Permit CITY OF TIGARD ELECTRICAL PERMIT
A ;
;, DEVELOPMENT PERMIT #: ELC97 -0787 Hall Blvd., Tigard, � SERVICES DATE ISSUED: 11/26/97 97223 (503) 6394171
PARCEL: 2S1O2CB -00303
SITE ADDRESS...: 13165 SW PACIFIC HWY
SUBDIVISION -NORTH TIGARDVILLE ADDITION ZONING:C —G
BLOCK • LOT •033 JURISDICTION: TIG
Project Description: Installation of twenty (20) branch circuits to existing
commercial site.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD'L 5O0SF...: 0 201 — 400 amp • 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY • 0 401 — 600 amp • 0 SIGNAL /PANEL • 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 — 200 amp • 0 W /SERVICE OR FEEDER: 0 PER INSPECTION • 0
201 — 400 amp • 0 1st W/O SRVC OR FDR.: 1 PER HOUR • 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 19 IN PLANT • 0
601 — 1000 amp • 0 PLAN REVIEW SECTION
1000+ amp /volt • 0 > =4 RES UNITS • > 600 VOLT NOMINAL..:
Reconnect only : 0 SVC /FDR >= 225 AMPS..: CLASS AREA /SPEC OCC.
Owner: FEES
BURGER KING type amount by date recpt
13165 SW PACIFIC HWY PRMT $ 130.00 TJH 11/26/97 97- 301270
TIGARD OR 97223 5PCT $ 6.50 TJH 11/26/97 97- 301270
Phone #:
Contractor:
XL ELECTRIC $ 136.50 TOTAL
581 LANCASTER DRIVE S.E.
SUITE #50 REQUIRED INSPECTIONS
SALEM OR 97301 Ceiling Cover Elect'1 Service
Phone #: 503 - 391 -9113 Wall Cover Elect'1 Final
Reg #..: 001094
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -014010 through DAR 952-001 -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling 15031246 -1987. /
Permittee Signature: Olt a, ,� ey�t Issued By: LA: ,frr% —'
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 : G9'1 Gt .a� 4 -._ DATE: 11/20
LICENSE NO: £ T I,
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ +1- + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Electrical Permit Application Plan Check # N'A
13125 SW HALL BLVD. Rec'd By T• Hanson
TIGARD OR 97223 Date Rec'd I I , •
Date to P.E. L.
Phone (503) 639 -4171, x304 Date to DST I , , /
Inspection (503) 639 -4175 Print or Type Permit # , ' ' 1 i
Fax (503) 684 - 7297 Incomplete or illegible will not be accepted Called rvkiilrtl,
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) BURGER KING Service included: Items Cost Sum
I
Address 1 31 6 5 SW PACIFIC HWY 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City /State /Zip, TIGARD, OR Each additional 500 sq. ft. or
Commercial ® Residential El Limited thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current licenses) ' 4b. Services or Feeders
Electrical Contractor XL ELECTRIC, INC. Installation, alteration, or relocation
or
Address 581 LANCASTER DR SE STE 50 200 amps to less $60.00 2
201 amps to 400 amps $80.00 2
City SALEM State OR Zip 9 7 3 01 401 amps to 600 amps $120.00 2
Phone No. • 5 0 3 -3 91 -91 1 3 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. 2 4- 2 6 9 c Exp.Date 1 0- 9 8
OR State CCB Reg. No.1 0 9 4 3 2 Exp.Date 1 2 - 9 8 4c. Temporary Services or Feeders
GOT Business Tax or Metro No. 4 7 0 0 Exp.Date 1 -1 - 9 8 Installation, alteration, or relocation
200 amps or less $50.00 2
f !� 201 amps to 400 amps $75.00 2
Signature of Supr. Elec'n
/ J �1 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. 2 4 81 S Exp.Date 1 0- 9 8 see "b" above.
Phone No. 503 -391 -91 1 3
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00 2
City State Zip b) The fee for branch circuits
ty p without purchase of
Phone No. service or feeder fee.
First branch circuit 1 $35.00 3 5 2
The installation is being made on property I own which is not Each additional branch circuit 1 9 $5.00 9 5 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional Inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00
* Submit 2 sets of plans with application where any of the above apply. 5. Fees:
130.00
Not required for temporary construction services. 5a. Enter total of above fees $ _ 5 0
5% Surcharge (.05 X total fees) $
NOTICE Subtotal $
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY .
