Permit r •►
C ITY OF TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00109
! 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/12/2005
PARCEL: 1 S134BC -00300
SITE ADDRESS: 12272 SW SCHOLLS FERRY RD ZONING: C -G
SUBDIVISION: GREENWAY TOWN CENTER LOT: JURISDICTION: TIG
Project Description: Add to alarm, sound system, data.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 3
Owner: Contractor:
BPP RETAIL LLC LAKE ELECTRONIC CONTRACTORS
BY BURNHAM PACIFIC PROPERTIES LEC SOUND + COMMUNICATIONS
ATTN: JOHN WATERS PO BOX 1550
SAN DIEGO, CA 92101 TUALTIN, OR 97063
Phone: Phone: 503 234 - 3044
Reg #: LIC 65381
ELE 3- 165CLE
FEES SUP 735LEA
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 5/12/2005 $225.00
[TAX] 8% State Surcharl 5/12/2005 $18.00
Total $243.00
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. TTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules ar set forth in OAR 952 - 001 -0010
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct quest UNC 03- 246 -6699.
Issued By: Permittee Signature: 01/o5
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.
.`
Electrical Permit Ap R eceived FOR OFFICE USE ONLY
City of Tigard Date/E1 : �k� of ` Permit No. _ ,, 00 )01
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 MAY 1 200 4 ? Date/B : Other Permit:
Inspection Line: 503.639.4175 . e' W Date Ready/By: ® See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TICA`i Notified/Method: Supplemental Information
1 .. -.:: k:`.. I-, ' :, %',._..,1 .,' -' • 1 ... , -' - PLAN_- REYLEW.
❑ New construction 71--Addition/alteration/reolacement ' Please check all that apply:
❑ Demolition ❑ Other: l'n ❑Service over 225 amps, comm'l ❑Hazardous location
�� 11 ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
. , i CATEG OF• CONSTRUGTI ONy ' _ "==-;` t = , : • 4 t,. z of 1- 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
❑ Multi- family u M aster builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
-INF RMATI AND > - • :• • "a Egress/lighting plan RV park
�•::, : ;; '°JOB.SI'�'E O ON LOCATION; ;�s:;� - ' a ''' ❑ P
Job no.: Job site address: /7-472 '
) ❑Health care facility ❑Other:
• Submit 2 sets of plans with any of the above.
City/State /ZIP: Q � Ole- � 9 Z Z NSF Q,,7 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: C ree� t �/�- „„ .. f FEE *SSCHEDUI:E �. -- -
Description L Qty. I Fee I Total I
Cross street/directions to job site: I New residential single- or multi - family dwelling unit.
2 Z --o � ✓� //�� N2 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 trap /parcel no.: Limited energy, residential 75.00 2
v r Limited energy, non - residential '3 75.00 2
1 .:- . 1-,. '4': '
. ". 4 `` = ` # DESCRIPTION •OF WORK. " ,' -:: ` :: ;i` 4•: :' Each manufactured or modular
/ 1 A A dwelling, service and /or feeder 90.90 2
t7r ' Q e - . ► . Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
• s ', ; ,;; 201 amps to 400 amps 106.85 2
❑-"Cl" •' . ; I .• ., .. ; . , �; :TENA.NT:, : _ > -
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 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
N* - a x r ,, "� �y- '? *`' b f A. Fee for branch circuits with
'.' ". e : '4 Q -, -. — - - NT:. -;tr''' : 4 =fi. .. _ -, 1 . ,.N`I.'CT" P V . ,' - �, !, - . , ..
� °� service or feeder fee, each
Business name: branch circuit 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address: '
Each add'I 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 -
1 f ''�'.C`.., .;; ° • '.;::.." f .4` , •i :: H'' ..a . i- energy panel, alteration, or
extension. Describe: Page 2 2
Business name:
,- Each additional inspection over allowable in any of the above
Address:
0 e'0)( l s-sn Per inspection 62.50
City/State/ZIP: T ati I Q- F g 9 '7162 Investigation per hour (I hr min) 62.50
r Industrial plant per hour 73.75
Phone: ( /Jp$- 2-3��5011f ax: >3) 3
Z3t� ozf3
A.,' F7, ..',`: ,'EEE:clorcAI" :PERMIT 'FEES' : . - s _ .
CCB Lic.: Z15 g ( Electrical Lic. d - /(C / �Suprv. Lic.: ?35-LEt Subtotal
•
Suprv. Electrician signature, required / ' 4( Plan review (25% of permit fee)
Print name: SI 4 --- ? $ I Date: / . State surcharge (8% of permit fee)
t� / 7 .. TOTAL PERMIT FEE
Authorized signature: 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- PermitApp.doc 12/03 440.46 IST(10 /02ICOM/WEB
r•
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
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:
•
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
•
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ 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:
*No licenses are required. Licenses are required
for all other installations
i:\ BuildinglPamio\ELC- PermaApp.doc 04/03
CITY OF TIGARD . , , .•
BUILDING DIVISION PERMIT #: ELR2005 00109
I 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 5/12/2005
Phone: (503) 639 -4171
Ai :wilt
Inspection Requests (24 Hrs.): (503) 639 -4175 - __..
INSPECTION WORKSHEET FOR DATE: 5/16/2005 TIME: 7 :09AM PAGE: 69
SITE ADDRESS: 12272 SW SCHOLLS FERRY RD CLASS OF WORK:
SUBDIVISION: GREENWAY TOWN CENTER LOT #: TYPE OF USE:
,PROJECT NAME: MCMENAMINS
DESCRIPTION: Add to alarm, sound system, data.
OWNER: BPP RETAIL LLC, PHONE #:
CONTRACTOR: LAKE ELECTRONIC CONTRACTORS PHONE #: 503 -234 -3044
Inspection Request Scheduled For: Date: 5 5/16/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 006882 -01 503-234 -3044 N
Corrections/Comments/Instructions:
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JPASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: - , - Date:S" /6- j Phone #: (503) 718-