Permit pry ri d -4 o CH) br anch C,(iaL ti
CITY OF TIGARD ELECTRICAL PERMIT
1111 °: COMMUNITY DEVELOPMENT Permit #: ELC2009-00060
TIGARD 13125 SW Hall Blvd., Tigard : OR 97223 503.639.4171 Date Issued: 02/13/2009
Parcel: 2S110AB00200
Jurisdiction: TIG
Site address: 14365 SW PACIFIC HWY
Subdivision: Lot:
Project: TIGARD FLEA MARKET
Project Description: Install (1) branch circuit for sign. 3/26/09 ADDED (4) branch circuits.
Owner: FEES
KOLVE, G C Quantity Description Date Amount
14389 SW PACIFIC HWY 1 [ELPRMT] ELC Permit 02/13/2009 $46.85
TIGARD, OR 97224 1 [TAX] 12% State Surcharge 02/13/2009 $5.62
PHONE: 27 da Investigation Fee (Equals 03/26/2009 $26.60
Permit Fee)
Contractor: 1 ea Investigation 12% 03/26/2009 $3.19
Surcharge
PHONE: -
FAX:
Type of Use: COM
Class of Work: Type of Const:
Occupancy Grp:
Total $82.26
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the
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 thro g OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.669 r 1.800.33 2344.
.h,
Issued By: _ d -d� • . . ' • a Permittee Signature: � N l
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.
CITY OF TIGARD ELECTRICAL PERMIT
111 ° PERMIT #: ELC2009-00060
° COMMUNITY DEVELOPMENT DATE ISSUED: 2/13/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 110AB -00200
SITE ADDRESS: 14365 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: CANTERBURY SQUARE LOT : 1 -3 JURISDICTION: TIG
PROJECT: TIGARD FLEA MARKET
Project Description: Install (1) branch circuit for sign.
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: 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: 1 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:
KOLVE, G C CHANCO INC
14389 SW PACIFIC HWY 3521 SW CARSON
TIGARD, OR 97224 PORTLAND, OR 97219
Phone: Contact #: PRI 503 245 - 7774
FAX 503 - 244 -4804
FEES
Description Date Amount Reg #: ELE C209
[ELPRMT] ELC Permit 2/13/2009 $46.85 LIC 171892
[TAX] 12% State Surchar 2/13/2009 $5.62 SUP 688S
Total $52.47 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: c
y (�41A_�- \„,�0�4 Perm Signature: � fc�riC�F,t ;3 C�YI.)i`YV\
OWNER INSTALLATION ONLY U
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
City RECEIVE
ecei ved
of Tigard Permit No.
514 h' g Date/By: 9 Q. ► 3 • �( st: (200:l o00�p
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 FEB 1 3 2009 Date/By: Other Permit: j02 , O • C % 28
TI G A IZ D Inspection Line: 503.639.4175 Date Ready/By: Juris: ��� See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: 'C ( ('.r Supplemental Information
TYPE OF woiWJILDING DIVISION PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGO OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
� 1�J less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ l- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION 9/9 ❑ Addition of new motor load of t 100HP or more. occupancy.
Job no.: Job site address: / f‹?? f cf�� @, /�i
/- Six or more residential units. 0 Recreational vehicle parks.
