Permit C ITY OF TIGARD ELECTRICAL PERMIT
° PERMIT #: ELC2006 - 00642
COMMUNITY DEVELOPMENT DATE ISSUED: 11/9/2006
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S136CC
SITE ADDRESS: 11744 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: COSTCO. (1) branch circuit to cell site. Job # 9224.
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: SIGNAUPANEL:
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: 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:
GRUNBAUM, HANS H AND MARILYN K ADK ELCTRIC, INC.
TRUSTEES PO BOX 2676
21390 SW EDY RD BATTLE GROUND, WA 98604
SHERWOOD, OR 97140
Phone: Contact #: PRI 360 608 - 0665
FAX 360 - 576 -6975
FEES
Description Date Amount Reg #: ELE 37 - 934C
[ELPRMT] ELC Permit 11/9/2006 $46.85 LIC 148882
[TAX] 8% State Surcharge 11/9/2006 $3.75 SUP 48535
Total $50.60 REQUIRED ITEMS AND REPORTS
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: �� ,,0 9 / :2 Permittee Signature: c?,\K
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.
Alan Kangas 13605766976 11/07/06 02:57P P.001
s.
Electrical Permit AREOEW ED . rill: (),..ER .E. t SE O \I.,1
City of Tigard ° �' ��` ^
13125 SW Sall Blvd. Tigard, O1I �/ (� r•. 9a, Retie..
Phone: 503.639.4171 Fare 503398. tl V [ L U U U +�- p
'�, D Other �^^�
inspection Line 503.639.4173 , _i- ./ ' + seePa6e2 Ow
Intranet www.c,e�.or.us } CII ' T n Y � OF TIGARD ' supplemental
.. ®t,l� VNQTtK. •
»mow
❑ New construction 0 Addition /alteration/replacement Please check all that apply.
❑ Demolition j,grotber: Call Sr.. m Qse vice ova 225 amps, COMA ❑ ilarardous location
DSaviee over 320 mope - rating QBuildag over 10,000 sq. ft, -
. :. cedscORY rOP•CQNRr'RVCrION1 •. ' • .. oft -ad 2- family dwellings 4 or more now residential
b 1 - ar 2- ; dwelling ❑ Q Memory ding ❑Sys over 600vob& nominal mils in are snactoae
❑ Multi-family ❑ Master builder ❑ Other g wet three stories QFeaedero.400 amps or more
Qotxstpaatload ova 99 prior,. Qtrtanufactored Aruatarer or
• • • ' . • •.IOB Srra INFORMATION 'AND LOCATION ,. DEgreadiishtiagplan RV park
Job no.: 221"1 j Job site a dtbosa; I f1 t- j� SW 'TCIC4: (.- ki1/o1 O Ore facility p - -
Srubmit' 2,_ sets of place with nay of the ahem
City/StatlAMfP: A ui 2 The above me not applicable to temporary construction service. • Suite/bldg. /apt. no.: Project name: C. .p .Mc 'ALAS ' • • ' ::1P7°O+' .SC Ott. <:B ::
Pea i zew 1 ••
' Cross
l � strect/di greet/directions to job site:
i I L I. G� S 6 294 t„'I) y . Tad w naafi-fiddly ly dwelling kv ?l l 02.91W I 1 itdivan . • LORI w} A. or less 143.13 4
Subdirisioa I Let no.: Es. add, 500 sq. B. or portion 33.40 1
Tax mep/paroCl no.:
Limitedcuagy, residential 73.00
II
Limited energy. nor. rcaida tia! 75.00
DBSCI ION 'OF 'WORK Eaob mowfedtued err modular
/�_� ,.1 �`, f `�„ �` mNor feeder 9090
�- Yr ' \ dwelling service Services or Redeem Malone/tom alteration, said/or relocation
200 amps or lase 8030
• 201 mats 400 amps 106.85 • Q. PROPERTY OWNER 1. Q: Tl�iwrrr 40! amps to 600 maps
160.60 •
Name: 601 •.•.to1.000. ,,... 240.60
Address: Over 1.000 amps or volts 454.63 2
Rwonnect 66,85 2
City/State/ZIP: Tenspwary service* or foeden lastallatlem altars lea, sodlor
Phone: ( ) — 1 Fax ( ) relocation
t 400 130030 2
Owner installation: Tors installations is being mate on property that I own which is not 201 A zep or less 0 .83 1
!!banded for sale, lease, runt, or exchange, Recanting to ORS 447, 449,157% and 701. 401 *taps a mps o amps to 600 mans 133.73 2
Owner signature: Date: Branch circdrs -new, attention, or exteodoa, per panel • •Q APPLICANT . Q• CONTACT" PERSON " ' . — A. Foe for branch circuits with
service or feeder fee, each
Basin= eat1 6antdr �h 6.GS 2
------ B Foe for branch circuits
Contact name: without service or feeder fee, 1 r t - 2
Address:
first March circuit 46.8 "1�
Eras add't bnmcb circuit 6.63 2
City/State/ZIP: Mfsedbareow service we feeder not Included)
Pump or irrigation circle 33.40 2
Phone ( ) l:ttx : ( ) Siga or oultioeliglaing 53.40 2
E-mail: Wane! eitosit(s) or !ironed-
• CONTRACTOR ' • • corny Pend, amnion. or
Business name:
'"[ t) fU c 1 _ extension. DeacYtbe: Page 2 2
,oddness: BOX an 4 Each addtdoord Inspection over allowable In any of nm above
Per inapectino ' 62.50
City/State/ZIP t � V� CV;DIADA 1avestigedim per hear 0 br coin) 6740
Phone: a.* 940- > Fax GU D 510 - U c f 5 Industritd plant per Lour 73.75
-r- -ELECTRICAL PERM t:F +ERS! %•'• ":' :•:•i ;'
l/ ��
CCB Lic.: j OJ 1 Electrical lac: 1C.1 ti. c, I Saprv. Lie.: 1t Subtotal 14w .c
Stipp Electrician signature, required: DA / , —
Plan review (25% of permit fee)
State
surcharge ( permit fee) 3,
Print ntlunc: l / , ' 11.0104 TOTAL PERMIT FEE ;5/:).t01)
Authorized signature: / , V m J ' 774l pima a epplk rase ire Mandeb not etrumed within 180 •
Print Mille' •� is, 1,1 - � , _. '. _ / ' V K , alter Set bt as complete
F eemedrodv Set 7ti Building laden ServiceBoud
wan •c�.•...�:..- ..... -. ,... _......n.....
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC200C.00842
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/9/2006
Phone: (503) 639 -4171 I
Inspection Requests (24 Hrs.): (503) 639 -4175 4 '
INSPECTION WORKSHEET FOR DATE: 1/3/2007 TIME: 7:07AM PAGE: 49
SITE ADDRESS: 11744 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: COSTCO
DESCRIPTION: COSTCO. (1) branch circuit to cell site. Job # 9224.
OWNER: GRUNBAUM, HANS H AND MARILYN K, PHONE #:
CONTRACTOR: ADK ELCTRIC, INC. PHONE #: 360.608 -0665
Inspection Request Scheduled For: Date: 1!3/2007 Pour Time:
Code # Inspection Description Confirm # ontact # Message
195 Misc. inspection ? 1 041711 -01 360.6013 -0665 N
Corre
ctions /Com t rrNents nstr uctions:
10 WC) RAC. (LOG 1,J
c‘k(i rE42A4Ak1 •
(\ vrek
f ' P ` ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
E] FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Q ' N ) v Date: I - 3 -Or] Phone #: (503) 718- 2-01