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # $ 11 A S n
Total balance Due
I: \DSTS \ELC96.APP Rev 9/96
Page No. 1 CASE HISTORY FOR CASE NO.: ELC97 -0787
BURGER RING
13165 SW PACIFIC HWY
04/09/98
Action Description Real/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Dane Done Date By
---- --- -- - -- --- - --
ELCC001 Application received / / / / 11/26/97 RECD TJH 11/26/97 TJH
ELCC003 Permit created / / / / 11/26/97 PASS TJH 11/26/97 TJH
ELCC500 (F)Issue permit / / / / 11/26/97 PASS TJH 11/26/97 TJH
ELCC700 Ceiling Cover / / / / 12/26/97 Will verifr proper securing of fixtures PASS BRP 12/26/97 B *P
at final.Ceiling was covered without
inspection.
ELCC700 Ceiling Cover 01/02/98 / / 01/02/98 PASS BRP 01/02/98 J *H
ELCC799 Elect'l Final / / / / 01/06/98 PASS BRP 01/08/98 J *H
ELCC800 Case Finaled / / / / 01/06/98 PASS BRP 01/08/98 J *H
CITY OF TIGARD BUILDING INSPECTION DIVISION FivrFAE`0
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: I a-'\ - zC 1 A.M. P.M. MST:
Location: 1 i Cp 5. Cz� U � ' /4I- � - BUP:
Tenant: �Q D,i (20../..., / 6 ././A. r A
. C Suite: o Bldg: MEC:
Contractor. l Ce O _.(2 , (J Phoq/ 3 �/— 9/0 PLM:
Owner Phone: ELC: 77 C-7 A2-
ELR:
SIT: '
BUILDING BLDG (con't) PLUMBING MECHANICAL E ' CTRICAL SITE
Site Post/Beam Post/Beam Post/Beam ' oil- ervice Sewer /Storm
Footing Roof UndFl/Slab Rough -In ■ eilin. Water Line
Slab Framing Top Out Gas Line Rou: -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Ahn Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved pprov Approved
Appr /Sdwlk Not Approved Not Approved Not Approved o oved Not Approved
' FINAL FINAL FINAL FINAL FINAL
,'?n/ 5 i r, k• N0rED, i
6 r? v vn D4,0 moo» Es -
Ch -k Cam /4hi /rI /X9( urQS 41' f2/ ii /•
O Call for reinspection Reinspection fee of $ required before next inspection Cl Unable to inspect
Inspector: Date: 0Z ,- 2_ C — ? Page of
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639-4175 Business Phone: 639 -4171
Date Requested: ' I 49 f 9 0 A.M. P. MST:
r
Location: f I 4 ' BUP:
Tenant: 1 _ - _fJ ..ice Suite: Bldg: MEC:
Contractor: 3a `' L I Phone: PLM:
Owner: Phone: ELC: ? 70 7
ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL l A� SITE
Site Post/Beam Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL EIZINL FINAL
/ () nl — q 7 - 0 2 9- 7
/ = / N . 4 - 4 . onr L i - 9 7-03‘,C
I
O Call for reinspection Reinspection fee of $ required before next inspection O Unable to inspect
Inspector: Date: / — 0 - F0 - P e of
• CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: -CJ 1.t∎ I - D - — 18 Nan BUP:
A.M. P.M. MST:
Location: l 3(1 ` C{ pci., ,...w N
Tenant Suite: Bldg: NEC:
Contractor: Phone: .3 q t — 97/3 PLM: -7
Owner: Phone: p ELC:q 7 -7 - O7 E 7
0-070-41 — } CJt _ c L ELR:
t eAPUTE - g- K1) SC h • V}1 -1-14)- J SIT:
UILDING BLDG (con't) PLIJAG V MECHANICAL LECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam over, ,ervice Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spk1r /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approv Approved
Appr /Sdwlk Not Approved Not Approved Not Approved v ed Not Approved
FINAL FINAL FINAL FINAL FINAL
r"-e-c // h ci 4. .S S _-_
..J
•
•
•
O Call for reinspection I ■ ' einspection fee of $ required before next inspection O Unable to inspect
F Inspector: / i Date: O 2 Page of
l