �e�L/ G , O Address: g-6 s-- E . �'"`'' -F�., - Each additional inspection over allowable in any of the above Ci /State/ZIP Per inspection 62.50 tar g S 4 7 / �� Investigation per hour (1 hr min) 62.50 Phone: ( ) 64_ 93 7 c 9 F (5 ) -" 7953 Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* sa Lic.: 75 to I Electrical LiLii . _ fc -e_l 7 Suprv. Lic S Subtotal 460 . 6 Suprv. Electrician signature, rec _ / / �// Plant review (25%ofpermit fee) Print name f b . .. D at e • /9 O TOTAL PERMIT FEE State surcharge (8% of permit fee) tr( Izi t :ilk u`S I' Cp / / / ' C Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: • I Date: • Fee methodology set by Tri -County Building Industry Service Board •• Number of inspections per Permit allowed. CITY OF TIGARD BUILDING DIVISION PERMIT #: ELG2005 00406 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 6/13/2005 Phone: (503) 639 -4171 : Inspection Requests (24 Hrs.): (503) 639 -4175 — INSPECTION WORKSHEET FOR DATE: 6/21/2005 TIME: 7:11AM PAGE: 100 SITE ADDRESS: 11746 SW PACIFIC HWY CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: STUPID PRICES FURNITURE OUTLET DESCRIPTION: (3) branch circuits for sign & outlets. OWNER: MONOGHAN FARMS, INC, PHONE #: CONTRACTOR: ROCKY MOUNTAIN ELECTRIC PHONE #: 503-618-9379 Inspection Request Scheduled For: Date: 6/21/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 009734 -01 503 - 618-9379 N Corrections /Comments /Instructions: c iKI ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: 6 Phone #: (503) 718 -