Permit Ai CITY OF TIGARD
DEVELOPMENT SERVICES ELECTRICAL PERMIT
PERMIT #: ELC2004 -00552
,, 1 DATE ISSUED: 8/27/2004
� II 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 102AA -01100
SITE ADDRESS: 12035 SW PACIFIC HWY A
SUBDIVISION: KINGSTON ZONING: C -G
BLOCK: LOT : 1 -7 JURISDICTION: TIG
Project Description: Alteration of (2) branch circuits to correct items discovered during reconnect inspection. Job No.
24 -1251
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:
TIGARD AUTO STOP PARTNERS CAPITOL ELECTRIC CO INC
300 ADMIRAL WAY #200 11401 NE MARX ST
EDMONDS, WA 98020 PORTLAND, OR 97220 -1041
Phone: Phone: 255 - 9488
Reg #: LIC 048748
SUP 3132S
FEES ELE 26 -496C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/27/2004 $53.50
[TAX] 8% State Surcharge 8/27/2004 $4 Rough -in
Elect'I Final
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
rule a forth in R 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 99 or 1-800-332- C Of.eAtet4
Iss d By: Permit Signature: ,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: � - - , �. = Ar t �� r = DATE: 4 111 7 )
LICENSE NO: g/ 3? 5
Call 639 -4175 by 7:00pm for an inspection the next business day
FOR OFFICE USE ONLY
Electrical Per Application Da��sy � Permit no.: ` L _,, /LS 5
City of Tigard Plan Revie Other Permit:
di r 13125 SW HALL BLVD., TIGARD, OR 97223 ,aill Date/By:
Phone: (503) 639 -4171 Fax (503) 598 -1960 CITY OF TIGARD Date Ready /By: Juris: / See Page 2 for
Inspection Line: 503 -639 -4175 - Notified/Method: I I aI Supplemental Information
Internet: www.ci.tigard.or.us •
TYPE OF WORK PLAN REVIEW
U New construction Addition/alteration /replacement Please check all that apply:
❑ Demolition Other: ❑ Service over 225 amps, comm'l ❑ Hazardous location
CATEGORY OF CONSTRUCTION ❑ Service over 320 amps - rating ❑ Building over 10,000 sq.ft.
U 1- and 2- family dwelling xi, Commercial /industrial U Accessory building of 1- and 2- family dwellings 4 or more new residential
❑ Multi- family ❑ Master Builder ❑ Other ❑ System over 600 volts nominal units in one structure
JOB SITE INFORMATION AND LOCATION ❑ Building over three stories ❑ Feeders, 400 amps or more
Job no.: 24 -1251 I Job site address: 12035 SW PACIFIC HWY El Occupant load over 99 persons r=1 Manufactured structures or
❑ Egress/lighting plan RV park
City /State/ZIP: TIGARD, OREGON 1=1 Health-care facility 1=1 Other:
Submit 2 sets of plans with any of the above.
Suite/bldg. /apt. no.: (Project name: CORRECTIONS The above are not applicable to temporary construction service.
FEE SCHEDULE
Cross Street/Directions to job site: Description I Qty. I Fee. I Total I "
New residential - single or multi - family dwelling unit.
Subdivision: I Lot no.: Includes attached garage.
