Permit A, . CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00724
�* DEVELOPMENT SERVICES DATE ISSUED: 11/10/2004
" �� I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S135DD-03301
SITE ADDRESS: 11945 SW PACIFIC HWY 248
SUBDIVISION: HOFFARBER TRACTS NO.1 ZONING. C -G
BLOCK: LOT : 002 JURISDICTION: TIG
Project Description: Electrical TI, move existing 150A panel and (18) branch circuits.
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: 1 W /SERVICE OR FEEDER: 18 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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: SVCIFDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
TIGARD PROPERTIES INC AMKOR ENTERPRISES INC
2106 SE OCHOCO ST PO BOX 1751
MILWAUKIE, OR 97222 LAKE OSWEGO, OR 97035
Phone: Phone: 503 - 744 - 0615
Reg #: LIC 150236
ELE 34 -582C
. FEES SUP 4490S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 11/10/200' $200.00
[TAX] 8% State Surcharge 11/10/200 $16.00 Elect'l Service
Rough -in
Total $216.00 Elect'l Final
•
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 set h i R 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 -332-
Is ued By: a Permit Signature: r z C _ --==,---_____---
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: Cs:- � � / DATE: ///
7`5`
LICENSE NO: S'.4 S
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application FOR OFFICE USE ONLY
City of Tikard Received
Datea : / 11, Amon perm...,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 41111
Date/B :
._ J I i Other Permit:
Inspection Line: 503.639.4175 ._:i j: Date Ready/By: .14;,..... Ea See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: /kik— Supplemental Information
*46kcit45.11
._ , . /-.,...„ :,:. . r.,,,, ,., • ,: ., ., .,,, ,., . --. .,,,..... .. „,.... :•,,C..4 '. i i , 'L'....:"...4.1;:T.1 , 4 1 ,46•41::. -, i;. , r ,, , , ....e:; - ,.,k1-_.ALv.. } .1)..,t :,..'_ -.." ,, ,-., ,‘, .. ; : ,:., • , ..'
0 New construction Addition/alteration/replacement Please check all that apply:
['Service over 225 amps, comm'l ['Hazardous location
0 Demolition 0 Other:
OSenrice over 320 amps - rating OBuildng over 10,000 sq. ft.,
-7.A `f,!..it V of 1- and 2-family dwellings 4 or more new residential
- _ - ::': , ..?@ , ....--A - - , , • - _ - . - . , - , 0•"..•,1 ....,, ,- . - _.2 - 4. ,, , ;., !...., ,.. ,..,. .'„ ..,.., ..:_ . _. J:c. ...i.
D 1- and 2-family dwelling Commercial/industrial 0 Accessory building ElSystern over 600 volts nominal -units in one structure
['Building over three stories ['Feeders, 400 amps or more
0 Multi-family 0 Master builder 0 Other:
00ccupant load over 99 persons 0Manufactured structures or
k kr . r , :... , ;,fatky,..P.".-t,';',el.v E,t : Y.:, r-1 RV. park
.- t..ie:.:.-,1!...-.: '-'if."•Vg.! ::!•.?!!,-f. -_, ,A;I:'..-:=', L..i Egess/lighting plan
Job no.: Job site address: // ys (silo peic..iic Ay D Hea lth-care facility 00ther:
Subm 2 sets of plans with any of the above.
City/State/ZIP: 7.4f 4 yci , 0 X 9 - 2 2 3 3, The above are not applicable to temporary construction service.