City/State /ZIP: /;//3, e---- /7 2 2-7 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: 1 i C ; \D '\ E IN riz ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: `-l/ Description P tion I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
J /fit G- Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.:
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
residential (with above sq. ft.) _
Services or feeders installation, alteration, and/or relocatio
200 amps or less 80.30 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name:
r �? �l U1 d -- 401 amps to 600 amps 160.60 2
//21:r /� 601 amps to 1,000 amps 240.60
454.65 2
Address: �� 2/)/ /44//- ., Over 1,000 amps or volts 2
City/State /ZIP: �� L� �-' / Temporary services or feeders installation, alteration, and/or
relocation
Phone: (J' 2j ` -' 2 Q --d I Fax: Kral 6CtX,,,7�� 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 599 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT ❑ CO PERSON above service or feeder fee, 6.65 2
� each branch circuit
Business name: �`� , (J «idles /1" L_ /B. Fee for branch circuits
Contact name: ,01/2-7 first t branch cir Q 4 frs nc ice
ir cuit or feeder fee, I 46.85 2
Address: /A L/� ,96 _Pj 17- 'jZ Each add'I branch circuit 6.65 2
—7r/ �' Miscellaneous (service or feeder not included)
City/State /ZIP: DD b Each manufactured or modular 90.90 2
Phone: ��77 Fax: �p� // , / �� // dwelling, service and/or feeder
(�a-3 2- 1) (- --C 6' ?) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: C ��67C) 2 C..-- Signal panel, er or t limited- o or
energy panel, alteration, or
Address: '7' (fGC.... t :�A) //14 -' extension. Describe: Page 2 2
City/State /ZIP: d ` 71L >p�,,,,,. - 9,Zf Each additional inspection over allowable in any of the above
( 2 ,7 -7 (��_7 Z�� X- Per inspection 62.50
Phone: �J Fax: J` Investigation per hour (I hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: y (o•z
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee): 5. (02
Authorized signature: TOTAL PERMIT FEE: 52 • (..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.
1:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 46I5T(1 l /05 /COMM'EB
e: Wa.AyLt, Q- top - tAiLd..
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: 1
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
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
1:\ Building 'Permits\ELC- PermitApp.doc 03/23/06
Feb 14 09 12:06p MIKE OR DAVE CHANDLER 5032444804 p.1
�,
CITY OF TIGARD
COMMUNITY DEVELOPMENT
`• ' " `' 13125 SW Hall Blvd., Tigard, OR 07223 503.639.4171
Electrical Signature Form R ECEIVED
IMPORTANT PERMIT NOTICE
FEB 1 8 2
CHANCO INC CITY OF TIGARD
3521 SW CARSON BUILDING DIVISION /
•
PORTLAND, OR 97219 (
vC
Permit #: ELC2009 - 00060
Date Issued:
Parcel: 23I 1 OAB- 00200_: •
Site Address:C14365 -SW- PACIFIC -HWY
Subdivision: CANTERBURY SQUARE
Lot: 1-3
Jurisdiction: TIG
Zoning: C-G
Project Name: TIGARD FLEA MARKET
Description: Install (1) branch circuit for sign.
•
Your company has been indicated as the electrical contractor for the permit referenced above. In order for the electrical
permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from
your company sign below and return this Electrical Signature Form prior to the start of the work. Please mail the form to:
City of Tigard, Building Division, 13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please call 503.718.2433.
No electrical inspections will be authorized until this completed form Is received
OWNER: ELECTRICAL CONTRACTOR:
KOLVE, G C CHANCO INC
14389 SW PACIFIC HWY 3521 SW CARSON
TIGARD, OR 97224 • PORTLAND, OR 97219
Phone #: Phone #: 503 - 245 - 7774
•
Reg #: ELS C209
LTC 171892
SUP 688S
AN INK SIGNATURE IS REQUIRED ON THIS FORM
•
•
X w Ara _ r � f a.0 d. Lt/ Lttarld.1 e/` 1p gg
Signature of Supervising Electrician Name (printed)
SUP LtC #
•
•
CITY OF TIGARD
• COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
Electrical Signature Form
•
IMPORTANT PERMIT NOTICE
CHANCO INC
3521 SW CARSON
PORTLAND, OR 97219
Permit #: ELC2009 - 00060
Date Issued:
Parcel: 2S 110AB -00200
Site Address: 14365 SW PACIFIC HWY
Subdivision: CANTERBURY SQUARE
Lot: 1 -
Jurisdiction: TIG
Zoning: C -G
Project Name: TIGARD FLEA MARKET
Description: Install (1) branch circuit for sign.
Your company has been indicated as the electrical contractor for the permit referenced above. In order for the electrical
permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from
your company sign below and return this Electrical Signature Form prior to the start of the work. Please mail the form to:
City of Tigard, Building Division, 13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please call 503.718.2433.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
KOLVE, G C CHANCO INC
14389 SW PACIFIC HWY 3521 SW CARSON
TIGARD, OR 97224 PORTLAND, OR 97219
Phone #: Phone #: 503 - 245 - 7774
Reg #: ELE C209
LIC 171892
SUP 688S
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
Signature of Supervising Electrician Name (printed) SUP LIC #