Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00735
DEVELOPMENT SERVICES DATE ISSUED: 9/29/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S135DD-03301
SITE ADDRESS: 11945 SW PACIFIC HWY 250 ZONING: C -G.
SUBDIVISION: HOFFARBER TRACTS NO.1 LOT : 002 JURISDICTION: TIG
Project Description: 12 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: 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: 11 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:
TIGARD PROPERTIES INC ADVANCED WRING SERVICES INC
8320 NE HWY 99 PO BOX 644
VANCOUVER, WA 98668 CLACKAMAS, OR 97015
Phone: 360 - 574 -6255 Phone: 503 - 310 -3655
FEES Reg #: ELE C7
tion Date Amount LIP 162591
Description SUP 46755
[ELPRMT] ELC Permit 9/29/2005 $122.00
[TAX] 8% State Surcharge 9/29/2005 $9.76 REQUIRED ITEMS AND REPORTS
Total $131.76
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 ditions
503 - 246 - 6699 or 1 - 800 - 2 Issued By: , Permittee Signature: /1 / �
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 A 1' • `'
Ci of Ti and 1 hi , " Perm No.'
h' g V Date/B� y Aq v � i e aoo5 -o0 5
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie u, -,. ,
Phone: 503.639.4171 Fax: 503.598.1960 Date/13 Other Permit:
Inspection Line: 503.639.4175 SEP 2 9 .',1 � ' - I� Date Re adyBy. s. El SeePage2 for
Internet: www.ci.tigard.or.us Notified/Method 7/ Supplemental Information
Ticatra PLAN REVIEW
❑ New construction joi klibiddatilithitsi/lalakiSION Please check all that apply:
❑ Demolition Other: ❑Service over 225 amps, comm'I ['Hazardous location
❑ Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ I and 2 family dwelling I 1 Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ['Feeders, 400 amps or more
❑ Multi - family 0 Master builder 0 Other
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
❑Health -care facility ['Other:
Job no.: Job site address: 0 951 1. 0. pAciF /C M N Submit 2 sets of plans with any of the above.
City/ State/ZIP: T 1 1,Ae . 012.-. 172 Z; The above are not applicable to temporary construction service.
9bld&/aPL no.: 2' O Project name: .4 CA 1 vJr2AP FEE* SCHEDULE
Description I Qty. I Fee. I Total I ••
Cross street/directions to job site: HALL 7 1 F (C. J-I,J' , 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'l 500 sq. ft or portion 33.40 I
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
F�5. P G c 1 -` 6 �si j dwelling service and/or feeder 90.90 2
f p Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: 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
❑ APPLICANT I ONTACT PERSON A Fee for branch circuits with
service or ,
IBC•
Business name: A 11 JAMCeN W I ei U ���J tt J , I branch c rcu ueder fee each 6.65 2 it Contact name: C e�r1.1 }U Nn N 6- N
B. w ee our branch cir feeder its
without service or feeder fee,
Address: F. 0 ��( &4L' each branch circuit i 46.85 `{� gS 2
Each add'I branch circuit I 1 6.65 73. 1S 2
City/ State/ZIP: , C VS ) OP. '1 70 Miscellaneous (service or feeder not included)
Phone: ( 55-0;) ,; . 7 � 9 e , Fax :: ( 50 Pump or irrigation circle 53.40 2
��� 7 o 37 Z Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
Business name: ��� extension. Describe: Page 2 2
A wI0� NG � o��/i INC,.
Address: p 0 o < 6,•1� Each additional inspection over allowable in any of the above
� ' Per inspection 62.50
City/State/ZIP: c%(►A cgl 1 't i oe , 9-761s Investigation per hour (I hr min) 62.50
Phone: (GO;) egg 2 ° 1 Sd Fax: (5 1,3 / - 4 -‘7•0 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 1625ci ) Electrical Lic.: G 7 Su: . Lic.: LIb7C,, S Subtotal 122 O0
Suprv. Electrician signature, required: . �� / Plan review (25% of permit fee)
Print name: 6 ItU l ' fl }L( TO/■1 Date: .9 /2 9 17(10 S State surcharge (8% of permit fee) 1 . 74
TOTAL PERMIT FEE /? /, 74,
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: 9) 21 I ZOOS • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\BuildineennitskELC-PeemitApp.doc I2/03 410- 4615T(I0/02/COM/WEB
a
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
PRESIDENTIAL WORK ONLY:
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:
•
COMMERCIAL WORK ONLY: —
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*
❑ 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 •
i:BuitdNB\Permiu\ELC- Pamiwpp.aa 04/03
0
CITY OF TIGARD A-
BUILDING DIVISION PERMIT #: ELC2005 -00735
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/29/2005
Phone: (503) 639 -4171 Zi�l�
Inspection Requests (24 Hrs.): (503) 639 -4175 `:_..
INSPECTION WORKSHEET FOR DATE: 10/10/2005 TIME: 7:04AM PAGE: 124
SITE ADDRESS: 11945 SW PACIFIC HWY 250_ CLASS OF WORK:
SUBDIVISION: HOFFARBER TRACTS NO.1 LOT #: 002 TYPE OF USE:
PROJECT NAME: JO -ANN FABRICS
DESCRIPTION: 12 branch circuits.
OWNER: TIGARD PROPERTIES INC, PHONE #: 360 -574 -6255
CONTRACTOR: ADVANCED WIRING SERVICES INC PHONE #: 503 310 - 3665
Inspection Request Scheduled For: Date: 10/10/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 017782 -01 503-833-2980 Y
Corrections /Comments /Instructions: l `
\ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL • ' A L FOR INSP-CTION ❑ ADDITIONAL FEES ASSESSED
Inspector: `, / , , " Date: 1°i 1(1 Phone #: (503) 718