Permit r , CITY OF TIGARD
DEVELOPMENT SERVICES ELECTRICAL PERMIT
I li I PE RM I T #: ELC98 -0275
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 05/26/98
PARCEL: 1S135DD -03301
SITE ADDRESS...:11945 SW PACIFIC HWY #250
SUBDIVISION •HOFFARBER TRACTS NO.1 ZONING:C —G
BLOCK • LOT :002 JURISDICTION: TIG
Project Description: Safeway - JOB #7663
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD'L 5O0SF...: 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: 1 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
TIGARD PROPERTIES type amount by date recpt
2106 SE OCHOCO ST PRMT $ 40.00 JSD 05/26/98 98- 306007
MILWAUKIE OR 97222 SPCT $ 2.00 JSD 05/26/98 98- 306007
Phone #:
Contractor:
ELECTRICAL DIMENSIONS INC $ 42.00 TOTAL
PO BOX 12146
3961 SW WILLAMS AVE REQUIRED INSPECTIONS
PORTLAND OR 97212 Ceiling Cover Elect'1 Service
Phone #: 282 -7255 Wall Cover Elect'1 Final
Reg #..: 000440
This per.it is issued subject to the regulations contained in a Tigard Municipal Code, State of Oregon Specialty Codes and all other
applicable laws. All work will be done in accordance with p oved plans. This permit will expire if work is not started within 180
days of issuance, or if work is suspended for more than 80 d ys. A :0 ON: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Those rules are set orth in 1 " 952-001-0010 through OAR 952-001-1%:7. You ay obtain a copy
of these rules or direct questions to OUNC b lling (503) j 987.
Permittee Signature: 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 : DATE:
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
l I
CITY OF TIGARD R'b"al Permit Application Plan Chec.
13125 SW HALL BLVD. Recd. f ap-
TIGARD OR 97223 MAY 2 6 1998 Date Re s
Date to P.E.
Phone (503) 639 -4171, x 304 Date to DST
Inspection (503) 639 -4175 CpPl DEVELO °Ptl flnt or Type Permit # EL- C 9g -c z
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development S �+ Number of Inspections per permit allowed
S
Name (or name of business) a Cw� Service included: Items Cost Sum
Address / / 9 ti S S W Pa 11 //i 4a. Residential - per unit
City/State/Zip 7 " i / u r d r9 r 97 Z. Z 3 Each additional it or less $110.00 4
ty p Each additionn al 500 sq. ft. or
Commercial ® Residential El Limited thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current licenses) 4b. Services or Feeders
Electrical Contra I nstallation, alteration, or relocation
��j }ror XI 'cc rt., - ea / Any, eti � � o�, 1.1.1c_ 200 amps or less $60.00 2
Address / e> 8 cv ! 2l "/b 201 amps to 400 amps $80.00 2
City 9arti a State Or Zip 97 0. t• L 401 amps to 600 amps $120.00 2
Phone No. 2- S Z- 7z 575" 601 amps to 1000 amps $180.00 2
Job No. 766 Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. .4, --4f3 2 Exp.Date o g
OR State CCB Reg. No. V Yoo V xp.Date 9 4c. Temporary Services or Feeders
COT Business Tax or Metro No. / /'7 - xp.Date 7/ii /Wil Installation, alteration, or relocation
200 amps or less $50.00 2
-
Signature of Su r. El ec'n ! /�✓ / / 201 amps to 400 amps $75.00 2
Si
g p 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. Z46y "S Exp.Date /6//96?) see "b" above.
Phone No. 2.41L 7ZS'S
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00 2
-
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee. 350.
First branch circuit / $35.00 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 Sao 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 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 $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. 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: 4/0 cc) Not required for temporary construction services. 5a. Enter total of above fees $ 200
5% Surcharge (.05 X total fees) $
NOTICE Subtotal $
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (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 Account #
1 17- DO
Total balance Due $
E
I: \DSTS \ELC96.APP Rev 9/96
1
Page No. 1 CASE HISTORY FOR CASE NO.: ELC98 -0275
• • TIGARD PROPERTIES
• 11945 SW PACIFIC HWY Unit: 250
11/18/98
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
ELCC001 Application received / / / / 05/26/98 USPS JSD 05/26/98 KJP
ELCO003 Permit created / / - / / 05/26/98 PASS JSD 05/26/98 KJP
ELCC500 (F)Issue permit / / / / 05/26/98 PASS JSD 05/26/98 KJP
ELCC799 Elect'1 Final / / / / / / 7/31/98 sent inspection request to Chuck 07/31/98 JT
D. /research "since we are going out lets
check this one for completion"
ELCC799 Elect'1 Final / / / / 08/04/98 wiring of vending machines PASS CD 08/04/98 CD
ELCC800 Case Finaled / / / / 08/05/98 PASS CD 08/05/98 J *H
ELCC920 Miscellaneous action / / / / 08/03/98 see comments under permit ' e1c98 - 0064. FAIL CD 08/03/98 CD
•
•
•
•
•
•
CITY OF TIGARD BUILDING INSPECTION DIVISION PLC 97 + ofc)
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested AM PM BLD
Location i / " _ / Mu_ . .'te . MEC
•
Contact Person PLM
Contractor Ph SWR
BUILDING Tare wner ELC 7?
Retaining Wall
Footing cl 7 l Foundation Access: � ) FPS
Ftg Drain _ � SGN
Crawl Drain Inspection Notes
Slab C�rL. / SIT
Post & Beam
Ext Sheath /Shear - C(2 ,
Int Sheath/Shear
Framing
Insulation • ,
�Cti
Drywall Nailing ' « 4s 4 (1/14- - L
Firewall
Fire Sprinkler
Fire Alarm ,�
Susp'd Ceiling U'"
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab •
Low Voltage
Fire Alarm
Fi
SS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA /
Approach /Sidewalk Date 3' 7 1 - 1? Inspector °Lel) Ext
Other
Final
PASS PART FAIL . DO NOT REMOVE this inspection record from the. job site.