Permit CITY OF TIGARD ELECTRICAL PERM
ip
° PERMIT #: ELC2007- 00087
COMMUNITY DEVELOPMENT DATE ISSUED: 2/7/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 110A6 -00200
SITE ADDRESS: 14295 SW PACIFIC HWY ZONING: C -
SUBDIVISION: CANTERBURY SQUARE LOT : 1 -3 JURISDICTION: TIG
Project Description: PENNY'S DELI.
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: 1
• LIMITED ENERGY: 401 - 600 amp: SIGNAUPANEL:
•
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: 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:
KAHLM SARBJIT MARTIN BROS SIGN INC
9334 SE PENNINGTON CT 3165 COMMERCIAL ST SE '
PORTLAND, OR 97266 SALEM, OR 97302
Phone: 206 850 - 1568 Contact #: PRI 364 - 2211
FAX 503 - 364 -4315
FEES
Description Date Amount Reg #: ELE 24 -23CLS
[ELPRMT] ELC Permit 2/7/2007 $53.40 LIC 64761
[TAX] 8% State Surcharge 2/7/2007 $4.27 SUP 399SIG
Total $57.67 REQUIRED ITEMS AND REPORTS
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: < - 74j Permittee Signature: j Q ,,Q.
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.
Si - Uvoa.
Elyctrical Permit Application
HE C ER/ : : F., ()FFI us,,-. 1_,,
�, r
• City of Tigard FEa 2 001 R Received e B — " - 7 >, tlL P No :� • I -.--# ‘k 13 125 S W Hall Blvd., Tigard, OR 97223 0 7 Plan Review
:7
' o Phone: 503.639.4171 Fax: 503.598. 96 '. - DatelB . Other Permit:
FIG n It I� Inspection Line: 503.639.4175 ( J Y Or I IA .. ) e Ready/By: y: Juris: See Page 2 for
Internet: www.tigard or.gov ■ , v ,. fied/Method Supplemental Information
TYPE OF WORK PLAN REVIEW '
Please dieck all that apply (submit 2 sets of plans wfitems checked below): '
❑ New construction. Addition /alteration/replacement
El Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other: ■ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 1%000 amps at ' volts or ■ Floating buildings.
less to ground, or exceeds 14,000 0 Commercial-use agricultural
❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ■ Fire pump. El Installation of 75 KVA or . .
0 Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ■ Addition ■
Job no.: I Job site address: /1„/ a C S• Sc �) `� � M ,,, fl
i I ■ Recreational vehi de parlcs.
■ Supply voltage for more than
City/State/ZIP: OR 9 7.3 r `�
Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: 1 ,,� sir ,_, p„� " `
r �''�_ , �_ I SCHEDULE
Cross street/directions to job site: #nn eh,•2a-J e Dmcrl. 'on CUM O � �
,� / //''�� New residential single- or multi-family dwelling unit.
/./ a '_ _ At - • . _ 4 ' _ — ' .4, /Y W - - Includes attached garage.
Subdivision: / Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion t
Limited energy, residential 00
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00
1 n
• .57 n j 1.0-1t44.1 si p P n / - residential with above .. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I S TENANT 201 amps to 400 amps 106.85 2
Name: p . z !t_ t� 401 amps to 600 amps 160.60 2
di, 7� 601 amps to 1,000 amps 240.60 2
Address: / � - S ` ' . - _ Over 1,000 amps or volts 454.65 2
City/State/ZIP: � e 9 7 2 Z �/ Temporary services or feeders installation, alteration, and/or
/ . i ` i` relocation
Phone: (573) 365/- ad // I Fax: (.03) 34L/ _ 143 is- 200 amps or less - 66.85 0
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 599 amps 133.75 2 •
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel •
A. Fee for branch circuits with
❑. ItWLICANT I ❑ CONTACT PERSON above service or feeder fee, • 6.65 2
�' �, each branch circuit
Business name: v 4 LS_ • J B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: . first branch circuit
Each add'I branch circuit 6.65 2 .
Miscellaneous (service or feeder not included)
I' Each manufactured or modular -
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
•
E - mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting / 53.40 453 2 '
n Signal circuit(s) or limited -
Business name: cpl Q ri 23,-- , ,!/e. C. energy panel, alteration, or
Address: 3 /Lg C457-1.2"),..‘e_4_ r, L . S extension. Describe: • Page 2 2
City/State/ZIP: 04 12 M . ` , 9730 Z Each additional ins . ction over allowable in an of the above
-�-1 Fax: Per inspection t
Phone:
4563) 36 (. - dot 11 I (S a3) 3 6 - q 3 /S Investigation per hour (I hr min) , t
CCB Lic.: 4 4 1 I Electrical Lic.: 0/4. ,3 e./...1 Suprv. Lic.: W_S, , Industrial plant per hour
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, requ' .> : , •••••" - Subtotal: .