1000 sq. ft. or less $ 145.15 4
Tax map /parcel no.: Ea. Add'I 500 sq. ft or portion S 33.40 I
DESCRIPTION OF WORK Limited energy residential $ 75.00 2
CODE VIOLATION CORRECTIONS Limited energy, non - residential S 75.00 2
Each manufactured home or modular
U PROPERTY OWNER I U TENANT dwelling, Service and/or feeder $ 90.90 _ 2
Name: Service or feeders installation, alteration, and /or relocation
C/O COAST REALESTATE SERVICES 200 amps or less 5 80.30 2
Address: 2610 WETMORE AVE 201 amps to 400 amps 5 106.85 2
401 amps to 600 amps $ 160.60 2
City /State /ZIP: EVERETT, WASHINGTON 98201 601 amps to 1000 amps $ 240.60 2
Over 1000 amps or volts $ 454.65 2
Phone: Fax; Reconnect only $ 66.85 _ 2
425- 339 -3638 Temporary services or feeders installation, alteration, and/or
Owner installation: This installation is being made on property that I own which is not relocation
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701 200 amps or less $ 66.85 l
Owner signature: Date: 201 amps to 400 amps $ 100.30 2
401 amps to 600 amps 5 133.75 _ 2
U APPLICANT I U CONTACT PERSON Branch circuits - new, alteration, or extension, per panel
Business Name: A. Fee for branch circuits with
service or feeder fee, each
Contact name: branch circuit $ 6.65 2
B. Fee for branch circuits
Address: without service or feeder fee,
each branch circuit 1 $ 46.85 46.85 2
City / State/ZIP: Each additional branch circuit: 1 $ 6.65 6.65 2
Miscellaneous (service or feeder not included)
Phone: Fax: Pump or irrigation circle $ 53.40 2
Sign or outline lighting $ 53.40 2
E -mail: Signal circuits(s) or limited -
CONTRACTOR energy panel, alteration, or -
Business Name: CAPITOL ELECTRIC CO., INC. extension. Describe: Page 2 2
Contact name: Each additional inspection over allowable in any of the above
Per inspection • $ 62.50 ,
Address: 11401 NE MARX ST. Investigation per hour (I hr min) $ 62.50
Industrial plant per hour 5 73.75
City/ State/ZIP: PORTLAND, OR 97220 -1041 ELECTRICAL PERMIT FEES'
Subtotal 53.50
Phone: 503 - 255 -9488 Fax: 503 - 257 -7121 Plan review (25% of permit fee'
State surcharge ( 8% of permit fee) 4.28
CCB Lic.: 48748 !Electrical Lic.: 26 -496C ISuprv. Lic.: 3132 -S TOTAL PERMIT FEE 57.78
Suprv. Electrician signature, required: This permit application expires if a permit Is not obtained within 180
days after It has been accepted as complete
Print Name: DARRELL MCNEEL � � ��JJ Date: 8/27/04 • Fee methodology set by Tri -County Building Industry Service Board
Authorized signatu 4 4 /,//I ��C� ••Number of inspections per permit allowed.
rC i�
Print Name: DARRELL MCNEEL
•
CITY OF TIGARD 24 -Hour
BUILDING : Inspection Ling: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
.c j =_
Received Date Requested _ g - AM PM BUP
Location (.?' 0 , 3 S p - , Suite - - - MEC
Contact Person Pli (9 7f -) -3 - 3 7? - PLM
Contractor Ph ( ) 42 S' _9 c ao SWR
BUILDING Tenant/Owner ELC D D ti
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain AIM
Slab Inspection Notes: -- - ∎ SIT
Post & Beam �!`-(! ✓L � 2.I31 '
Shear Anchors -- C � ! U
Ext Sheath/Shear
Int Sheath/Shear (II::
Framing
Insulation 0 ON CO PO w & 15 ?Ilk. NG� oil/ A- c Ae s
Drywall Nailing
Firewall MUST_ gC CHF, C,e.� FD61 _ p /e && & P�%R- 7011
Fire Sprinkler /
Fire Alarm /46-7 4--me cjy 7 ��` � L ( s
Susp'd Ceiling
Roof ,Ili{ 1551 MCA K C Eg--_. EL &i l E//
Other:
Final OP /4F P4-71/■%■- oift/U c(Lc ! /5 r/ VZ PEI
PASS PART FAIL PLUMBING (iv, /Z Gui '. - , i . 3 f11C && Aft
Post
e r l abm
Un P � 7 /97$i ?.
Under Slab / - -
Rough-In / I S �- C D�� -6. 5 r 7 EL-E- /Z-+ G 1�7Y
Water Service
Sanitary Sewer LA- K[ G. 5 / GK'S e
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan 710 P /2.€ V c r 8 F- t NA
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
UG/Slab
Low Voltage
Fire Alarm
PART FAIL ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
0 Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line v ✓ 16„, A-Rt5,66e/oi ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL