Permit •
CITY OF TIGARD ELECTRICALPERMIT -
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT #: ELR2004 -00186
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/28/2004
SITE ADDRESS: 12240 SW SCHOLLS FERRY RD PARCEL: 1S134BC -00300
SUBDIVISION: GREENWAY TOWN CENTER ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Limited energy for HVAC 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: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
BPP RETAIL LLC OES LLC
BY BURNHAM PACIFIC PROPERTIES 12785 SW TV HWY SUITE F
ATTN: JOHN WATERS ALOHA, OR 97006
SAN DIEGO, CA 92101
Phone: Phone: 503 649 - 4642
Reg #: LIC 159395
ELE 34 -572C
SUP 4587S
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 6/28/2004 $75.00 Elect'I Final
[TAX] 8% State Surchar€ 6/28/2004 $6.00
Total $81.00
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 o low rules - : • pted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
t ough OAR 952 -001 -4 00. You ma A p: i • co •ies of these rules or direct questions to OUNC at (503) 46 -6699.
ued by :.! •_ , /, / • / / Permittee 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 7:00 P.M. for an inspection needed the next business day
El 1 Permit Application FOR OFFICE USE ONLY
City of Tigard Da eB� le Or PennitNo.: G4 Avev
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Q.�
Phone: 503.639.4171 Fax: 503.598.1960 :t7 Rot � I ' Date/By: Other Ponta: H ie f „ewe, a/
Inspection Line: 503.639.4175 : ! �� Date Ready/By: , 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: . / !iP Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other; ❑ Service over 225 amps, comm'l ❑ Hazardous location
0 Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building ❑ System over 600 volts nominal units in one structure
❑Budding over three stories ❑ Feeders, 400 amps or more
❑ Multi- family 0 Master builder ❑Other:
❑ Occupant load over 99 persons ❑ Manufactured structures or
JOB SITE INFORMATION AND LOCATION ['Egress/lighting plan RV park
Job no.: Job site address: 12240 SW Scholls Ferry Road
12 Health-care facility ❑Other.
Submit 2 sets of plans with any of the above.
City/State/ZIP: Tigard, Oregon The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: Rite Aid Remodel FEE* SCHEDULE
Description I Qty. I Fee. I Total I ••
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
Relocate one thermostat sensor dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: Rite Aid Sote #5353 601 amps to 1,000 amps 240.60 2
Address: 12440 SW Scholls Ferry Rd Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/ State/ZIP: Tigard, Oregon Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( )
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each • 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address: '
Each add'I branch circuit 6.65 2
City / State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or f?'°
extension. Describe: Relocate ( Page 2 2
Business name: Oregon Electrical Specialties HVAC sensor
Address: 12785 SW Tualatin Valley Highway, Suite F Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: Aloha, OR 97006 Investigation per hour (1 hr min) 62.50
Phone: (503) 649 -4642 Fax: (503) 649 -4652 Industrial plant per hour 73.75 _
ELECTRICAL PERMIT FEES*
CCB Lic.: 159395 Electrical Lic.: 34 2C Suprv. Lic.: 4587S S u bt o t a l ate
Suprv. Electrician signature, required: 1111 �o � �o (25% permit fee) Plan review 25% of t fee
4 - Print name: / _. Date: 6/23/04 State surcharge (8% of permit fee) p r�
LSs TOTAL PERMIT FEE
Sl Qv—
Authorized signature: d_-�t! This permit application expires if a permit is not obtained within 1b0
days after It has been accepted as complete
Print name: � -vi Date: 6/23/04 Fee methodology set by Tri County Building Indust y Service Board
•• Number of inspections net aermit allowed.
CITY OF TIGARD 24 -Hour
BUILDING Inspection JAW: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 8 -q " e=rri AM PM BUP
Location / 22 4 10 �- f(olx-S FGRlt4 Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner — /9'1 ELC
Footing
Foundation ELC
Access: l 8
Ftg Drain � ELR 2E4- 00 — L 'c'
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Nailing •i'p V kvh mu1/ wir Ns
Firewall
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
Fir- larm
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S ITE 0 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line / ADA I ' M /7L6j'
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL