Permit n
A CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
�� DEVELOPMENT SERVICES PERMIT #: ELR2005 -00062
- �� f — 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/25/2005
PARCEL: 1 S 134BC -00300
SITE ADDRESS: 12272 SW SCHOLLS FERRY RD ZONING: C -G
SUBDIVISION: GREENWAY TOWN CENTER LOT: JURISDICTION: TIG
Project Description: Low voltage for HVAC wiring. Job No. 2555
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: 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: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
BPP RETAIL LLC HVAC INC
BY BURNHAM PACIFIC PROPERTIES 5188 SE INTERNATIONAL WAY
ATTN: JOHN WATERS MILWAUKIE, OR 97222
SAN DIEGO, CA 92101
Phone: Phone: 503 462 - 4822
Reg #: LIC 50897
ELE 26-571CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 3/25/2005 $75.00
[TAX] 8% State Surcharl 3/25/2005 $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
throw
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OAR 9 -001- 1 . You may obtain copies of these rules or direct qu ;ons to OUNC,$503-246-6699.
Issue Permittee Signature: ,p p
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.
k
Electrical Permit Application FOR OFFICE USE ONLY
Received Electrical
Date/By: -- a GS Permit No.: � L ��IDO SY)CO6
City of Tigard Planning Approval Sign
13125 SW Hall Blvd.
Date/By: Permit No.:
" Rev iew Other
Tigard, Oregon 97223 E AV E D eBy: Permit No.:
Phone: 503 -639 -4171 Fax: 503 - 598 -1960 / Post - Review Land Use
Internet: www.ci.tigard.or.us A I c Date/By: Case No.:
1 •
24 -hour Inspection Request: 503 -639 -4175 = -- ° : I . Contact Name/Me thod: Na/ Method: Ju • Su See Page l for
r �- Supplemental Information.
CITY OF TICi.A D
TYPE OF WO ' , • y_15 (ON PLAN REVIEW (Please check all that apply)
❑ New construction
r . emo ition El Service over 225 amps- 0 Health-care facility
commercial
Additio . - a . o t r eplacement El Other: Other: ❑ Hazardous location
EGORY OF CONSTRUCTION Service over 320 amps - rating of ❑ Building over 10,000 square feet,
I & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ;'2 "ommercia / ustrial ❑ System over 600 volts nominal one structure
❑Building over three stories 0 400 amps or more
El Accessory Building • • ulti- Family
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
Job site address: / 2,2,7 2. �w oU , The above are not a to temporary construction service.
Suite #: Bldg. /Apt. #: t^ FEE* SCHEDULE
Number of inspections per permit allowed
Project Name: Gvee,ft ?tdt, (tiaki tahtt f*, Description Qty Fee (ea.) Total
Cross street/Directions to job site: New residential - single or multi- family per j
dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 I
Subdivision: Limited energy, residential
Lot #: 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
MO VD t /.1.)/./Y C4(.. a Services or feeders - Installation,
Tvu'/t. W O�YZ17'S alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
Name: Over 1000 amps or volts 454.65 2
Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
City /State /Zip: alteration, or relocation:
200 amps or less 66.85 I
Phone: Fax: 201 amps to 400 amps 100.30 2
❑ APPLICANT ❑ CONTACT PERSON 401 to 600 amps 133.75 2
Branch circuits - new, alteration, or
Name: extension per panel:
Address: A. Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
Phone: service or feeder fee, first branch circuit 46.85 2
Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Job No: a 5 5 Each sign or outline lighting 53.40 2
Signal circuit(s) or a limited energy panel,
Business Name: / e.� alteration, or extension Page 2 2
Description:
Address: 5l8$ Se vtc o'na( wa (4
City/State /Zip: ix , C .k ,, O f Each additional inspection over the allowable in any of the above:
Per inspection per hour (min. I hour) 62.50
Phone: SO3 —( Ga- qw., Fax: 563- 1/ - 6,555 Investigation fee:
CCB Lic. #: 43'50FsR7 Lic. #: ac,- 57i' eLE Other.
Supervising electrician Electrical Permit Fees*
Subtotal $
Signature required: Plan Review (25% of Permit Fee) $
Print Name: 'wpm \A/t (cpyl I Lic. #: c9143.4 L> State Surcharge (8% of Permit Fee) $
Authorized TOTAL PERMIT FEE $
r Notice: This permit application expires if a permit is not obtained within
Signature: --� A A A �tl Oh(d6 `Pate: 2/ 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
See rc k.e� t� to
(Please print name)
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03
1 `1
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information -
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems
0 Burglar Alarm
❑ Garage Door Opener
❑ Heating, Ventilation and Air Conditioning System
❑ Vacuum Systems
Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
Audio and Stereo Systems
Boiler Controls
Clock Systems
0 Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
0 Intercom and Paging Systems
1=1 Landscape Irrigation Control
Medical
E l Nurse Calls
❑ Outdoor Landscape Lighting
❑ Protective Signaling •
n Other •
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 -00062
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/25/2005
Phone: (503) 639 -4171 .m I ��Al l t
Inspection Requests (24 Hrs.): (503) 639 -4175 —_..61- 11.
INSPECTION WORKSHEET FOR DATE: 5/18/2005 TIME: 7:34AM - PAGE: 72
SITE ADDRESS: 12272 SW SCHOLLS FERRY RD CLASS OF WORK:
SUBDIVISION: GREENWAY TOWN CENTER LOT #: TYPE OF USE:
PROJECT NAME: MCMENAMINS
DESCRIPTION: Low voltage for HVAC wiring. Job No. 2555
OWNER: BPP RETAIL LLC, PHONE #:
CONTRACTOR: HVAC INC PHONE #: 503462-4822
Inspection Request Scheduled For: Date: 5/18 /2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 007172 -01 503-462 -4822 N
Corrections /Comments /Instructions:
1
C 1
J
illy
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �j 4/( 0 Date; 6)P Phone #: (503) 718-