Permit " CITY OF TIGARD° ELECTRICAL PERMIT
PERMIT #: ELC2005 -00612
i DEVELOPMENT SERVICES DATE ISSUED: 8/22/2005
��' II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S103DD -00800
SITE ADDRESS: 13815 SW PACIFIC HWY 80 ZONING: C -G
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: Change out service, (8) 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/ FOR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: 8 PER INSPECTION:
201 - 400 amp: 1st WIO SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 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:
D.W. SIVERS COMPANY AMKOR ENTERPRISES INC
4730 SW MACADAM AVE PO BOX 1751
•
#101 LAKE OSWEGO, OR 97035
PORTLAND„ OR 97201
Phone: Phone: 503 - 744 -0615
FEES Reg #: LIC 150236
ELE 34-582C
Description Date Amount
SUP 44905 905
[ELPRMT] ELC Permit 8/22/2005 $133.50
[TAX] 8% State Surcharge 8/22/2005 $10.68 REQUIRED ITEMS AND REPORTS
Total $144.18
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 - 332 -2344.
Issued By: �, q Sp Permittee Signature: 0� ��—
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 Application FOR OFFICE VS[, ONLY
City of Tigard ECE V ED .' ', _ (fs '� Permit No.: �
13125 SW Hall Blvd., Tigard, OR 9 2 Date/B � �
Plan Review
Phone: 503.639.4171 Fax: 503.598.196 11(? G s� 7 c� - ;1i •)1
1 R eoeiv Date/B . Other Permit:
Inspection Line: 503.639.4175 I $U 2 2 00h Ohl , -.
p _ Date Ready/By. ® See Page 2 for
Internet: www.ci.tigard.or.us V n Notified/Method: I Supplemental Information
T r tpPF L��ION
i PLAN REVIEW
❑ New construction ig Ail A ,,,, ^^ nteration/replacement Please check all that apply:
❑ Demolition 0 Other: OService over 225 amps, comm'I 0 Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ACommercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
El Multi - family 0 Master builder 0 Other: ❑Building over three stories OFeeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION RV park
❑Egress/lighting plan P
r ❑Health -care facility ❑der:
Job no.: Job site address:
43 /-f SW pA e,' C elf"
t /
Submit 2 sets of plans with any of the above.
City /State/ZIP: T y d L p, o g 9 - 7 .)-?-3 The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name: D on u -f S' . , Description I Qty. I Fee. I Total I ••
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
' y W/ � S -P,1. U, G 2 t ^A �. dwelling, or and/or feeder 90.90 2
5 ,.....e....- Services or feeders installation, alteration, and/or relocation
Add 6P C.-/(r-u; 1- 200 amps or less / 80.30 yo .? 0 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 Cr CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
Business name: branch circuit 6.65 :572 2
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'l branch circuit 6.65 2
City/State/ZIP: 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 circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
• extension. Describe: Page 2 2
Business name: 4/zi lea I � r • c�� •
Address: j--- j--- / Each additional inspection over allowable in any of the above
? ' O f ! Per inspection 62.50
City/State/ZIP: L,1 lc-P 05 to 2 y O (}X 97 '. 3 V Investigation per hour (l hr min) 62.50
Phone: ( .3) -2LJ L. -- v 6 l j Fax: (/p3) ( 6 -- 6 � 3 Industrial plant per hour _ 73.75
v E lectrical Lic.: Suprv. Lic.: ,26 Subtotal 5 ELECTRICAL PERMIT EES%
CCB Lic.: yy
ll y3 �� 6'�� P J
Suprv. Electrician signature, required: 0� e. _ - D. Plan review (25% of permit fee)
J State surcharge (8% of permit fee) 1Q. 6
Print name: L f'I h C - S , / Date: c p- -- ZZ l e, I y
TOTAL PERMIT FEE / 1 1 V , ) t !
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: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PamitApp.doc 12/03 440.4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
•
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL 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
is\ Building \Permib\ELC- PennitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00612
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/22/2005
Phone: (503) 639 -4171 /fur
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/7/2005 TIME: 7:05AM PAGE: 17
SITE ADDRESS: 13815 SW PACIFIC HWY 80 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: DONUT SHOP
DESCRIPTION: Change out service, (8) circuits.
OWNER: SIVERS COMPANY, D.W. PHONE if:
CONTRACTOR: AMKOR ENTERPRISES INC PHONE #: 503-744-0615
Inspection Request Scheduled For: Date: 10/7/2005 Pour Time:
Code # spe . - escription Confirm # Contact # Message
199 Electrical final 017752 -01 503. 7440615 Y
Correcti • ns /Co p en s • tions:
2S `• tkibv e A . ,.czov i ', Nom ►
►'� PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
• AIL ❑ C L FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: '4'47 Date: 1 17 ac Phone #: (503) 718- 2 /VC •