Permit CITY OF TIGARD ELECTRICAL PERMIT
r d ,� DEVELOPMENT SERVICES PERMIT #: ELC97 -0664
DATE ISSUED: 10/09/97
!+L -_.. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 6394171
PARCEL: 2S1O2BD -02000
SITE ADDRESS...:12885 SW PACIFIC HWY
SUBDIVISION •NORTH TIGARDVILLE ADDITION ZONING:C —G
BLOCK • LOT •038 JURISDICTION: TIG
Project Description : Add a first branch circuit to an existing gas station.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD'L 500SF...: 0 201 — 400 amp • 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY • 0 401 — 600 amp • 0 SIGNAL /PANEL • 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 — 200 amp • 0 W /SERVICE OR FEEDER: 0 PER INSPECTION • 0
201 — 400 amp • 0 1st W/0 SRVC OR FDR.: 1 PER HOUR • 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 0 IN PLANT • 0
601 — 1000 amp • 0 PLAN REVIEW SECTION
1000+ amp /volt : 0 > =4 RES UNITS ) 600 VOLT NOMINAL..:
Reconnect only • 0 SVC /FDR >= 225 AMPS..: CLASS AREA /SPEC OCC.:
Owner: FEES
WESTERN ASTRO GAS STATION type amount by date recpt
12885 SW PACIFIC HWY PRMT $ 35.00 GEO 10/09/97 97- 299918
TIGARD OR 97223 SPCT $ 1.75 GEO 10/09/97 97- 299918
Phone #:
Contractor:
PHOENIX ELECTRIC CO $ 36.75 TOTAL
7379 SW TECH CENTER DR.
REQUIRED INSPECTIONS
TIGARD OR 97223 Ceiling Cover Underground Cove
Phone #: 684 -3600 Wall Cover Elect' 1 Service
Reg #..: 000522
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952- 001 -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling (503)246 -1987.
Permittee Signature: /ljj► Issued By:
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: 0s17
DATE: ICJ D y Q
LICENSE NO: 4//7a S
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
OCT, -08 -97 WED 03:41 P11 PHOENIX ELECTRIC FAX NO, 503 684 3611 __ P. 02/02
CITY OF TIGARD Electrical Permit Application Plan Clear 0
13125 SW HALL. BLVD. Reed By
TIGARD OR 97223 Date Rec'd
Phone (503) 639 - 4171, x304 Date to P.E.
Inspection (503) 639 -4175 Print or Typ Date to DST
Fax (503) 684 - 7297 Incomplete or illegible will not be accepte Permit �`�
1. Job Address: - 4. Complete Fee Schedule Below:
Name of Developme • • V C � .. p r Number of Inspections per permit allowed -
Name (or name of busin- . ! - ' (1. _:�, Service included: Items Cost Sum
Address . . . "t-L) - -lste.AS1 1 (, Q.3 4a. Residential - per unit
City /State/71p - ..► _ P��f1 1000 sq. ft or less $110.00 4
Each additional 500 sq. ff. or
Commercial 11 Residential ❑ portion thereof $25,00 1
limited Energy $25.00
Each Maned Home or MeaWar
Dwelling Service or Feeder $sa,00 2
2a. Contract • r installation only:
(Attach cop ‘ II current Been -_=__: :) - ■ 4b. Services or Feeders
Electrical Contrac • • .` • _ 7 . , „ ... ft" Installation, alteration, or relocation
AddiRss ai .7\.,_) . -'. " 1ailn 200 amps or less $60.00 2 -
City. b A. +L Stake j L �p 201 amps to 400 amps $80.00 2
401 amps to 600 amps $120.00 2
Phone No. s�. (,�+ (, - - ' ms's' 601 amps to 1000 amps $180.00 2
Job No. �t_).-s. - ()'. Over 1000 amps or volts $340.00 , 2
Elec. Cont. Lice. No. -.1 e- Exp.Date VD 9 ROCO onl $50.00 2
OR State CCB Reg. No. 5 Exp.Date t 9 1' 4c Temporary Servloes or Feeders
COT Business Tax or Metro No. 44 £- Exp.Date t. '11." Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Supt. Elec'n 201 amps to 400 amps $75.00 2
��/ 401 amps to 600 amps $100.00 2
License No. O Over 600 amps to 1000 volts, .
Exp.Date see "b" above.
Phone No. - • of)
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations:
a) The fee for branch chvuits with
purchase of service or
Print Owner's Name feeder fee_
Address Each branch circuit $5.00 - 2
City State b) The tee for branch circuits
Zp without purchase of
Phone No. , service or feeder fee.
First branch circuit \ $35.00 S. )Q 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 2
intended for sale, lease or rent 6e. Miscellaneous
Owner's Signature (service or }caner not included)
Each pump or irrigation circle 540.00 2
Each sign or outline lighting $40.00 2
3, Plan Review section (if required);* Signal circuit(s) or a limited energy
panel. alteration or extension 540.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
a or more residential units in one structure 41. Each additional inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour - $55,00
as described in N.E.C. Chapter 5 In Plant - $55.00
' Submit 2 sets of plans with application where any of the above apply. S. Fees:
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total tees) $
NQT1C. • Subtotal $
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review It requirrarl(Sec.3) $
NOT COMMENCED WITHIN 180 DAYS. OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. Trust Aocaunt s .5:)-) -R "2 S
Total balance Due
8/16/99 Activities for Case #: ELC97 -00664
8:41:04 PM
•
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 10/9/97 GEO RECD GEO 10/9/97
ELCC003 Permit created 10/9/97 GEO PASS GEO 10/9/97
ELCC799 Elect'I Final 10/9/97 12/17/97 BRP PASS B'P 12/17/97
ELCC500 (F)Issue permit 10/9/97 GEO PASS GEO 10/9/97
ELCC800 Case Fineled 12/18/97 • BRP PASS J'H 12/18/97 one circuit installed; two
heaters approved.
Page 1 of 1 •
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CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: (c — 7 :1 7 A.M. P.M. MST:
Location: -..../1 I .. � � IZ. -/, ■ffd ■-■.-
BUP:
Tenant: 14 r Ef1 �� 5 ' / '
/
�� __ � v e�te: Bldg: MEC:
Contractor: L!l� /f� /. %! f� / , it '.A. L Phone: - 600 PLM:
Owner: / I Phone: ELC: rQ
ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ELECTRICALS SITE
Site Post/Beam Post/Beam Post/Beam Cover/Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In i ' . ` Water Line
Slab Framing Top Out Gas Line • ough -In 1 CU.t� UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approv Approved
Appr /Sdwlk Not Approved Not Approved Not Approved oved Not Approved
FINAL FINAL FINAL FINAL
1I e z /P, it"----C. /)1 S/4 t/e—d___
rc- --- : **---
1 - * - ----- -- ---- j
D Call for rein ... I O Reinspection fee of $ ) 2requir fore ne ' spection 0 Unable to inspect /4 1
Inspector: Date( Page of