Suite/bldg./apt. no.:
g' .! .:'
Aeg Project name: p a 9, , ,, e , S' el o d ria,..t0.2"•-"e: ''' , --'f-.' - . • — ÷"---,..-- , - ''-':•-••.., ' • ,
..../ ----/ eser1 tioo 1 Qty. I Fee. 1 Total I **
Cross street/directions to job site: 9q 0 k H4// //,,c/ 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
i'•'' : Y:),■Arl:07* :4, k Each manufactured or modular
. dwelling, service and/or feeder 90.90 2
/O 9P'4 ti CA C.> ', &jolt" lee ii'l d 0 /19 // I P) j Services or feeders installation, alteration, and/or relocatio
U C- , 4',4 /12) ,4 '.. ipei 4 e// 200 amps or less / 80.30 J. a 2
'', "Y.;:-t: . -.= ICiniekiiyiiiiii ••• `'i•f:"- -_.','L il!-,iv., ., i. • iq, T i mo dsr. , ;r 4 ;,- ; ,„ , ,, , ,1 -- -&•., 201 amps to 400 amps 106.85 2
- ' ` " -f - - ,- - - - - — , t . - - - - - r- - ----- •-- - - a - - - — 401 amps to 600 amps 160 60 2
Name: - asikg.1> VP.bP ) a: . 641 eof.341 01-£ N3 601 amps to 1,000 amps 240.60 2
454.65 2
Address: sa ,„ ,... 9 , 5 i se. avow_ 0120151 ,tive O amps or volts
v ItercXect only - 66.85 2
City/State/ZIP: H , , 2. / Drnb O&. 1.72.6 0 Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) (549 579. 7/(f3 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
.1 .'- . " 4 f-rattniggicitkr ., .. 7 ' .; 'it ,:. . 6:•5 44; ; ..i. k Fee for branch circuits with
.1: , • ;'--t°:;,' ;,.: ::-.... . ', ,,i -•.: . .54•E' ::--• ";. --4,..:,-.. ..i kih-; - -:' ...,-- -' ...: : , - f - '-...- service or feeder fee, each id 6.65 &) 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
each branch circuit
Address:
Each addl branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) I Fax: : ( ) Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited-
1 .,,•. i'.1,, i i r - ".••••;;;' . ic , ,_ i',f e...,1:12 energy panel, alteration, or
extension. Describe: Page 2 2
Business name: ,4, y eo,e fep-ti-,3 C...--
Each additional inspection over allowable in any of the above
Address: 0 3 ox / 7 ... 1-- 1
Per inspection 62.50
City/State/Z1P: t r- 0
pg 9 of Investigation per hour (1 hr min) 62.50
Phone: (6>7) 7 0, c36/ "-- I Fax: (6,3 ) Z3 e _ /3 2 Industrial plant per hour 73.75
\t% --! '''' '''''.- ''"• irrii• 4 rt - r.c" -- • tr"
:v : 1 ' :7- 1,v,-----..,:-... ..-•,---trr.-..,fp-,.4,41...-- ,...•••••;:;-...J •!.-
... CCB Lic.: / Z _> 3 1 Electrical Lic.: 7 _ ..fe Suprv. Lic.: eAt. & S Subtotal Afy, 00
. .
Suprv. Electrician signature, required: . 74/ c °fe .. 1 i 6r7 Plan review (25% of permit fee)
State surcharge (8% of permit fee) /it ' 00
Print name: "EA i . 7 c .3 4 , . Date: "/ // ,:t, /0 SZ,
TOTAL PERMIT FEE gj 4, ‘947
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.
BBuildineermits‘ELC.PermitApp.doc 12103 440-4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
�� SIDE � :7 x'. -WO,O .. WE V - 5-._ ; ��f
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:
•
s j . E:,L, F . � T
:7s�77��p, "y
k]vV_L�1'LF .•'.. 1 � 1 ,.�.. T�:' ® 7ril%I�L;•4�: .. :s'� 7 ,1
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
• ❑ Boiler Controls • V .
❑ Clock Systems
❑ Data Telecommunication Installation
❑ 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'.Pamiu\ELC- PemutApp.doc 04/03
A CITY OF TIGARD
i BUILDING DIVISION PERMIT #: ELC2004 -00724
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/10/2004
Phone: (503) 639 -4171 i 9gp ,
Inspection Requests (24 Hrs.): (503) 639 - 4175 ° :
P
INSPECTION WORKSHEET FOR DATE: 5/13/2005 TIME: 7:12AM PAGE: 5
SITE ADDRESS: 11945 SW PACIFIC HWY 2413 CLASS OF WORK:
SUBDIVISION: HOFFARBER TRACTS NO.1 LOT #: 002 TYPE OF USE:
PROJECT NAME: FISH MARKET
DESCRIPTION: Electrical TI, move existing 150A panel and (18) branch circuits.
OWNER: TIGARD PROPERTIES INC, PHONE #:
CONTRACTOR: AMKOR ENTERPRISES INC PHONE #: 503 - 0615
Inspection Request Scheduled For: Date: 5/13/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 006847 -01 503-744 -0615 Y
Corrections/Comments/Instructions:
j i 6 AP)Pkob
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 6/ g L ,/ ly i Date: _ / 1 `c Phone #: (503) 718-