Permit CITY T I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
A A , DEVELOPMENT SERVICES PERMIT #: ELR2005 -00421
$111 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/22/2005
PARCEL: 1S134BC-00300
. SITE ADDRESS: 12244 SW SCHOLLS FERRY RD ZONING: C -G
SUBDIVISION: GREENWAY TOWN CENTER LOT: JURISDICTION: TIG
Project Description: Audio /Stereo.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
BPP RETAIL LLC VERSATILE CABLING, INC.
BY BURNHAM PACIFIC PROPERTIES 12606 NE 95TH ST #C -130
ATTN: JOHN WATERS VANCOUVER, WA 98682
SAN DIEGO, CA 92101
Phone: Phone: 360 - 816 -1021
•
Reg #: LIC 161614
ELE 37- 1048CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 11/22/200E $75.00
[TAX] 8% State Surcha 11/22/200`. $6.00
Total $81.00
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.
Issued By: p 7TH Permittee Signature: _yP,-z Ps
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 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
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.
d
4
• Electrical Permit Api i� o V E I)
Received 7 /��zD 5/1,Z i
- City of Tigard 1 �Ra F �B Date/By: // j �_ Permit No. .[ /J[
13125 SW Hall Blvd., Tigard, OR 97223 Ma 2 Y 200 Plan Review
Phone: 503.639.4171 Fax: 503'.598.1960, 4.0 . • 1 ' +� Date/By: Other Permit:
C�Bl YOrF T IGi`1�J-::..Z±il `III ruris: ®Seep e 2 for
Inspection Line: 503.639.4175 Date Re /By: ag
Internet: www.ci.tigard.or.us OUIL®I4�O DIVI ;K)6 \i Notified/Method: -3-k-" Supplemental Information
TYPE OF WORK PLAN REVIEW
ew construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other:
['Service over 225 amps, com'I ['Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ,laConunercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories OFeeders, 400 amps or more
❑ Multi - family 0 Master builder ❑ Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: 2._1-414 . _t L ❑Health -care facility ❑der
S Y3� �11��� f �z/`{ Submit 2 sets of plans with any of the above.
City/State/ZIP: i 4 i 3 4 11 2.1 The above are not applicable to temporary construction service.
T
Suite/bldg./apt. no.: Project name: �l l /
a f / >�4,-Q FEE* SCHEDULE
Description I Qty. I Fee. I Total I ••
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
5Lur Inclu des attached garage.
L. -�' 1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
ill) (� dwelling, service and/or feeder 90.90 2
C! 1 v (S i6 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
RECEIVED p /. 401 amps to 600 amps 160.60 2
Name: RECEIVED PLANNING 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: NOV 2 1 2005 Temporary services or feeders installation, alteration, and/or
- e relocation
Phone: ( ) Fax: ( CITY OF TIGARD 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 own w tch 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: tS - 15- n...it. c 6.0 v,.. branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'l branch circuit 6.65 2
City/ State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax :: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
CONTRACTOR energy panel, alteration, or
extension. Describe: l Page 2 !./'a) 2
Business name: I) Cr 5 a C AK
Address:1 1
Each additional inspection over allowable in any of the above
0 " 11 iJ e 'j St k. � �� 1 Per inspection 62.50
City/State/ZIP: If o r n C tr c t gto F Investigation per hour (1 hr min) 62.50
Phone: (yip 1 to , . 1 D Fax: 0/�) ?"I Le .- 0'6 Lga„?._ Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES* •
CCB Lic.: f igi Lo i Lt Electrical Lic.: 4 ®e/ Suprv. Lice jt Subtotal 16 G DV
P
Su rv. Electrician signature, required: CL `~'1 Plan review (25% of permit fee) • Print name: [L ` r � Date: / 1 QJ State surcharge (8% of permit fee) . CD
TOTAL PERMIT FEE ) i ()
Authorized signature: P i-ate This permit application expires If a 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 Board
•• Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PermaApp.doc 12/03 440-4615T(10/02/COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 -00421
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/22/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 `'I - -
INSPECTION WORKSHEET FOR DATE: 12/22/2005 TIME: 7:03AM PAGE: 53
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SITE ADDRESS: 12244 SW SCHOLLS FERRY RD CLASS OF WORK:
SUBDIVISION: GREENWAY TOWN CENTER LOT #: TYPE OF USE:
PROJECT NAME: DOLLAR TREE
DESCRIPTION: Audio/Stereo.
OWNER: BPP RETAIL LLC, PHONE #:
CONTRACTOR: VERSATILE CABLING, INC. PHONE #: 360 -816 -1021
Inspection Request Scheduled For: Date: 12/22/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 023897 -01 360-601-7940 N
Corrections /Comments/ Instructions:
•
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL . ❑ CALL FO INSPECTION ❑ ADDITIONAL FEES ASSESSED
I
Inspector: s I I 4 Date: f 7, ell one #: (503) 718-