Permit � -. CITY OF TIGARD ELECTRICAL PERMIT-
A RESTRICTED ENERGY
1 DEVELOPMENT SERVICES PERMIT #: ELR2002 -00307
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/23/02
SITE ADDRESS: 11834 SW PACIFIC HWY PARCEL: 2S101 BB -00301
SUBDIVISION: TIGARD ROAD GARDENS ZONING: C -G
BLOCK: LOT: 001 JURISDICTION: TIG
Proiect Description: 011388: tank level system wiring.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
SHELL OIL PRODUCTS BOYLES ELECTRIC, INC.
11834 SW PACIFIC HWY. P.O. BOX 1227
TIGARD, OR 97223 BORING, OR 97009
Phone: not available Phone: 503- 668 -7440
Reg #: LIC 137002
ELE 3 -465C
SUP 3404 -S
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 12/20/02 $75.00 Elect'I Final
[ELPLCK] ELR Pln Rev 12/20/02 $18.75
[TAX] 8% State Tax 12/20/02 $6.00
Total $99.75
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.
Issued by 41441.1__ 'A � Permittee Signature
-- ter
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 ) C _ I " r ° , DATE:
LICENSE NO: . n 4 /0 1 /
S
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
t0.
* : = Electrical Permit App
- Date received: / Permit no. _
j.4..> ,, • RE CEIVE
,ji' � �1 � C llty of Tigard RECEIVED no.: Expire date:
City of Tigard Add 13125 SW Hall Blvd, !gaud, OR 97223 Date issued: ByBe) Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 'DEC 2 0 20 02 Case file no.: Payment type:
Land use approval: CITY OF TIGARD
. . _ DIVISION
TYPE OF I'ERlNI1T
❑ 1 & 2 family dwelling or accessory i Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction O Addition/alteration /replacement ❑ Other: Cl Partial
JOB SITE INFORMATION
Job address:
5 S(,v CtC_' • s C .E)(,Jy Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: IBlock: ISubdivision:
Project name: I Description and location of work on premises: 1 h k 1-Fse 1 554 -6„. Lo, t , ,t�
Estimated date of completion/inspection:
CONTRACTOR APPLICATION,. -
Job no: I_ I ,. ? 3�� Fee -- Max
17/30,1 Description Qty. (ea.) Total no. insp
Business name: E? S r 1 ee l- r c, _lm L New residential - single or multi - family per
Address: Q , rola _ dwelling unit. Includes attached garage.
e
City: )acv 1 t \Q I Stat I ZIP: C? .�.01C1 q • Service included:
Phone: ( D ( I k•'3.yt/a 1Fax: &16151 -mail: 1000 sq. ft. or less 4
CCB no.: 13 I Elec. bus. lic. no:. . - 4 ( 5 C Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City etro lic. no.: (c 4 9 Limitedener
c / gy, non-residential 2
/ _ la . (1 ,(a Each manufactured home or modular dwelling
: ° "
Siure o su ry g electrician (required) Date Service and/or feeder 2
g 0. ' FS Y6 ( Services or feeders—installation,
elect. name nt ) : J License no: 3 S alteration or relocation:
' PROPERTY OWNER 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: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only l
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 llation, alteration, or relocation:
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, 1
or extension per panel:
Name: A. Fee for branch circuits with purchasc 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: 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps - commercial ❑ 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 O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, Old
O System over 600 volts nominal more residential units in one structure alteration, or extension* I /S 2
0 Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan O Other. Per inspection I I I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other 7
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ 'r S 0O _
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ I `b •
Credit card number: / / within 180 days after it has been State surcharge (8 %) $ (< -0 0
Expires accepted as complete. TOTAL $ . C f q " 7 S
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (NW/COM)
, �t
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEtS: •
Complete Fee Schedule Below: .TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
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
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1
Limited Energy $75.00 ❑ Burglar Alarm
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 $66.85 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 ❑ 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 $ r7 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\forms \elc- fees.doc 08/30/01
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1 John Boyles Office: 503- 668 -7440 PO BOX 1227
• Electrical Contractor Fax: 503 -668 -7615 Boring OR 97009
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CITY OF TIGARD 24 -Hour
BUILDING • Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/ / BUP
1
Received Date Requested / l 'C3 AM PM BUP
Location / / i )4/ [? . Suite MEC
Contact Person Ph ( ) PLM
Contractor lr S ac?fi C Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access: Ftg Drain ELR
Crawl
Crawl Drain
Slab Inspection Notes: - SIT
Post & Beam QQdYj
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall 1 � 1 Wa6 Fire Sprinkler �[ (�
Fire Alarm
Susp'd Ceiling
Roof �� a
L
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 L�
Rough -In
UG/Sla� -
Fire Alarm
PART FAIL El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA D /L/— 03 6 Inspector _ Ext
Approach/Sidewalk P
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL