Permit •
/ CITY OF TIGARD ELECTRICAL PERMIT
�t. - PERMIT #: ELC2003 -00451
�,0I�E ' DEVELOPMENT SERVICES DATE ISSUED: 8/5/03
13125 (503) 639 -4171
PARCEL: 1S136AD-06400
SITE ADDRESS: 11440 SW PACIFIC HWY ZONING: C -G
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Job #01-1534 New fueling dispensers.
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:
TIGARD BP SERVICE CO INC BOYLES ELECTRIC, INC.
11440 SW PACIFIC HWY P.O. BOX 1227
TIGARD, OR 97223 BORING, OR 97009
Phone: Phone: 503 - 668 - 7440
Reg #: LIC 137002
ELE 3 -465C
FEES SUP 3404 -S
Description Date Amount Required Inspections
[ELPRMT] ELC Permit 7/25/03 $60.15
[ELPLCK] ELC Pln Rev 7/25/03 $15.04 Rough - in
[TAX] 8% State Tax 7/25/03 $4.81 Elect'I Final
Total $80.00
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 44.
Issued By: 0 Permit Signature: CM oil L'C!fhTYL.)
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: O'Yl �Q4Q t addc-in DATE:
LICENSE NO: S 7 0 qS
Call 639 -4175 by 7:00pm for an inspection the next business day
•k o ijr s 75
Electrical Permit App
..-.,
Datereceived7i -' Permitno.:Etd - cad 1
I:1,' I'1 City of Tigard RECEIVED Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By:63 I Receipt no.:
Phone: (503) 639 -4171 JUL
Fax: (503) 598 -1960 2 , . 2003 Case file no.: Payment type:
Land use approval: CITY OF 7
TYPE OF PERMIT
O 1 & 2 family dwelling or accessory Q1ommercial/industrial O Multi- family O Tenant improvement
O New construction O Addition/alteration /replacement O Other: O Partial
JOB SITE INFORMATION ,
Job address:
y l(d 8,A> t�C t i Loy Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: !Block: 'Subdivision:
Project name: (6 . )10,0 •7 I Description and location of work on premises: y i e W 4'.€- (; vt d (S Q f ,,,t,-Q(a .Q._
Estimated date of completion/inspection: ! ^ •
. :-• ----- EON AllPtiGATIO ;'-'7 ----- t- SCTILDU L T _
Job no: 01 IS .?-)y Fee Max
Business name: �jp 1 ICS � e fi r ■ C. i ly1C Description Qty. (ea.) Total no. insp
Address: � r e New residential- single or multi - family per
�� I rl �G � ��� dwelling unit. Includes attadnedgarage.
City: `C- t IA I State014. I ZIP: -j 0OS' - Serviceinduded:
Phone: (A ( -IIIJ( I Fax: f 606151E-mail: 1000 sq. ft. or less 4
CCB no.: ) • � Q6a Elec. bus. lie. no:, ?� - WAS -(�. Each additional 500 sq. ft. or portion thereof
/- Limited energy, residential 2
City e_
etro lie. no.: . tic' Limited ener
g non-residential 2
3 Each manufactured homom or
home or modular dwelling
Srg re of supervrs electrician (required) Date Service and/or feeder 2
Su elect. name (print): License no: $ Services or feeders— installation,
,
PROPERTY G1i'NER alteration or relocation:
. 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: '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 installation, alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
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 2
City: . I State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E-mail: of service or feeder fee, first branch circuit: 1 g6 2
Each additional branch circuit: A. ( f3,3c
PLAN REVIEW (Please check all that apply), Misc. (Service or feeder not included):
❑ Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps -rating of 1&2 1i Hazardous location Each signor outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension' 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other.
Per inspection I I I
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 for more information. Notice: This permit application Permit fee $ (G 5
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at t . %) $ 1 . 04
Credit card number: / / within 180 days after it has been State surcharge (8 %) $ LI ` ' n I
Expires accepted as complete. TOTAL $ . 0 •O C)
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6/00/COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FE : Ie.
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4-
Check Type of Work Involved:
Residential - per unit
1000 sq. ft or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular
Dwelling Service or Feeder $90.90 2 ❑ Garage Door Opener
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2 ❑ Vacuum Systems"
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2
Reconnect only $65.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 -260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. ❑ Audio and Stereo Systems
Branch Circuits
New, alteration or extension per panel ❑ Boiler Controls
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems •
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑
or feeder fee. Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑
(Service or feeder not included) Instrumentation
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control"
Minor Labels (10) $125.00
Each additional inspection over p Medical
the allowable In any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ ❑ Other
8% State Surcharge $
Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
• Enter total of above fees $
❑ Trust Account #
8% State Surcharge $
All New Commercial Buildings require 2 sets of plans.
Total Balance Due $
i:dsts\forrns\elc- fees.doc 08/30/01 •
BOYLES ELECTRIC, .... -.. INC.
i ll John Boyles
Office: 503- 668 -7440 PO BOX 1227
Electrical Contractor Fax: 503- 668 -7615 Boring 0h &E I " C D
P L •0 Re oIew Fda- JUL 24 2003
G CITY OF TIGARD
BUILDING DIVISION
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1.1 I S "-IS ,,r TY OF TIGARD
Co only ovally t Approved . . ........... rJ:
he work as described in: 1
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SEe Letter to. Follow.
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CITY OF TIGARD 24 -Hour
BUI'DRN'Q► Inspection • (503) 63 75
INSPECTION DIVISION Business 639 - 4171 MST
BUP
Received Date Requested � AM PM BUP
Location If li Yo P Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) (e4- 3 ( 1d SWR
BUILDING Tenant/Owner ELC �— de e7 1
S`(
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
Drywall Nailing
Fire wall
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
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
e g i At j PART FAIL
SITE Please call for reinspe tion RE: El Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date / Inspecto Ext
Other:
Final DO NOT REMOVE this inspection record from e Job site.
PASS PART FAIL