Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00082
a� ra DEVELOPMENT SERVICES DATE ISSUED: 2/14/2005
r' �! 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 1S135DD-00600
SITE ADDRESS: 11831 SW PACIFIC HWY
SUBDIVISION: HOFFARBER TRACTS NO.2 ZONING: C -G
BLOCK: LOT : 040 JURISDICTION: TIG
Project Description: Sign connection. Job # 62740.
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: 1 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:
YOUNG'S FUNERAL HOME INC FRAHLER ELECTRIC CO
11831 SW PACIFIC HWY 11860 SWGREEN BURG RD
TIGARD, OR 97223 TIGARD, OR 97223
Phone: Phone: 503 - 639 - 4627
FEES Reg #: LIC 37410
Description Date Amount SUP 3 4 -
p ELE 34 -133
C
[ELPRMT] ELC Permit 2/14/2005 $53.50
[TAX] 8% State Surcharge 2/14/2005 $4.28 REQUIRED ITEMS AND REPORTS
Total $57.78
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: r p Permit Signature: X11 n
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 7:00pm for an inspection the next business day
•
Electrical Permit Appli It FOR OFFICE USE ONLY
City of Tigard RCe1VGd P er mitNo.: G 9 r') /
Date/By:pZ' /�/ 7J �� e. vV
13125 SW Hall Blvd., Tigard, OR 97223 `,,i ' i \ � Date/By: Plan
Phone: .D ■ I ne: 503.639.4171 Fax: 503.598.1960 CQ 1 . - . ;f l OtberPermit:
i
Inspt ton Line: 503.639.4175 Date Ready/By la See Page 2 for
Internet: wwa+.cl.ilgard onus ITY O F Tl ' ' Notified/Method: 'ri Supplemental Information
Zi 4 - �' S 7 i �, - � i� -'`' S F f Ri. Idl at{- ,� `i` ft. r - '[
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❑ New construction ® Addition/alteration/replacement L 1 Please check all that apply:
El Demolition [3 Other ❑Service over 225 amps, coma 'l ❑Hazardous location
- - ❑Service over 320 amps - rating ❑ Buildng over r 10,000 sq..
L , 4 ,+ " � 1 : ;:L ,-,„ 'r k � � r' � 4 ) _ 1 ' t L i" � 1 � , J EE f e ` .. �'? r :y - ,p.gkw. 11.- mod._ y
j : o f 1 -an 2 - f am il dwellin 4 or more stew residentia
❑ 1 and 2 family dwelling ® Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in on_e structure
ID Multi family ❑Master builder ❑Other: ❑Building over three stories ❑Feeders, 4100 amps or mo
['Occupant load over 99 persons ['Manufactured structures
L Y t i t• ,` -.. � ' ,I.�tii� 5 7 , , ? aDS,,Tf IsyC;``w 4c - i "' ! �'f a y E s/h tin tan RV. park
• Job no.: 62740 Job site address: 11831 SW PACIFIC HIGHWAY ❑Health - care facility ❑other:
Submit 2 sets of plans with any of the above.
City/State/ZIP: TIGARD, OR 97223 The above are not applicable to temporary constru ction service.
-
Suite/bldg./apt. no.: Project name: y. S a = ;� v., i" s } ., ' fi � ; " ' l -r". � ?" .. .