Plan review (25% of permit fee): •
• Print name ` o L � d State surcharge (8% of permit fee): ! ? 1'
Authorized signature: - TOTAL PERMIT FEE: .57. b 7
Print name: Date: This permit application expires if a permit is not obtained within 180 -
• days after it has been accepted as complete.
• Number of inspections allowed per permit.
I: \ Building \Pamia\ELC- PemmitApp.doc 05 /23/06 440-46 15T(1 I/05 /COM/WEB
Electrical Permit Application - City of Tigard X
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
El Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
El Vacuum Systems*
El Other.
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
•
system
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
El HVAC •
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls '
El Outdoor Landscape Lighting*
El Protective Signaling
•
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building\Pamib\ELC- PamitApp.doc 03/23/06
CITY OF TIGARD
1 BUILDING DIVISION PERMIT #: ELC2007- 00087
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/7/2007
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 4_ _..
INSPECTION WORKSHEET FOR DATE: 6128/2007 TIME: 7:01AM PAGE: 72
SITE ADDRESS: 14295 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: CANTERBURY SQUARE LOT #: 1 -3 TYPE OF USE:
PROJECT NAME: PENNYS DELI
DESCRIPTION: PENNY'S DELI.
OWNER: SARBJIT, KAHLM PHONE #: 206- B50 -15GB
CONTRACTOR: MARTIN BROS SIGN INC PHONE #: 364 -2211
Inspection Request Scheduled For: Date: 6/28/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final - 051101 -01 503 -890 -1563 N
Corrections /Comments/ Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C M tv k-.. Date: 6'1A Cn Phone #: (503) 718 - l \ O •
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007- 000137
13125 SW Hall Blvd., Tigard, OR 97223 A, DATE ISSUED: 2/7/2007
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/13/2007 TIME: 7:01AM PAGE: 91
SITE ADDRESS: 14295 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: CANTERBURY SQUARE LOT #: 1 -3 TYPE OF USE:
PROJECT NAME: PENNYS DELI
DESCRIPTION: PENNY'S DELI.
OWNER: SARBJIT, KAHLM PHONE #: 206 -850 -1568
CONTRACTOR: MARTIN BROS SIGN INC PHONE #: 364 -2211
Inspection Request Scheduled For: Date: 6/13/2007 Pour Time:
Code # Inspection Description Cm�t Contact # Message
188 Electrical final � 050085.01 503364 -2211 N
Corrections /Comments/ Instructions:
S n N N o ►� 5T to -.
C/o* sl
fiN
•
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: t7 ( ( 3 `01 Phone #: (503) 718 -2
CITY OF TIGARD
BUILDING DIVISION . ' PERMIT #: ELC2007 -00087
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/7/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 „JAI-
INSPECTION WORKSHEET FOR DATE: 3/7/2007 TIME: 7:18AM PAGE: 53
SITE ADDRESS: 142% SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: CANTERBURY SQUARE LOT #: 1 - TYPE OF USE:
PROJECT NAME: PENNYS DELI
DESCRIPTION: PENNY'S DELI.
OWNER: SARBJIT, KAHLM PHONE #: 206 850-15G8
CONTRACTOR: MARTIN BROS SIGN INC PHONE #: 364 -2711
Inspection Request Scheduled For: Date: 3/7 /2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 044443.01 503 -364 -2211 N
Corrections/Comments/Instructions:
d , N 4-D - CF . Ar t
The electrical Installation defects noted
on this report shall be corrected and
an inspection request made within 20
calendar trays per UAR 918 - 271 -0030
•
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS
FAIL N tisq CALL FOR INSPECTION N ADDITIONAL FEES ASSESSED
Inspector: 3 ' N W Date: Z J " Cr) Phone #: (503) 718- 1-4410
CITY OF TIGARD '
BUILDING DIVISION #: ELC2007- 00087
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 2/7/2007
Phone: (503) 639 -4171 .�sant
Inspection Requests (24 Hrs.): (503) 639 -4175 . -,._W
INSPECTION WORKSHEET FOR DATE: 3/7/2007 TIME: 7:18AM PAGE: 52
SITE ADDRESS: 14295 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: CANTERBURY SQUARE LOT #: 1-3 TYPE OF USE:
PROJECT NAME: PENNYS DELI
DESCRIPTION: PENNY'S DELI
OWNER: SARBJIT, KAHLM PHONE #: 206.8150.1561:
CONTRACTOR: MAR BROS SIGN INC PHONE #: 361 2217
Inspection Request Scheduled For: Date: 3/7/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
140 Sign installation 044449 -02 503-364 -2211 N
Corrections /Comments /Instructions:
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ,❑ ADDITIONAL FEES ASSESSED
Inspector: G f `+ (5t... Date: 3 -1 r0'1 Phone #: (503) 718- 14417