Permit CITY ITY O F TIGARD ELECTRICAL PERMIT
A 0., � � PERMIT #: ELC2002 -00529
- ` DEVELOPMENT SERVICES DATE ISSUED: 10/10/02
'`- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 102 C B -00302
SITE ADARESS: 13285 SW PACIFIC HWY 7 -11 ZONING: C -G
SUBDIVISION:
BLOCK: LOT : 033 JURISDICTION: TIG
Project Description: Install 1 200amp feeder and 4 branch circuits to coffee island.
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: 1 W /SERVICE OR FEEDER: 4 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
PLAN REVIEW SECTION
601 0 amp/volt: amp:
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
ALADDIN MOTOR INNS ROSE CITY ELECTRIC CO INC
BY BENZENISTE, IRVING 4012 NE CULLY BLVD
10155 SW CAPITOL HWY PORTLAND, OR 97213
PORTLAND, OR 97219 .
Phone: Phone: 287 - 6164
Reg #: ELE 26 -113C
FEES
Description Date Amount Required Inspections
[ELPRMT] ELC Permit 10/10/02 $106.90
[TAX] 8% State Tax 10/10/02 $8.55 Elect'I Service
Rough -in
Total $115.45 Elect'I 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 are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1. 800-33 -2344.
Issued By: {� GC,1 / 'u Permit Signature: �� 60.�i( 0,0,1 14 4,---
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: al(4) •/ - '/)C'-/ J1 / DATE:
LICENSE NO: I 1 S
Call 639 -4175 by 7:00pm for an inspection the next business day
.., 41 ._ • Electrical Permit Application
Date received ge0 o /Z j� Permit no. y..O6 J r'
- . . ..0 ' City of Tigard - t� , Project/appl. no.: Expire date:
ei and Address: 13 BI; igard, OR 9 By: Recei t no.: -._
ty o r 8 Phone: (5 ) 639 -4171 -. i Date issued: - B y I p
Fax: (503) 5 - 0C� liks , Case file no.: Payment type: -
Land use approval: " k l - n ' s --
O 1 & 2 family dwelling or accessory ommercial/mdustrial 0 Multi - family O Tenant improvement •
O New construction 0 Addition/alteration /replacement 0 Other. O Partial
JOB SITE INFORMATION
Job address: ' -5 sr ( (,L i L - .1 > Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: I Block: I Su bdi ision: U
Project name: - 7_ I i en S f b escription and location of work on premises: �2 er� -f ' - f C.t�-
Estimated date of completion/insp _ . XL T S H
r
CONTRACTOR APPLICATION FEE SCI IEDU.E
. Job no: ((n 31 Fee M ,-
Business name: ROSE CTTY FT ;FCTRTC CO TNC - Description . Qty. (ea) Total no.lasp
New residential - single or mold- family per
Address: 4012 NE GULLY BLVD • ' dwellingtmlc Includes attached garage.
City: PORTLAND I State: OR I Z '7213 Seriice included:
Ph5r @3 287 616 4 1 I t:Q 3 282 1 S 6 ail: 1000 sq. ft. or less 4
CCB no.:. 3567 t Elec. bus. lic. no: 26 113C Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City /metro lie. no • (71 Limited energy, non-residential 2
J 1 v I 1-(t cr y Each manufactured home or modular dwelling
Signature of supervising e ectrician (required) .. . Date l I Service and/or feeder 2
Sup. elect name (print): R L Gotham License no: 2127S Services or feeders — installation,
alteratlon orrelocatlon:
PROPERTY OWNER 200 amps or less I 11a� X37 2
Name (print): '7_ It 5-1-,re j I` :'° L1 f e v. ' 201 amps to 400 amps 2
Mailing address: - A a -,r' t p ' u , d , /l 401 amps to 600 amps 2
J 601 amps to 1000 stops 2
City: - 1 — t _ ir b, l ISS tate: I ZIP: Over 1000 amps or volts 2
Phone: 60 3 I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders . •
which is not intended for sale, lease, rent, or exchange according to iastallatiou , alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 • s 2
ENGINEER Branch circuits - new, alteration,
or extension per panel: Name: A Fee for branch circuits with purchase of b' I
Address: - service or feeder fee, each branch circuit d'p 2
City: [ She: • I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
. .. ..... _ Phone: Fax: E - mail: Each additional biancb.ciratit: .._ - - __ .. _ ...
