Permit a CITY OF TIGARD EVI / ELECTRICAL PERMIT
ti COMMUNITY DEVELOPMENT Permit #: ELC2012 -00464
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/06/2012
Parcel: 1 S134BC00300
Jurisdiction: Tigard
Site address: 12280 SW SCHOLLS FERRY RD
Project: Little Caesars Subdivision: WINDSOR PLACE Lot: 32
Project Description: (19) branch circuits and low voltage for data. 8/20/12 adding sign elc
Contractor: BELL MOUNTAIN ELECTRICAL TECHNOLOGIES LLC Owner: FW OR- GREENWAY TOWN CENTER LLC
PO BOX 895 PO BOX 790830
BATTLE GROUND, WA 98604 SAN ANTONIO, TX 78279
PHONE: 360 - 624 -1580 PHONE:
FAX: 360 - 666 -5053
FEES
Quantity Description Date Amount
19 crt Branch Circuits wo /Purchase 08/06/2012 $189.74
Specifics: Service or Feeder
1 ea Signal circuit or Limited 08/06/2012 $75.00
Type of Use: COM Energy Panel
Class of Work: ALT 1 ea 12% State Surcharge - 08/06/2012 $31.77
Electrical
Type of Const: 1 ea Sign or Outline Lighting 08/20/2012 $67.84
Occupancy Grp: 0 ea 12% State Surcharge - 08/20/2012 $8.14
Electrical
•
Total $372.49
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code. State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 001 -009. You may jnacoPY of the rules or direct questions to OUNC by calling 1987 or 1.800.332.2344.
Issued By: ,� • L 41-
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' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
CITY OF TIGARD ELECTRICAL PERMIT
1111
a. COMMUNITY DEVELOPMENT Permit p: ELC2012 00464 •
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/06/2012
Parcel: 1 S 134BC00300
Jurisdiction: Tigard
Site address: 12280 SW SCHOLLS FERRY RD
Project: Little Caesars Subdivision: WINDSOR PLACE Lot: 32
Project Description: (19) branch circuits and low voltage for data.
Contractor: BELL MOUNTAIN ELECTRICAL TECHNOLOGIES LLC Owner: FW OR- GREENWAY TOWN CENTER LLC
PO BOX 895 PO BOX 790830
BATTLE GROUND, WA 98604 SAN ANTONIO, TX 78279
PHONE: 360 - 624 -1580 PHONE:
FAX: 360 - 666 -5053
FEES
Quantity ,Description Date Amount
19 crt Branch Circuits wo /Purchase 08/06/2012 $189.74
Specifics: Service or Feeder
1 ea Signal circuit or Limited 08/06/2012 $75.00
Type of Use: COM Energy Panel
Class-of Work: ALT 1 ea 12% State Surcharge - 08/06/2012 $31.77
Electrical
Type of Const:
Occupancy Grp:
Total $296.51
Required Items and Reports (Conditions)
This pe• it is issued subje to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be d• e in accordance with a. .rove. •fans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
day- ATTENTION: Oregon law -qui >s u to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 001 -0010 th ugh OAR 952 -r • 0091. ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
/• ,// / /
4-" z3.7‘.1.4 4 ..._.=T____
Is 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' Date: k_ 4. /1
LICENSE NO. —5.10 (o y 3
• Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
Electrical Permit Applicatio 1701,. i s FOR OFFICE USE ONLY
City of Tigard y Date /B : :. ff f, r--)y.16 Pennit No.: £'2. CO,aC /a roc 6 Received
a 13125 SW Hall Blvd., Tigard, OR 97223 2012
I I
AUG Al I r Plan Review
ltl Phone: 503.718.2439 Fax: 503.598.1960 U G Date/By: Other Permit: ,
Inspection Line: 503.639.4175 1y t; Date Ready/By: Juris: ® See Page 2 for
TIGARD Internet: www.tigard-or.gov C 1 ' -`''' qU Supplemental Notified/Method: Su lemental Information
TYPE OF PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
El New construction ®Addition/alteration / replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A "E ", "1 -2 ", "I -3 ",
Job no.: Job site address: 12280 SW Scholls Ferry Rd. - I00HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP7 OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Little Caesars ❑ Service or feeder. 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: SW Corner of SW 121 Ave Description I Qtv. I Fee. I Total I •
& SW Scholls Ferry Road in Greenway Town Center New residential single or multi- family dwelling unit.
t7 Y Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: , Limited energy, residential 75.00 2
1 DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
Electrical to Tenant Space residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ® TENANT 201 amps to 400 amps 133.56 2
Name: Michael Akhavi 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 18681 SW Tualatin Valley HWY Over 1,000 amps or volts 552.26 2
City/State/ZIP: Aloha, OR 97006 Temporary services or feeders installation, alteration, and /or
Y relocation
Phone: (503)608 -7085 Fax: (503)642 -3322 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, Q er panel
Owner signature: • Date: A. Fee for branch circuits with
0 APPLICANT I ® CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: Little Caesars B. Fee for branch circuits without
service or feeder fee, first 1 56.18 56.18 2
Contact name: Michael Akhavi branch circuit
Each add'l branch circuit 18 7.42 133.56 2
Address: 18681 SW Tualatin Valley HWY Miscellaneous (service or feeder not included)
City/State/ZIP: Aloha, OR 97006 Each manufactured or modular 67.84 2
tY dwelling, service and/or feeder
Phone: (503) 608 - 7085 Fax: : (503) 642 - 3322 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
. Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-energy
Business name: Bell Mountain Electrical Technologies LLC panel, alteration, or extension. I Page 2 75.00 2
Each additional inspection over allowable in any of the above
Address: PO Box 895 Additional inspection (I hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /State /ZIP: Battle Ground, WA 986004 Industrial plant (1 hr min) 78.18/ hr
Phone: (360) 624 -1580 Fax: (360) 666 -5053 Inspections for which no fee is 90.00 / hr
specifically listed (V2 hr min) _
CCB Lic.: 176481 Electrical Lic.: C700 Suprv. Lic.: 5664S ELECTRICAL PERMIT FEES
Subtotal: _ 264.74
Suprv. Electrician signature, required:
/ / _--- Plan review (25% of permit fee):
Print name: Terry Carlson Date: 8 - - 2012 State surcharge (12% of permit fee): 31.7?
TOTAL PERMIT FEE: 296.54
Authorized signatl� �t
J �� / /VC, ` This permit application expires if a permit is not obtained within 180
Print name: Terry Carlsoll� l Date: 8 -3 -2012 • days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:' Building \Permits\ELC -PermitApp.doc 07/01/10 4404615T(11/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES: •
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
- ❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other: _
COMMERCIAL WORK ONLY:
Fee for each commercial - $75.00 •
system
(SEE OAR 918- 309 -0000) •
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
p Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations -
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10