Desolation Qty. Fee- Total
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
HIGHWAY 99 AND SW WARNER 1,000 sq. ft or less , 145.15
Subdivision: Lot no.: Ea. add'1500 sq. ft. or portion 33.40
Tax map /parcel no.: Limited energy, residential 75.00
Limited energy, non-residential 75.00
, .t..=4.1±2Y: S:ti« :sk' ' , <, _ : ° . $, 'P t � ' ° ' 4 ,- `� ,`_,:.,.x ,.&-. `.jE_p = 2 Each manufactured or modular
CONNECT SIGN dwelling, service and/or feeder 90.90
Services or feeders Installation, alteration, and/ or relocation
200 amps or less 80.30
-07. ^2 .., } � . 0 ,f ' r` F , � G ,'` ' :ig:W - 1- u , l 35.- � iripR '9 h. e ` a i 201 amps W 400 amps 106.85
a.S._a. . -, ' Zu....Ar -L .._�, s -_.. .1_ ,_._ _ i_.._ ._z.1 .... - -"= = - .t__. _.. 11 .Ei :-2 401 amps to 600 amps 160.60
Name: . 601 amps to 1,000 amps 240.60
Address: - - - .. - Over 1,000 amps or volts 454.65
Reconnect only - • 66.85
City/ State/ZIP: . Temporary services or feeders installation, alte ration, and/or
Phone: ( ) - ' Fax: ( ) - - relocation
200 amps or less 66.85
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
7 ?,rkF 5 -- ; - -'t 4 v l l r l f,• +' 1 �. r r hit " ; ti� ;; P:7 ; T i _ A. Fee for branch circuits with
'? E 1 „. . ?'._� . ..,-�._
_.. �. 12 _ _ _ -4r;AKt_ _
!. .'u ALT i r
. - .<: ' : -., _: :14. y] service or feeder fee, each
Business name: branch circuit 6.65
B. Fee for branch circuits
Contact name: without service or feeder fee 1 46.85 46.85
Address: each branch circuit
Each add'l branch circuit 1 6.65 1 6.65
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax: : ( ) Pump or irrigation circle 53.40
Sign or outline lighting 53.40
E -mail: Signal circuit(s) or limited -
3
Y X5 '•• , � ."rr ", .TfCg .-4 77 P V rI i c T � " ; + : « ' . " = 's }^ r .4 ? . ;" 1 energy panel, alteration. or
kL:�L.3..a _ - - Wt . - . L.r= ti.
..s *f. ��•_..- i . 3 • mammon. Describe: Paget
Business name: F9AHLER FT FCTRIC COMPANY
- Each additional inspection over allowable In any of the abov
Address: 11860 SW GREENBURG ROAD
Per inspection 62.50
City/ State/ZIP: TIGARD, OR - 97223 Investigation per hour (I hr min) 62.50
- - Indushial plant per hour 73.75
Phone: (503) 639 -4627 F ax: ( 503 . ) 639- 4673. h ' L ti r.�,� 11 s ty�5� , o� �_ ;
_...511{,'4+ 4. :1' -t-t L-_ .F- � 'Z..it -. �A?ll
CCB Lic.: 37410 Electrical Lic.: 34 -13C Suprv. Lic.: 1816S • - Subtotal 53.50
Suprv. Electrician signature, required: L � Plan review (25 °(o of permit fee
Print name: R. W. F'� Date: 02/10/05 State surcharge (8% of permit fee) 4.28
TOTAL PERMIT FEE 57.78
Authorized signature: This permit application expires if a permit Is not obtained within 1S
• day, after It has been accepted as complete
Print name: Date: • Fee methodology set by Tri- Comity Building Industry Service Board
•• Number of inspections per permit allowed.
c1BufdinglPermiedELGpermitApp .doc 12/03 440- 4615T(10ro2/COtd/Wm
Electrical Permit Application - City of Tigard - Page 2 - Supplemental Information
LIlVIITED ENERGY PERMIT FEES:
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:
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
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El 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
c .aoe 04/03
CITY OF TIGARD ' '
•
BUILDING DIVISION PERMIT #: ELC2005 -00082
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/14/2005
Phone: (503) 639 -4171 am �'
Inspection Requests (24 Hrs.): (503) 639 -4175 I l.•
INSPECTION WORKSHEET FOR DATE: 3/16/2005 TIME: 7:11AM PAGE: 1
SITE ADDRESS: 11831 SW PACIFIC H1NY CLASS OF WORK:
SUBDIVISION: HOFFARBER TRACTS NO.2 LOT #: 040 TYPE OF USE:
PROJECT NAME: YOUNG'S FUNERAL HOME
DESCRIPTION: Sign connection. Job # 62740.
OWNER: YOUNG'S FUNERAL HOME INC, PHONE #:
CONTRACTOR: FRAHLER ELECTRIC CO PHONE #: 503 - 639.4627
Inspection Request Scheduled For: Date: 3/16/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 001939 -01 503 - 639 -4627 Y
Corrections /Comments /Instructions:
M PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: y� U Date:_ Phone #: (503) 718 -