PLAN REVIEW (Please check all that apple) Misc. (Service or feeder not Included):
O Service over 275 amps- commercial O Realtlt care facility Each pump or irrigation circle 2
O Service over 320 amps -rating of 1812 O Hazardous lotion Each sign or outline lighting 2
familydwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 System over 600 volts nominal mom residential units in one structure alteration, or extension* - 2
O Building over three stories _ O Faders, 400 amps or more . *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV pant Each additional inspection over the allowable in any of the above:
O Egress/lighting plan O Other • Per inspection I I I I •
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. _ Other
Permit fee $ (b / r;
Na an Jurisdictions accept =Et card', please call jmi.d;cdoo for more information . Notice: This permit application
V q�
O Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $
• Credit card member. / / within 180 days after it has been State surcharge (8%) Expires accepted as complete. TOTAL $ f
Named cardholder as shown ea credit card
$ •
Cardholder signature Amount 440.4615 01000/CON)
•
Electrical Permit Fees: Limited Energy Fees: - ,
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee — $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total `, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or ❑
portion thereof - $33.40 1 Burglar Alarm
Umited Energy • . $75.00
Each Manufd Home or Modular Garage Door Opener'
Dwelling Service or Feeder $90.90 2
Services or Feeders 3' ❑ Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation 4
200 amps or less $80.30 u 2 Vacuum Systems`
201 amps to 400 amps $106.85 2 El
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2
Over 1000 amps or volts $454.65 2 •
Reconnect only $66.85 2
•
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each System $75.00
200 amps or less $66.85 2 (SEE OAR 918 -260 -260)
201 amps to 400 amps $100.30 2 Check Type of Work Involved:
401 amps to 600 amps $133.75 2
Over 600 amps to 1000 volts,
Ej Audio and Stereo Systems
see "b" above.
Branch Circuits ' Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits Clock S
with purchase of service or • •
feeder fee.
• - • Each branch circuit $6.65 � . 2 ❑ Data Telecommunication Insta
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 HVAC
Each additional branch circuit $6.65 Eil
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy Landscape Irrigation Control'
panel, alteration or extension $75.00
Minor Labels (10) $125.00
❑ Medical
Each additional inspection over
the allowable in any of the above Nurse Calls
Per inspection $62.50
Per hour $62.50
In Plant $73.75 Outdoor Landscape lighting'
Fees: ❑ Protective Signaling
Enter total of above fees $ - _ ❑ Other
8% State Surcharge $ Number of Systems
•
- .
25% Plan Review Fee
* No licenses are required. Licenses are required for all other installations
See 'Plan RevievJ' section on $
front of application. Fees: Q
•
Total Balance Due $ Enter total of above fees $
El Trust Account # 8% State Surcharge $
y�
Total Balance Due $
i Msts\form'e1c- fees.doc 10/09/00
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
/-_3 BUP
Received Date Requested /a AM PM BUP
Location / 3 F. 5 Suite MEC
Contact Person I Ph ( ) c)--O 3 F3 7 PLM
Contractor j � Ph ) 2 S �� /4' SWR
' n a "' 3c7 --
BUILDING Tenant/�er 6- ELC — v D 6--a-
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm f C
Susp'd Ceiling -
Roof 1/7 ) ) `fz 7
Other:
Final 14i s r• I , . !
PASS PART FAIL -
PLUMBING l iA )d q C6,e pQ Ca lPi nQ
Post & Beam / ��`
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains 11 •
Catch Basin / Manhole
Oh - Storm Drain � �-
Shower Pan
Other:
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
PART FAIL ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
❑ Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date / cQ3) Inspector _ AL, • Est
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL