Permit S � L C TRICAL PERMIT
I TY O G TI ARD •
PERMIT #: ELC2002 -00245
DEVELOPMENT SERVICES DATE ISSUED: 11/12/03
" EI 13125 SW Hall Blvd., Tistard, OR 97223 (503) 639 -4171
PARCEL: 2S115BD-02600
SITE ADDRESS: 16875 SW PACIFIC HWY
SUBDIVISION: ZONING:
BLOCK: LOT : JURISDICTION: KIN
Project Description: New 4,243 sq.ft. gas station /convenience store •
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: 2
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 0 W /SERVICE OR FEEDER: 66 PER INSPECTION:
201 - 400 amp: 0 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: f tp EA ADD'L BRNCH CIRC: 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: X
Owner: Contractor:
SPACE AGE FUEL INC BOYLES ELECTRIC, INC.
PO BOX 607 P.O. BOX 1227
GRESHAM, OR 97030 BORING, OR 97009
Phone: 503 - 665 -5693 Phone: 503 - 668 -7440
Reg #: LIC 137002
ELE 3 -465C
FEES SUP 3404 -S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 11/12/03 $749.50
[ELPLCK] ELC Pln Rev 11/12/03 $187.38 Rough -in
[TAX] 8% State Surcharge 11/12/03 $59.96 Wall Cover •
Underground Cover
Total $996.84 Low Voltage Inspection
Elect'I Service
Elect'I Service
Elect] Filial
This Permit is issued subject to the regulations contained in the Tigard Muniapal 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- 800 - 332 -2344.
• /
Issued By: , !t !N. 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 INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: • DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
FROM 30YLES ELECTRIC FAX NO. : 5036687615 Nov. 05 2003 04:30PM P2
� � Electrical Permit Application
Dale received: 3). 1 12 Permit no, CZOdZ — ddZ/ -
t j.1`�l'1 City of Tigard Projncuappl. no.: Expire sett
,, Ciry n/ 7lbard Address: 13125 SW Hall Blvd, Tigard, OR 972 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
1 11 l'E 01.' P1.111i11I I'
L I 1 & 2 family dwelling or access t ammercial /industrial 0 Multi - family 0 Tenant improvement
8;11-New construction 0 Addition /alteration/replacement 0 Other: 0 Partial
.11)11 ti11'1 IN1 :01 a1:1'I 10N
Joh address: VirWLIFINSANJairAllM Bldg. no.: Suite no,: Test map/tax lot /account no.:
Lot: Bloc : Subdivi: , : ((etetq Gi Z
Project name:44 '4 e c , i L escdp (ion an' location of work on promises: AJe.. !. ,5, . .
estimated date of co Ietlon/ins • ection:
l'ON'1 RA( '1'(►It :U'I'I.ICi ll0N HA.: S('lll•;1)IILh.
Job ter: I s1 r ,
Fee Max
Business name: • , • •,. „L Dowd Non Bal. Ins t
New residential - dnglo or mull) -family per
. Address; .fd Ir'Sri . 1 -; - dwelltngttolt Includes attached garage.
_City: t f s State: 0._ ZIP: It b q • Servleeincluded:
Phone: _ & Ail PDX: , _ 1000 a.. ft. or less 4
Each additional 500 sq. ft, or portion Ihomuf Ell MIN
CCB no.: (' b 0 ;� Elec. boa. Hc. no; 1 (1.6 Limited enemy, nsidential
City/ ID lie, no.: (Z(. lr - Limited energy.twn- rnaidentinl 11111111111N1111111=1111 r ��, , , _ ,- • Rath manufactured home or 'nodular dwelling
Sist ~f , of supervising c r clan (re9ttired) Da Service and/or feeder 2
S r cct. nama rint): 31,414 , S rvlcesor ceders -11unallatirm,
(p �; Li ccnaono:, altor`allon
11(011:11 1 1' '.N l:lt 200 amps or less
Name(.rint): A kOtnm,: to400amps MIN
/ % � I u m,sto600 nm. s �� / � ''
Militia. address: �r,�,'f�'�i Qum stnl000 tsm. MEIN
City: ,,_41 1i / / ZIP: / 30 (EL 1000umpsurvolts 11111111= MO 2
Phone: (, 5 ;.i Fax:1. ' / / B -mall: ttacon 'eel ant _Ill MUM I
Owner installation: Thei installation IS being made on property I own Tempo • ryservicea orfeedan►
which Is not intended t"pr sale, lease, rent, or exchange according to Inrtxllotl , alteration, arreloealient
ORS 447, 455, 479, 670. 701. 200 amps • lo ss 2
201 amps 10 • OD amps 2
Owner's signature: ..... - - -_.. _ Date: 401 to 600 am is 2
1•:NGINI:l :It Branch circuit new,altoretlon,
, or extension per • nob 6�
Name:
A,- / ' / h 114/ A. Pots for bratich of ells with purchase of� `� d /z,
Address: ;"// li ' 9' . . S. service or feeder f - -, each brunch circuit r I0,�j 464,9t7 2
City: f s , M, ? B. tree for branch cite 'ts without purchase
tilt, 4i of service or feeder . , brat branch circu
B ach additional bran • ci cult: =ME
PLAN It l• :1•II•:t's (1'Ir•:rsc chuck 1111 Ilea apply) Misc. Service orfeede .otincluded):
Service over 225 umps•commcrcial Cl Ith•curefunnity Each pump or irrigation circle 2
O Savior over 320 umpe rating of 1 &2 lif Hazardous location Each sign or outline lighting 2
family dwellings C1 Building over 10,000 square feet four or Signal circult(s) or n limited energy panel. ... � JV 2
O System over 600 volts nominal more residential units in one structure alteration, or extension* J .7
Q Building over three stories 0 Feeders, 400 amps or more +Description: _7.46/i4-- mat 1 bra et A4, I ......—
LI Occupant load over 99 persons O Manufactured structures or RV park Each addltlonel Inspection over the allowable In any of the above:
0 egress/lightingplan Q Oilier.
