Permit CITY OF T I GA R D ELECTRICAL PERMIT
PERMIT #: ELC2004 -00716
Azli.=.0 DEVELOPMENT SERVICES DATE ISSUED: 11/9/2004
" III 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S126C0-01108
SITE ADDRESS: 09800 SW WASHINGTON SQUARE RD
SUBDIVISION: ZONING. C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: (6) branch circuits for remodel.
Job No: Sears AC
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: 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: 5 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:
SEARS ROEBUCK AND CO ST JOHNS ELECTRIC INC
DEPT 768TAX, B2 -116A 4415 NE MINNEHAHA
3333 BEVERLY RD VANCOUVER, WA 98661
HOFFMAN ESTATES, IL 60179
Phone: 1- 800 - 349 -4358 Phone: 360- 693 -5100
Reg #: LIC 43135
SUP 3024S
FEES ELE 37 -350C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 11/9/2004 $80.10
[TAX] 8% State Surcharge 11/9/2004 $6.41 Rough -
Elect'l Final
Total $86.51
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 - -t o '• OAR 952 - 001 -0010 through OAR 952 - 001 -0100 You may obtain copies of these rules or direct questions to OUNC at (503)
246 ;699 or 1-800-33 3 • •
Issu = • By: ! ! ��� Permit Signature
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 INSTALLATI • N ONLY
j _ /
SIGNATURE OF SUPR. ELEC'N: � I' � ' '"/ / f DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
•
NOV-5-2004 09:13 FROM: ST. JOHNS �RIC 3606991345 TO:15035981960 P.1
Electrical Permit i� D G i orf'lcl. USE ()NIA'
City ij>C Tigard 0 5 20�� n sy: l 46.4 --��A �i 11 4. 61iX'
13125 SW Hall Blvd., Tigard, OR 972 OV Review
Phone: 503.639.4171 Fax: 503.59. : � ', �' a B y :
Other Permit
Inspection Line: 503.639.4175 � t� ` OF TIGr r-' -, u ° my, r I RI See Page 2for
Internet: www.ci.tigard.or.us -
BUIL ®IiVG DIVISIO ` • � Notified/Method: ejtQ • I Supplemental information
0 New construction ❑ Addition/alteration/replacement Please ch- that app y:
❑ Demolition Other: ❑Service over 225 amps, comm'I ❑Hazardous location
[ �w 1 ❑Service over 320 amps- rating ❑ Buildng over 10,000 sq. ft.,
, + a C 0111 0/TY antiti UJ(C, to ORI ' ' t' '" 7 r o f I- an d 2-family dwellings 4 or more new residential
i ^ Y
❑ 1- and 2- family dwelling J ® mm
Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories ❑Feeders, 400 amps or more
❑ MuIU faintly 0 Master builder 0 Other ❑Occupant load over 99 persons ❑Manufactured structures or
. ,1 ` x..1:07.0 671f f 0•i / aa,a ° a U n 0.1:j i'`ll•,11,' -- .../. 1 41;..., - ❑Egress/l[ghting plan RV park
Job no.: SEARS AC Job site address: 9800 SW WASHINGTON SQIJARE RD ❑ Health - care facility ['Other.
Submit 2 sets of plans with any of the above.
City / State/ZIP: TIGARD , OR The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: l Project name: „:161,44 4,4r0 L t rrif2, CdF DQ>g�i
Daafpdon I Qty. I Fee. I Total I "
Cross street/directions to job site: GREENBURG New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea add'I 500 sq. ft. or portion 33.40 , 1
Limited energy, residential 75.00 2
Tax map /parcel no.: , .
' " i"`" �" ' "� O O WO u Limited energy, non-residential 75.00 2
'
fi I F v ''•r „ 6 i a,,:� c? .Y. �r _` M Each manufactured or modular
.
REMODEL dwelling, service and/or feeder 90.90 2
Services or feeders Installation, alteration, and/or relocation
200 amps or less 80.30 2
;1;4. i =, i s ti y r-
u •,,.. ` j �` j��,� r'P , , , , 201 amps to 400 amps 106.85 2
: =_....:r�tii'' , . _ • ,. � . a • '1- . , .t ;,. y. _, =•a , : - i+ � :. . 1 , , ., 40 t amps to 600 amps 160.60 2
Name: SEARS NATIONAL CUSTOMER RELATIONS 601 amps to 1,000 amps 240.60 2
Address: 3333 BEVERLY ROAD Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City / State/ZIP: HOFFMAN ESTATES , IL 60179 Temporary services or feeders installation, alteration, and/or
Phone: relocation
( 800 349 -4358 I Fax: ( ) 200 amps or less 66.85 I
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 133.7$ 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
7:0 a i I T' V si��. `` ` } ' r c . 7?•;: , B', A. Fee for branch circuits with
service or Business name: branch circuit
der fee, each 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder fee, 1 46.85 46 .85 2
Address: each branch circuit
Each add'I branch circuit 5 6.65 33.25 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) I p er:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s)or limited -
17‘'.' fir i t , a - z:ii k 1 i ct a F�'tF "°' t =" ` ,,,x ngy , alteration
,ir�..�.. ,'n.. � :: t,..�� - `-- �a_..:.,L.9:.tt3ff �'i ;r11, ,'r, e
xtension er Des cribe panel , or Page 2 2
Business name: ST . JOHNS ELECTRIC , INC .
Address: 4415 NE MINNEHAHA STREET Each additional inspection over allowable in any of the above
Per Inspection 62.50
City/ State/Z1P: VANCOUVER, WA 98661 Investigation per hour (1 hr min) 62.50
Phone: ( 360 ) 693 -5100 I Fes ( 360 699 -1345 Industrial plant per hour 73.75 T.
CCB Lie.: 43135 I Electrical Lic OC uprv. Lic.: 3024 Su btotal 80.10 - `
Suprv. Electrician signature, required: r 10 ti 101 Plan review (25% of permit fee)
1111 State surcharge (8% of permit fee) 6.41
Print name: DEAN R. B Date: 11 -04 -04 TOTAL PERMIT FEE 86.51
Authorized signature: c This permit application expires if o permit is not o6taineli within tan
��
days after It has been accepted as complete
Print name: DEAN R. BJIM I Date: 11 -04 -04 • Fee methodology set by Tri -County Building Industry Service Board
•• Number of inspections per permit allowed.
istauildinemoiuNELC- PuwitAppdoe 12103 I
0 ( 440.1615T(10/02/COM/MF9
1L
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested /' t' ' AM PM BUP
Location ! S CO LOP ' 5 Q Suite MEC
Contact Person Ph (360 ) 9 3- 5706 PLM
Contractor Ph ( ) SWR �1 /
BUILDING Tenant/Owner ELC °f q 86 7/
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT �� /
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation Pte/ I C iAL
Drywall Nailing 77 LcL
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
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 / /4' ADA ' r / . `O y l u'i� -V
Approach/Sidewalk Date t Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL