Permit CITY TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00161
w ` DEVELOPMENT SERVICES DATE ISSUED: 3/24/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
17-5-0 PARCEL: 1S136DC-04500
SITE ADDRESS: D6 SW DARTMOUTH ST 100
SUBDIVISION: PP1995 -013 ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Job #5400 TI: Installation of (3) branch circuits to Deli department.
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: 2 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:
WAREMART INC ELECTRICAL DIMENSIONS INC
BY BURKE + NICKEL PO BOX 12146
3336E 32ND ST #217 3961 N WILLAMS AVE
TULSA, OK 74135 PORTLAND, OR 97212
Phone: • Phone: 282 -7255
Reg #: LIC 44008
SUP 2964S
FEES ELE 26 -432C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 3/24/03 $60.15
[TAX] 8% State Tax 3/24/03 $4.81 Rough -
Elect'l Final
Total $64.96
•
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 or 1-800- 2 -2344.
Issued By: ,1�� do J Permit Signature: (�) 0---,,p_AQb
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 639 -4175 by 7:00pm for an inspection the next business day •
Electrical Permit Applicat .
Datereceived3 o2'/—a Permit no. . A . 0(,)/z,1 Zvt t. City of TigardR C EIV E Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall - BTigard, OR 97223 Date issued: By Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 MAR 2 0 2 03 Case file no.: Payment type:
Land use approval: C ' OF I AGI CQS
TYPE OF PERMIT •
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ier enant improvement
- ❑ New construction • ( - ( ❑ Addition/alteration/replacement 0 Other: • ❑ Partial
•
JOB SITE INFORMATION
Job address: 7 w A AO ynNA -ri,1 Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision: p . , - ii f • r ^ •
'Project name: i ‘ • ,- a Description and location of work on premises: - MPr '2
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE '
Job no: �. , 4 C� - Fee Max
Business name: �I YI f 1 E farl AK< ,..1 Al Descr Qty. (ea ) .Total no. insp
/ New residential - single or awtti- family iption per
Address: O nx J) t'; 44 dwellinguait
to n A K) ti I State• k ZIP 7
1
City: : „2 Service included:
7
Phone:2g 2-726r I Fax: ..14, 19 E -mail: loon sq. ft or less 4
Each additional 500 sq. ft or portion thereof
CCB' no.: oQ I Elec. bus. lic. no: 26 -04,3_2C, Limited energy, residential 2
City /met 1 no.: t , f l f - Limited energy, non - residential 2
% f/,,,, /�� Each manufactured home or modular dwelling
�''T
Signs re o supervising electrician (required) Date Qr� � Service and/or feeder 2
Sup. elect name (print): , .. r • Lice no: - ,� �� Services orfeedets— installation,
C alteration or relocation:
PROPERTY OWNER 200 amps or less- 2
Name (print): 201 amps to 400 amps 2 2
401 amps to 600 amps •
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - .
which is not intended for sale, lease, rent; or exchange according to allation,alteration,orrelocatioa 2
• ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps • •
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration, •
or extension per panel:
. Name: - - A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit
City: 1 S tom• - , I rd': B. Fee for branch circuits without purchase 16
of service or feeder fee, first branch circuit: / �.
Phone: Fax: E -mail: Each additional branch circuit: a loi L 5 I3,.'.6
PLAN REVIEW (P lease check all that apply) Misc. Servlce orfeedernot Included):
U Service over 225 amps - commercial • 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of 1&2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories 0 Feeders, 400 amps or more 'Description: :
Cl Occupant load over 99 persons U Manufactured structures or RV park - Each additional inspection over the allowable in any of the above:
O Egreess/lightingplan 0 Other Per inspection
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other •
Not all jurisdictions accept credit cards, please call jurisdiction Sr more information. Notice: This permit application Permit fee $ '
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / I within 180 days after it has been State surcharge (8 %)
Expires accepted as complete. TOTAL $ . �� r
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6A0/COM)
Electrical Permit Fees: Limited Energy Fees: •,
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total `►' Check Type of Work Involved:
Residential - per unit 4 Audio and Stereo Systems
1000 sq. fl or less $145.15
Each additional 500 sq. ft. or .1 ❑
portion thereof $33.40 Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular 2 ❑ Garage Door Opener
Dwelling Service or Feeder $90.90
Services or Feeders 0 Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation 2
200 amps or less $80.30 Vacuum Systems'
• 201 amps to 400 amps $106.85 . 2
•
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ED
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
TYPE OF WORK INVOLVED= COMMERCIAL ONLY
Temporary Services or Feeders Fee for each system $75.00
amps Installation. alteration, or relocation $66.85 2 (SEE OAR 918- 260 -260)
200 a or less
201 amps to 400 amps $100.30 2 •
Check Type of Work Involved:
401 amps to 600 amps $133.75. 2
Over 600 amps to 1000 volts,
rj Audio and Stereo Systems
see "b" above.
Branch Circuits . Boiler Controls
New, alteration or extension per panel Ei
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee. ,
ee. $6.65 2 ❑ Data Telecommunication Installation
Each branch circuit
b) The fee for branch circuits
without purchase of service Are Alarm Installation
or feeder fee. e-
First branch circuit $46.85 4(� a HVAC
Each additional branch circuit $6.65 /3t go o
Miscellaneous El Instrumentation
(Service or feeder not included) $53.40
Each pump or irrigation circle Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy ❑ Landscape Irrigation Control
panel, alteration or extension . $75.00
Minor Labels (10) $125.00 ❑
Medical
Each additional inspection over .
the allowable in any of the above .
bove ❑ N urse Calls:_
Per inspection $62.50
Per hour $62.50- Outdoor Landscape Lighting'
In Plant $73.75 1:1
r
Fees: ❑ Protective.Signaling. .
Enter total of above fees $ ' J 12 Other G k l I CK " �4. Lie e L ` :2:2. P' (! t'e
8% State Surcharge $ 4'6 / • 3 Number of Systems
25% Fee $ * No licenses are required. licenses are required for all other installations
See e " "P Plan n R evi viev/' section on
front of application. Fees:
Total Balance Due .
$ �'�4`' `4 Enter total of above fees. $ •
❑ Trust Account # 8% State Surcharge
Total Balance Due $. i
i:\dsts\forms\cic- fees.doc 10/09/0 .. . _ _ .
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 - 4171
BUP
Received Date Requested - °R AM PM BUP
Location ?f Suite /o MEC
Contact Person Ph ( ) 2-82 70253 PLM
Contractor ) Ph ( ) SWR
BUILDING Tenant/Owner /1/(-241C.-?) ELC J - /6
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
•
Int Sheath/Shear
Framing r7 ( f _
Drywall PrO /� j it. 573 '? 72 / Drywall Nailing 9
Fi rewal I
Fire Sprinkler
Fire Alarm 4
Susp'd Ceiling
Roof Other: !� _. . 1. yi '1
Final
PASS PART FAIL (_t3.3) 2 ' - /
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.
0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Da l03 Inspector • / a *�
Other: V
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
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