Per inspection 1. 1 L I
Submit,,, acts of plans with any of the above. Investigation fee •
The above are not r , usable to temporary construction service. other
$ /T../ it fee _
Not all JutlxUmKuu ac rod
ch ms
ca, Ideate cell 11111141 fur more information. Notice: This permit application Permit / 61)
CI visa 0 MasterCard expires if a permit is not obtained Plan review (00...c_ %) $ . / 8 1 3
crodu card number. -,,_ (�� within 180 da after it ha been State surcharge (8%) $ - 59. ci
$ complain. TO')<'AL
accepted as complain. $ r. �, ' �,l
Marro of cardholder as shown on credit gaud � 7
Ganlholder stemmas Amount �—
440-4615 (atOWrOM)
•
FILE COPY REVISION
APPROVED
P Electrical Permit Application
el Date received: Permit no.:
\ ` g' •.1 City of Tigard � - _ ty g Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ;- Eemmercial/industrial ❑ Multi - family ❑ Tenant improvement
t -New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: 6g- ) S S hi p C..l r_, c ) Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: ISubdiviion: •
Project name: K1 C,) J&. I Description and location of work on premises: j q As S k, e ,`,.)
Estimated date of co J
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Q ,7.._. I S '? d Fee Max
Business name: �3 l� �,''l o c 4( ,. 1 ,,,c._ Description Qty. (ea) Total no. insp
'- " New residential - single or multi - family per
Address: lac) /Sd to 5..71 dwelling mdt. Includes attached garage.
City: it2 Ad I State:pr_I ZIP:1000 c' Service Included:
e - 7tc-t (I I 6 J&. -'7 6i SI 1 000 s ft. or less 4
Phone: Fax: I E -mail: q
I . 3 ) d 0) . 3-_ Li b C E Each additional 500 sq. ft. or portion thereof
CCB no.: El ec. bus. lie. no:,
Limited energy, residential 2
City/ 4 0 : tro lic. no.: (.j y' Limited ener gy, non-residential 2
/ ^ t // ...-s, 3
b Each manufactured home or modular dwelling
Sig r - ,fe of supervising a clan (required) Date Service and/or feeder 2
Services or feeders — installation,
S . act. name (print): r ,_- Li cens e no:3Wri alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): </� i� 201 amps to 400 amps 2
Mailing address: °-'� 401 amps to 600 amps 2
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 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, S
Name: or extension per panel: 6 �
A. Fee for branch circuits with purchase of 6E 1 3 F y 6
Address: service or feeder fee, each branch circuit 0 s • 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail: Each additional branch circuit:
' PLAN REVIEII' (Please check all that apply) Misc. (Service or feeder not included):
O 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, Z LSO 2
O System over 600 volts nominal more residential units in one structure alteration, or extension* �t
O Building over three stories 0 Feeders, 400 amps or more *Description: 7A,J K /✓1 /I n/ , t1 A ^. D (—‘411 Sv 1-e-• -.
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/lighting plan 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 for more information. Notice: This permit application Permit fee $ 7 /
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (a %) $ 1 k) b
Credit card number. / / within 180 days after it has been State surcharge (8 %) $
Expires accepted as complete. TOTAL $ .
Name of cardholder as shown on credit card
Cardholder signature Amount
440 -4615 (6100/COM)
1,
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
•
Complete Fee Schedule
COIi~I Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Number Schedule of Inspections Restricted Energy Fee $75.00
pe ctio pe r 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 I $160.60 I a) (3° 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. /3Q , (1
Each branch circuit � b $6. VV ❑ 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 o0
panel, alteration or extension a $75.00 S ❑ 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
s°
3__L'' Enter total of above fees $ 7 ❑
Other
8% State Surcharge $ S, 46 Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ i t 7 33: * No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $ 97
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
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: '(503) 639 -4171 MST
BUP
Received'V/2 3 Date Requested / -3/7 AM PM BUP
Location /6 f 7 5 P Suite MEC
Contact Person �� u���— Ph ( _ 5 g3) 66 — i' VO PLM
Contractor ' Gn < i Exec' Ph ( ) SWR /
BUILDING Tenant/Owner 49Z-cP Z - e � � — 7 00 2 / 5
Footing OO
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
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab )1)
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
• . rm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• S . ART FAIL
SITE _ 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk - Date 3 _ G V Inspect Ext
Other:
Final DO NOT REMOVE this Inspection record f om the Job te.
PASS PART FAIL