Permit a CITY OF TIGARD ELECTRICAL PERMIT
11111 I COMMUNITY DEVELOPMENT Permit #: ELC2013 00252
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/02/2013
Parcel: 2S113AA00500
Jurisdiction: Tigard
Site address: 16112 SW 72ND AVE B18
Project: Acosta Food Service Subdivision: ROSEWOOD ACRE TRACTS Lot: PT A & F
Project Description: (1) feeder and (5) branch circuits for new walk -in cooler
Contractor: DELSTAR ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 1371 ATTN: N PIVEN
TUALATIN, OR 97062 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 684 -8848 PHONE:
FAX: 503 - 684 -8312
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 05/02/2013 $100.70
Specifics:, amps or less
5 at Branch Circuits w /Purchase 05/02/2013 $37.10
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 05/02/2013 $16.54
Electrical
Type of Const:
Occupancy Grp:
Total $154.34
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 app 4- • e law. All work will
be done in - - •r•an - .1h approved • , ns. This permit will expire if work is not started within 180 days of nce, or i work .is sus for more the 180
days. AT NTION: Oregon law equires you to follow the rules adopted by the Oregon Utility Notifica ter. hose rule- set forth in OAR
952-001-0410 th •ugh OAR 952 • r 1 -009r o may obtain a copy of the rules or direct questions to OUNC by calling 5033. • 10.33 344. a
Issued = I / / Permittee Signature: ` \ 1 1&r ∎sm � VB
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:
\ ONT TOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' -� , a0.` Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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 Applicati I nit t I C I I t I l .l (1\ 1 1
CEIVED Received
City of Tigard Date/B : Permit No.: � c/3-6
74 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
a Phone: 503.718.2439 Fax: 503.59>;.l%� 2 ?013 Date/B : Other Permit: wie„40/3 / ,
T I c.A K u Inspection Line: 503.639.4175 Date Ready/By: toils 0 See Page 2 for
Internet: www.tigard -or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE INI,, »G 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.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ 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. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A" "E" "1 - ", "l - 3"
Job no.: Job site address: 16112 SW 72" Ave. IoOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard, OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Acosta Marketing ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description
Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.:
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
75.00 2
Connect new walk -in freezer. I- feeder 5- circuits residential (with above sq. ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation, alteration, and/or relocation _
❑ PROPERTY OWNER ❑ TENANT 200 amps or less 1 100.70 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( ) relocation
200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
® APPLICANT 1 ❑ CONTACT PERSON A. Fee for branch circuits with
above service or feeder fee, 5 7 42 37.10 2
Business name: Delstar Electric, Inc. each branch circuit
B. Fee for branch circuits without
Contact name: Randy McAlister service or feeder fee, first 56.18 2
branch circuit
Address: P.O. Box 1371 Each add'I branch circuit 7.42 2
City/State/ZIP: Tualatin, OR 97062 Miscellaneous (service or feeder not included)
Each manufactured or modular
67.84 2
Phone: (503) 684 - 8848 Fax: : (503) 684 - 8312 dwelling, service and/or feeder
Reconnect only 67.84 2
E -mail: randy @delstarelectric.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Delstar Electric, Inc. Signal circuit(s) or limited -energy
panel, alteration, or extension. Page 2 2
Address: P.O. Box 1371 Each additional inspection over allowable in any of the above
Additional inspection (I hr min) 66.25/ hr
City/State/ZIP: Tualatin, OR 97062
Investigation (1 hr min) 66.25/ hr
Phone: (503) 684 - 8848 Fax: (503) 684 Industrial plant (1 hr min) 78.18 / hr
Ins ions for which no fee is
CCB Lic.: 63667 14044 Electrica 'a =4- ■4 C "�t�� Sup L .: 3214S � " % specifically listed (Y. hr min) 90.00/ hr
Suprv. Electrician signature, required: ELECTRICAL PERMIT FEES
i�
l�' Subtotal: 137.8
Print name: Randy McAlister Date: 5/2/2013 Plan review (25% of permit fee):
State surcharge (12% of permit fee): 16.54
Authorized signature: TOTAL PERMIT FEE: 154.34
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_040913.doc 440.4615T( I I /05 /COM/WEB
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
16112 SW 72ND AVE B18, TIGARD, OR, 97224
Commercial - Electrical
199 Electrical final
06/06/2013 00:00
ELC2013-00252
PASS - No C of O
Violation Summary:
Inspector Contractor