Permit `
PERMIT #: ELC2000 -00622
4,,jt DEVELOPMENT SERVICES DATE ISSUED: 11/6/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S134BC-00300
SITE ADDRESS: 12286 SW SCHOLLS FERRY RD
SUBDIVISION: ZONING: C -G
BLOCK: • LOT : JURISDICTION: TIG
Project Description: Installation of two branch circuits.
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: 1 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:
BURNHAM PACIFIC ROBERT FOSS ELECTRIC
10135 SE SUNNYSIDE RD 335 DEANA ST NE
SUITE 250 SALEM, OR 97301
CLACKAMAS, OR 97015
Phone: Phone:
503 - 581 -8406
Reg #: ELE 24 -435C
LIC 144969
SUP 4451S
FEES Required Inspections
Type By Date Amount Receipt
Elect'l Service
PLCK CTR 11/6/00 $53.50 2720000000( Elect'l Final
5PCT CTR 11/6/00 $4.28 2720000000(
Total $57.78
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopt • • he Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies • these ru :s or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE � , � ISSUED : Y: / /, -
1111 L _ ,L /_ Jam i
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
ONT . • C • R INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: • DATE:.
LICENSE NO: 4
Call 639 -4175 by 7:00pm for an inspection the next business day
•
, A, A Electrical Permit Application
Date received: / / -& -V 0 Permit no.: E(,L' -"Cie*
-,-11, ;.I I City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 et ... C y - / Case file no.: Payment type:
Land use approval:
TYPE OF PERAVIIT
❑ 1 & 2 family dwelling or accessory 0 ommercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ddition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: 1 22810 SW - OI 1$ Eery (-p Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: I Description and location of work on premises:
Estimated date of completion/inspection: ( L7 Zoo 0
CONTRACTOR APPLICATION FEE SCIIEDU.E
Job no: Fee Max
Business name: ROA FvSS e,‘.e-c.'i'R -tc _ Description Qty. (ea.) Total no. insp
Address: 335 ^l7c��j> -SA Na dwelling dwelling tmif. Includes attached garage.
City: ,t> 1..- 6400 I State:o ZIP: 97 3o 1 Service included:
3
Phone: 50 - ! � I Fax: I E -mail: 1000 sq. ft. or less • 4
CCB no.: /441-11,9 I Elec. bus. lic. no: Z.41 - il 35C. Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City /metro lic. no.: L . 0 - , At, Limited energy, non - residential 2
1 t' /b /Zco0 Each manufactured home or modular dwelling
Signature supervising electrician (required) Dat ( Service and/or feeder 2
Sup. elect. name (print): License no: Services or feeders - installation,
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 I
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, atteration,orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701. 201 201 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 to
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail: Each additional branch circuit: /
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps- commercial O Health -care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of 1&2 O 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,
O System over 600 volts nominal more residential units in one structure alteration, or extension* _ 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons O Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan 0 Other. Per inspection 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 $
0 Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
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 (6/00 /COM)
Electrical Permit Fees: Limited Energy Fees: X' .
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 4, Check Type of Work Involved:
Residential - per unit
1000 sq. ff. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 I I Burglar Alarm
Limited Energy $75.00
Each Manuf'd Home or Modular ❑ Garage Door Opener'
Dwelling Service or Feeder $90.90. 2
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
200 amps or less $66.85 2 Fee for each system $75.00
201 amps to 400 amps $100.30 2 (SEE OAR 918-260 -260)
401 amps to 600 amps $133.75 2
Over 600 amps to 1000 volts, Check Type of Work Involved:
see "b" above.
Branch Circuits ❑ Audio and Stereo Systems
New, alteration or extension per panel ❑
a) The fee for branch circuits Boiler Controls
with purchase of service or
feeder fee. ❑ Clock Systems
Each branch circuit $6.65 2
b) The fee for branch circuits pi Data Telecommunication Installation
without purchase of service
or feeder fee. , t6... 1 Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 (O ❑ 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
Minor Labels (10) $125.00 ❑ Landscape Irrigation Control
Each additional inspection over ❑ Medical
the allowable in any of the above
Per inspection $62.50
Per hour $62.50 ❑ Nurse Calls
In Plant $73.75 ❑
Outdoor Landscape Lighting
Fees:
2 YO n Protective Signaling
Enter total of above fees $ ✓
8% State Surcharge $
n Other
25% Plan Review Fee 1 Number of Systems
See "Plan Review" section on $ ,/ • * No licenses are required. Licenses are required for all other installations
front of application. ` q
Total Balance Due $ , 7' 7 Fees:
❑ Trust Account # Enter total of above fees $
8% State Surcharge $
Total Balance Due $
-
i:\dsts\forrns \elc- fees.doc 10/09/00
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST v gj
BUP
Date Requested / / --/ AM PM BLD
Location l Z Z- 0 6 Sw —ra / �{✓✓ , Suite MEC
Contact Person R 6-e r Ph 03 rf7 3fU} PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC o&b& Tim (o Z Z—
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler _ -- - L< -.a - _ -_
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
TRICA
Rough In
UG /Slab
Low Voltage
Fire Alarm
in
RT FAIL
BackfilUGrading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: ( ] Unable to inspect - no access
ADA
Approach /Sidewalk I, ��
Other Dat Inspector __ — E
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.