Permit .;„ CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00037
DEVELOPMENT SERVICES DATE ISSUED: 1/26/2005
rlll 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: Dishwasher circuit.
RESIDENTIAL UNIT TEMP SRVCIFEEDERS 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: 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 ST JOHNS ELECTRIC INC
036/0002 4415 NE MINNEHAHA
PO BOX 66207 VANCOUVER, WA 98661
CHICAGO, IL 60666
Phone: Phone: 360 - 693 - 5100
Reg #: LIC 43135
SUP 3024S
FEES ELE 37 -350C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 1/26/2005 $46.85
[TAX] 8% State Surcharge 1/26/2005 $3.75 Rough -in
Elect'I Final
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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 tility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules y dir,= t quest s to C at (503)
2466699 or 1 -800-33 344.
Issued By: 04 � j ,1� 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
Electrical Permit Ap R: o 0-9 FOR OFFICE USE ONLY
• City-of tgard Received
By: 1 --D.-Lo f� Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 n 2005
Date/By: - OS �v, C�a o� -� D�
Phone: 503.639.4171 Fax: 503.598.1960 O / �::.Hh A gey� \ Date/By: Other Permit:
Inspection Line: 503.639.4175 _l j. r.•i I Date Ready/By: Loris: El See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGA • ,, Notified/Method: (— IU Supplemental Information
. _ - x. ! ,1c;-1.' v PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply:
° I El Demolition 0 Other: ❑Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of l- 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
El Multi - family ❑Master builder ❑Other: ❑Building over three stories ❑ Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: 12388 SW SCHOLLS FERRY ROAD ❑ Health - care facility ❑Other:
Subm 2 sets of plans with any of the above.
City/State/ZIP: TIGARD, OR 97 223 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: MCDONALDS
FEE* SCHEDULE
Description I Qty. I Fee. I 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 I 4
Subdivision: Lot no.: Ea. add'l 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
dwelling, service and/or feeder 90.90 2
NEW CIRCUIT FOR DISHWASHER 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: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
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 I ❑ 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,
Address:
each branch circuit 1 46.85 46 .85 2
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
extension. Describe: Page 2 2
Business name:
ST. JOHNS ELECTRIC, INC.
Address: Each additional inspection over allowable in any of the above
4415 NE MINNEHAHA STREET Per inspection 62.50
City/State/ZIP: VANCOUVER, WA 98661 Investigation per hour (I hr min) 62.50
Phone: ( 360 ) 693 - 5100 Fes' ( 3Fin ) 99 - 1345 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 4'1 1 15 Electrical Lic.: — a / Suprv. Lic.: S ubtotal
3n 74s 46.85
Suprv. Electrician signature, required: / ' Plan review (25% of permit fee)
State surcharge (8% of permit fee) 3.75
Print name: DEAN R. BJ Date: 01 - -
TOTAL PERMIT FEE 50.60
Authorized si nature:
g ^ � G , „ This permit application expires if a permit is not obtained within IN
days after it has been accepted as complete
Print name DEAN R R. BJUR Date: 01 -25 -05 * Fee methodology set by Tri -County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Buiiding \Permits\ELC- PermitApp.doc 17/03 440- 4615T(10 /07/COM/WEB •
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: 4503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested Z - Z, AM PM BUP
Location 1 2-3 E 3 S'<6{ D u-S F( 2.i . Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner M L MY/le/n.1)5 ELC 2 °D 5 000 3 7
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors -
Ext Sheath/Shear
Ina Sheath /Shear
Framing D. I $1-1 Lc —SK u 1 7" .IMI I
Insulation �P2� FT'-O, __ F` /v��
Drywall Nailing
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
F = t arm
PASS PART FAIL
111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S rt Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
Approach/Sidewalk Date �Z� 0 `� Inspector ` G�€�''�7 Ext
PP
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL