Permit CITY OF TIGARD ELECTRICAL PERMIT
.•' PERMIT #: ELC2005 -00039
In DEVELOPMENT SERVICES DATE ISSUED: 1/26/2005
AU- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S134BC-00500
SITE ADDRESS: 12388 SW SCHOLLS FERRY RD
SUBDIVISION: PP1993 -057 ZONING: C -G
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: Addition of (5) 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: 4 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:
MCDONALD'S CORPORATION NEW TECH ELECTRIC
036/0002 20811 NW CORNELL ROAD
PO BOX 66207 HILLSBORO, OR 97124
CHICAGO, IL 60666
Phone: Phone: 503 - 648 - 1900
Reg #: LIC 41868
SUP 3849S
FEES ELE 26 -418c
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 1/26/2005 $73.45
[TAX] 8% State Surcharge 1/26/2005 $5.88 Rough -in
Elect'I Final
•
Total $79.33
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 or 1 -800- 332 -2344.
Issued By: 7: 7:-/Z Permit Signature: _ Cif\ 4
OWNER INSTALLATION ONLY 4
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
01/26/05 WED 11:54 FAX 503 648 3131 NEW TECH ELEC LI001
, _ /0 —oa y 7
Exec deal Permit A liCafton . D FOR OFT' ICE USE ONIA'
City of Tigard Q r Received _
R V Date/B : / , k /� Ai Permit N , - ' _ "•70.3 -a", ,
13125 SW Hall Blvd., Tigard, OR 9735 Py Rc
Phone: 503.639.4171 Far 503598.1960 ' Other' Permit
s
In ection line: 503. 639.4175 � � Date/BY:
P JAN 2 � 2005 �1y ?�1 I Dote Ready/By: �: / ® See Page 2 fur
Interact www.ci.tigard.or.us N.n1fie �•thod: I U Supplemental Information
L�
.,, I \‘;'1,,2',;,' r ' r 1 ' if' ' 'r*1 ( ,
❑ New construction ❑ "• r .11,s . alteration /replacement PIeasc check all that apply:
['Service over 225 ❑ Demolition P.:. Other: ' - . , t
LL s
i;';ii5ii ? : : :,;,. . , rn : � :; S ry ere over 320 s Gratin Buildug over 10, sq.
_'. _:.. r � ;,irl;in :,`,n1rrRr; dwellings
residential
_ I ❑ c amp 8 ❑ ft,
of 3 -an 2- family dw Iliags 4 or more new resi sari
❑ l- and 2 - family dwelling JiirComtnercia1industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder ❑Other ['Building over three stories ❑Feeders, 400 amps or more
,.... _ .. Multi-family --. - _ , on structures
: • -. , 1 ! 1 ; 111 ;''' ,-..-1.' FIT'�_il :I ,)j i +_t,b.'.;I'. "r!: AC)J.14.1 . 1 'CZi. ..l l y,
ClOccupant load over
... . - - - .. , . :' , gress/lightiog plan RV park
persons 5 or
Job no.: •c, rr Yob site address: • - • ['Health -cart facility pother:
• • t • -'- • Submit/. sets of plans with any of the above.
City /State/ZIP: `1'i • - ,,,, e . 2 3 The above are not applicable to temporary construction service,
is Suite/bldg./apt no • Project name: i O/�R t 11.112)2.= . ` .!.. "? }IL° ' . � e : :;i , : :: r .
Dt8ert con Q(Y. Fee. Total
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'l 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: limited energy, residential 75.00 r 2
...... "....,,...,..�,, ... ..., Limited energy. non-residential
75.00 2
-- .- :.- :- . :. :.., :, :.,- ,� ... , ...._.. ._, r:4....,.__ _... -._ .:': : :L_ :_i "__.._ „____ :,.• :_.: Each manufactured or modular
dweuinp and/or feeder 9040 , 2.
' ` Services or feeders installation, alteration, and/or relocation
200 amps or less 8030 2
ry .,
201 amps to 400 amps lOG,85 2
t �i , �, "i('r :iY `;1� :,'n�!4ta�: ; : . 1. -- �
' �f 1iS+�1al.4� - - , 1 P P
Name: n . j..- =-- 401 amps to 600 amps 160.60 2
uGLO r t 601 amps to 1,000 amps 240.60 2
Address: • v., �� - . p Over 1,000 amps or volts 454.65 2
_ Reconnect only 66.85 2
City/State/ZIP: TAR oF� Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( ) - relocation
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
-
:'[Fl[ :_1i•'lblLili),'1•,`.rlr'r t _r - ..I - +•" ''� , �'rV .i
. .r .4 ,-`,. '. A. Pee ff .L... . F Yt. - 4 17r ; .Vl11 s, , i. ... . t
[- : : : :.._ : _., . : :. ,,: ;r.1f !_r..'L!atr :v_.C!�,.. �. ��._...--- -- ._- ...._ :JI :. : ....,�..,,.., ` ��!i::ar,.. :. : : , � -
y
~- ; " "'" : ` :� for branch circuits with
service or feeder fee, each � 7
Business name: branch circuit 6.65 u fe_° 2
B. Fee for branch circuits
Contact name: without service or feeder fee, 44,E 2
each branch eacranc circuit 1 _ _
Address: Each add'I branch circuit 6,65 2 _
City/S tate2IP: Miscellaneous (service or feeder not Included)
Phone: ( ) Fax: ; ( ) Pump or irrigation circle - 53.40 •
Sign or outline lighting 53,40 2
E -mail: • Signal circuit(s) or limited -
� + 'rte =- - ^,.; i" - - energy panel, a
':`ci a „ t . r vetoer':; �� c^ '���'` alteration. or
— extension. Describe: Page 2 2
Business name: - _ E 1ELTg. c
Address: 2-D b I hl e--00...N.1 g - ‘9° Each additional inspection over allowable in any of the above
• Per inspection 6250
City/State/ZIP: I LL..S - v et - lZ Investigation per hour (I hr can) 62.50
Phone: (Sow L $ - 14 G v Fax: ( Industrial plant per hour 73.75
:: :yes : 7R av%" i= i Tian E35:a'�i•Lg(p.2.r uCg,F,, �'�°i� :ti :� >21)
CCB Lic.: 41 11 . Electrical Lic.: x `.14.I ex, Suprv. Lic.: 7 fe r♦ ciS Subtotal ,l 3.1.s
Suprv. Electrician signature, required: I r Plan review (25% of permit fee) -----
\ -40
Print name: 1...\-.)-t \ 1 —) MINIIIII Date: � - Z � � (�� State surcharge (8% of permit fee)
TOTAL PERMIT PEE 5 7 1 33
Authorized signature:
This permit application expires Ira permit is not obtained within 180
days after It has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Bonn!
” Number of Iaspeetions per permit avowed
1:u3utrdlsgwmnlite\ iL,C.Perndupp.doe 13!03 m
A .•a6t5Tttoro2JCOMJWeD
- - ra. l A 4.a 6 .4 1 •�..
CITY OF TIGARD 24-Hour
BUILDING Inspection Lipp: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested ° AM PM BUP
Location D 8, �� - uite MEC
Contact Person Ph ( ) 1 9 g PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner Goo—y) ELC DO-c - OOd37
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: e e /� r SIT 4101 Post & Beam ( � O r / sY � .FAh
Ext Sheath/Shear
-`
Ext eah/h ER
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall �
Fire Sprinkler a t
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
Fire Alarm
111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Iti PART FAIL
SI 0 Please call for reinspection RE: Unable to inspect — no access
Fire ADASupply Line _ 28 -05- // fit
Approach/Sidewalk
Date Inspector l Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL