Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00954
DEVELOPM NT SERVICES DATE ISSUED: 12/14/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171 PARCEL: 1S134BC - 00300
SITE ADDRESS: 12268 SW SCHOLLS FERRY RD ZONING: C -G
SUBDIVISION: GREENWAY TOWN CENTER LOT : JURISDICTION: TIG
Project Description: TI, (3) circuits for lottery machines - Job No. 11806
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:
BPP RETAIL LLC COHO ELECTRIC INC
BY BURNHAM PACIFIC PROPERTIES PO BOX 40
ATTN: JOHN WATERS WILSONVILLE, OR 97070
SAN DIEGO, CA 92101
Phone: Contact #: PRI 503- 582 -9774
FAX 503 - 582 -9774
FEES
Description Date Amount Reg #: LIC 157169
[ELPRMT] ELC Permit 12/14/200: $60.15 ELE 3 -575C
[TAX] 8% State Surcharge 12/14/200: $4.81 SUP 17815
Total $64.96 REQUIRED ITEMS AND REPORTS
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
suspen• - • • : - than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules : re set forth in O• ' 9 -01 -00 ' through OAR 952 - 001 .0100. You may obtain copies oft - - les or direct questions to OUNC at
503 '46 -6699 or 1- 800 -33' 2344. •
Iss - d By: •
L- . 4 A Permittee Signa - • 1
�rfa� i
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:
, OONTRACTOR INSTILLATION ONLY
G 4 1•
SIGNATURE OF SUPR. ELEC' " : J • r• i tr DATE:
LICENSE NO: / 7q1.5
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Dec 12 05 10:11a p. 2
tt' l al Permit App11C _ FOR OFFICE USE ONLY
RSV ED Received i Permit No„ (-
City of Tigard DatdHy /y /0 6� f F ems - 109s y_
13125 SW Hall Blvd., Tigard, Olt 97223 Flan Review
Phone: 503.639.4171 Fax: 503.538.1960 e � 1 2 2O ' " °"ir
''�ti patdily: Other l�crmit:
Inspection Line: 503.639.4175 O C .n,,� ���., Date Ready/By. 7 RI Pase for
Itttemet: www.ci.tigard.or.us Y OF TAG' - • Notified/Method: - •/ /a Supplemental Information
TY 0: •31V S PLA RE
0 New construction Addition /alterativn/replacemcnt Please check all that apply:
❑Service over 225 amps, contm'I ❑IIazardous location
[Demolition [j Other: - 0 Service over 320 amps - rating ❑1luildng over 10,000 sq. ft.,
CAT a OR? OF CONSTRUCTION of 1- and 2.1autily dwellings 4 or more new residential
❑ 1 - and 2 family dwelling Commercial/industrial El Accessory building QSystcm ovc 600 volts nominal units in one structure
❑Re acting over three stories ❑Feeders, 400 amps or more
❑ Multi - family ❑ Mastcr builder 0 Other: ❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Ee.ress/ighting RV park
Job no.: \ c Job site address: 1a''C�� C' ` \ C 11c QHcalrh - care facility ❑Other:
u �7 W �.1� Submit ; sets of plans with any of the above.
City /State/Z11': "' nr U Q C� ?� The above arc not applicable to temporary construction service.
). PEE" SCHEDULE
Suite/bldgJapt. no Project name_ \ -•• •• • . .
,, �L- �. DesOtipttoe Oty. Fes. 'rot ■t
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. Tin add'I 500 sq. ft. orportiO 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel nn..
