Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009-00351
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/17/2009
Parcel: 2S115BA02600
Jurisdiction: Tigard
Site address: 16230 SW PACIFIC HWY 120
Subdivision: Lot: 0
Project: Little Caesars Pizza
Project Description: Install (1) 200 amp panel, and (24) branch circuits.
Owner: FEES
SN PROPERTIES PARTNERSHIP Quantity Description Date Amount
1121 SW SALMON ST 1 ea Services or Feeders - 200 07/17/2009 $80.30
PORTLAND, OR 97205 amps or less
PHONE: 24 crt Branch Circuits w /Purchase 07/17/2009 $159.60
Service or Feeder
1 ea 12% State Surcharge - 07/17/2009 $28.79
Contractor: Electrical
HILLSBORO ELECTRIC LLC
21185 NW EVERGREEN PKWY #110
HILLSBORO, OR 97124
PHONE: 503 - 439 -9666
FAX: 503 - 601 -3680
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $268.69
Required Items and Reports (Conditions)
1 Pln Gen INSTALL 12 ADDTNL PKNG SPACES
2 Pln Gen PLNG DIV. FINAL INSPECTION
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 through OAR 952-001-0100. You U(litt.L mayobtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Q 1 l Q Permittee Signature: j\V-P
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' 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.
- 07 -15 `09 14:89 FROM - Hillsboro Electric 503 - 601 -3620 T -770 P002/002 F -565
Electrical Permit Application
City of Tigard , Y g) R000t;
13125 SW Hall Blvd., Ti 7 , • o c v � : Ycamg ___ ) ) /i _ r -.
I
^ Phone: 503.639.4171 Pea I . • I Review
�l ) a�
I . , . • ; r , Inspection Line: 503.639,41 5 UL 5 2 009 may- _ - - Other ;r ( • „q. -,
Internet; www.tigard-or.gov oReady/B r
$etd-ot.gov T / Nonce s See Page for
TYPE Q a � 7 1,�?� �\ $aPPtdeeaM)laforma — tEo� `
❑ New construction 1• Additio i t '! ^ -; ,., e Please all W / � plW
apply *limit 1 seta of plans w!i[eta3 checked b
p Demolition ❑ Other: C I Service a fender 400 amps or more q Building over three stories.
where the available fault current ❑ Marinas and boatyards.
1 -and 2 -famil d wellin exceeds 10,000 amps at 150 volts or LI Floating buildinp-
0 Y g C0tnlnercjayind{ jal ❑ q ggpry building tees to ground, or exceeds 14,000 ❑ Commercial -use agrieultural
❑ Multi- family 0 Master builder (, Oar: 0 EFirPumPI other installations. buildings.
JOB SITE E 11YF0 ❑ Installation of 75 KVA or
� libtA'l7QN AND
• ❑Emer y separstely
Job no.: + ; Job site adthcas: ` y ['Addition
IOONPO oro motor load of ❑ occupancy. , «$••� ••1� 1,3 ^ 'hem I sy ❑sixccmore
City/State/ZIP : f I resid uni te. Cl R oral vehicle parks.
//4 V 1'� 0 ❑Heelth.pt fscihtioe-
['Supply voltage for morn than
$uitalbldgJapt. DO.: p T � (] IFaaatdoua locations. 600 volts nominal.
J , .� �� ❑ aarlon or feeder soon ,pups or tree.
Cross street/directions to job site;
- �� IEEE ; •:.: ,.• ..; ,
New resident d Qb
aglo- or multi- tltmrfly rive elq� trait •
Includes attached garage.
Subdivision:
I Lot step.: 1,000 aq, ft or seas 145.15 q
Tax map/p n0.' — Ba add'l
_ 500 sq ft. or portion 33.40 1
-- .. • .. :•,Dli C1I011QN 0F. WOR8(• - Limited
ith energy', residential
_ 1 1 �wuli above sq. R -) _ 75.00 2
Limited energy, mufti-family
-- • residential (with above eq. fl.) 75.00 2
Services or feeders lnstallatiou alterattob am
` �' ? > ' 7'Y. O' !lVElt 1YA11 200 amps or less d/or rely - M • p
Tlr� 201 8 0.30 . ' 2
Name: , .: • • .. amgys t o 400 atnps 106.85 2
4 ° 1 omPs tO 600 011 Me 160.60
2
Address: R _" 601 amps to 1,000 amps IN1 240.60 • 2
Over 1.000 amps or volts -
454.65 2 .
City/State/ZIP:
Temporary services or feeders installation, alteration, / ad/or
Phone: ( ) ) — rdoeatine
_ I Fes ( ) 200 amps or seas
O Ow lnshllatioa: This installation is
w 66.85 I
n st sal l being made on Property th I own which is not 201 amps le 400 =Ps 100.30
0, ease, rent, or atchange according to ORS 447 449, 670, and 701. 401 atppa to 599 amps 133.75 2
Owner signature: _ Branch dreglts- r - �
' "` � , — A Fee "' silter —r or extension, pe le
:•Z i,` ` •` r 0 n1)f' for breach r lit fee
Business name: -
cacti service or fiancee fee C J
ranch
13, Fee for branch circuits
Contact name: without service or feeder Ica,
Address; _ fifer breach circuit 46.85 2
Each add'1 branch circuit 6.65 • 2
City/State/Z11): M1.edh:tpas (service or reader not lndaded)
Phone: ( ) • m°r manufactured or modular - -
Pax: ; ( ) dwts Elio , service and/or feeder 90.90 2
E-mail: • only 66.85 •
# 110 • ;•, • : ..,.• .cor7ucrot . •: Pump . o inau circle 53.40 z
Business Si a uUina li
name: t! BQRQ ELEc L I signa cirourt(s) or limited- S3'� 2
cue Panel, Adds: • 21185 NW EVERGREEN PKWY �' or
txfeasiom. Describe: Page 2 2
CitytemeJZIP: HILLSBORO OR 97124 •Each additional Ina over allowable i!t as of t he above
E1one ( 503) 4399666 Fa x (50 ) . h 1 _ • h Prey croon 62.50
` CC
Lic.: 134481 Ele rit al i.ic.: 3 4 — 4 9 9 : S Lie : 4 9 41 Iaduatrial l am I'm min) 62.50
Suprv. Electrician m S A Per ��
signature, required: � I + �_ ELECTRICAL, PERMIT FEES
• Point name: JOEY V T T / Subtotal: ,
ACC* Date; 1 �!!a1 P lan review (25% of permit $o):
Authorized signature; a �+�*`� Stale surcharge (12% of permit fee): . ; • 1
Print name: TOTAL PERMIT ME: `j�tC +7.T i.
1 Aar,.• T3L permit application expire* K r permk Hie Not O. P 4 , 1S p
t.'1BuildieAPerwir■Vo P-1 a..., ....,...c ».... � • err.. -._ _ a erase it Mesa been accepted a! ODep*� l ' (� cam'
{ 4 •LC �l