Limited energy. non - residential 75.00 2
1)ESCRXPT XON OF WORK • Rach manufactured or modular
I `d't[ ds , service and /or feeeier 90.90 , 2
G _,_` __, �,►/ w , a. \ • ` - Services or feeders installation, alteration. and/or relocation
._ Gv 200 amps or less 80.30 2 _
• PROPERTY I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: \_ t✓ 601 amps to 1,000 amps 240.60 - 2 _
Address:
` Over 1,000 amps or volts 454.65 2
_ c." fi r.. ) -rl `S •
" .. •
— \ • •• • �- _ Reconnect only 66.85 2
C try /Statc/Zli': V , , Qa Q� aQ Temporary services or feeders Installation, alteration, and/or
...... relocation
Phone: ( (Q% €-- Fax 200 stops 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. a01 amps to 600 a mps _ 13 2
Owner signature:_ .. • _ _
.. __... Date; , Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT _' — " I ❑ CONTACT PERSON A. Fee forbrattch circuits with Service or feeder fee, each 6.65 2
Business naate: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fcc, 1 46.1t5 4‘ 2
Address: each branch circuit
Each add'! branch circuit (3 6.65 \3, , 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Phone ( ) I }r3X:: ( ) Purrrp or irrigation Circle - __ - 53.40_ - 2
1 • Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited•
CONTRACTOR energy panel, alteration, or
_ extension Describe: Page 2 2
(
Business name: , U�v �r, _.: ." -� rl�.
Address: P, 2):-.4 t,,i Q1 Each additional inspection over allowable In an y of the above
n Per inspection 62.50
City /State/ZIP: lei v , ,, \ . c25ps, C-1, ` s,` Investigation per 8 p hour ( j_____ I hr mi 62.50
Phone: ( ) - c_1 "(�, F ( ) .� q .. Industrial plant per hour 73.75 -
ELECTRICAL PERMIT FEES'
CCB Lie. :.‘....c-3-1i b i I Electrical Lie.: .-5 Suprv. Lic.: \--1‹.) la Subtotal 1 -
i
Suprv. Electrician signature, required: . . at Plan review (25% of permit fee) -
t .
• Print .___ xname; � tt ; y
State surcharge (8% of permit fee) v
- ... _ -_ 1 TOTAL PERMIT FEE Elk . 6
Authorized signature: 1 ,lA 7 ,)1 rhN permit application expires If a permit is not obtained within 1110
days after it has been accepted as complete
Print name: c `Vt littlY.4 Date: \ _ , - • Fee methodology set by 7ti Building Industry Service Board
**Number of inspections per permit allowed.
iNBuri Iins\t'amits\EGGPermitkpp.doc 12/03 . 440- 4615T110/07/C0MlW
CITY OF TIGARD
BUILDING DIVISION " PERMIT #: ELC2005 009:A
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1211.4 /2005
Phone: (503) 639 -4171 emu il �I
Inspection Requests (24 Hrs.): (503) 639 -4175 W °1_-
INSPECTION WORKSHEET FOR DATE: 1/11/2006 TIME: 7:01AM PAGE: 91
SITE ADDRESS: 12268 SW SCHOLLS FERRY RD CLASS OF WORK:
SUBDIVISION: GREENWAY TOWN CENTER LOT #: TYPE OF USE:
PROJECT NAME: LUCKY JADE
DESCRIPTION: TI, (3) circuits for lottery machines - Job No. 11006
OWNER: BPP RETAIL LLC, PHONE #:
CONTRACTOR: COHO ELECTRIC INC PHONE #: 503-582 -9774
Inspection Request Scheduled For: Date: 1/11/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 02451 503-888870 N
Corrections /Comments /Instructions:
' ,
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ,//' Date: !�G 6� Phone #: (503) 718 -2-f %
CITY OF TIGARD
BUILDING DIVISION " PERMIT #: ELC2005- 00954
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12!14/2005
Phone: (503) 639- 4171����j�
Inspection Requests (24 Hrs.): (503) 639 -4175 �!±+
INSPECTION WORKSHEET FOR DATE: 12/19/2005 TIME: 7:01AM PAGE: 26
SITE ADDRESS: 12268 SW SCHOLLS FERRY RD CLASS OF WORK:
SUBDIVISION: GREENWAY TOWN CENTER LOT #: TYPE OF USE:
PROJECT NAME: LUCKY JADE
DESCRIPTION: TI, (3) circuits for lottery machines - Job No. 11806
OWNER: BPP RETAIL LLC. PHONE #:
CONTRACTOR: COHO ELECTRIC INC PHONE #: 503-582 -9774
Inspection Request Scheduled For: Date: 17119/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 023692 -01 503.582 -9774 Y
•
•
Corrections /Comments /Instructions: /
1 461 �1 . zo
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL 1O ACCESS
'FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: '' 1 V Q Date: y e t Phone #: (503) 718- 2 q''