Permit qii y OF T I GA R D ELECTRICAL PERMIT
PERMIT #: ELC2005 -00235
6r DEVELOPMENT SERVICES DATE ISSUED: 4/4/2005
r�l I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S134BC-00300
SITE ADDRESS: 12272 SW SCHOLLS FERRY RD ZONING: C -G
SUBDIVISION: GREENWAY TOWN CENTER LOT : JURISDICTION: TIG
Project Description: 8 br. circuits.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 7 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
BPP RETAIL LLC ROBERTS ELECTRIC INC
BY BURNHAM PACIFIC PROPERTIES 5759 SW 48TH AVE
ATTN: JOHN WATERS PORTLAND, OR 97221
SAN DIEGO, CA 92101
Phone: Phone: 503- 244 -7754
FEES Reg #: SUP 3886S
tion Date Amount LLC 34
Description ELE 34 -23C
[ELPRMT] ELC Permit 4/4/2005 $93.40
[TAX] 8% State Surcharge 4/4/2005 $7.47 REQUIRED ITEMS AND REPORTS
Total $100.87
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 que tions to OUNC at
503 - 246 -6699 or 1 -% g0- 332 -2344. f �
Issued By: l v''r�1 / i
- � ! 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'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 VED FOR OFFICE USE ONLY
City of Tigard Received
' Permit No.: - _ el /Air OCAS
13125 SW Hall Blvd., Tigard, OR 97223�pR 0 4 2005 Plan Review
Phone: 503.639.4171 Fax: 503.598.19 . , Date /By: Other Permit:
Inspection Line: 503.639.4175 CITY OF TIGARD - r I Date Ready /By: Juris: ® See Page 2 for
Internet: www.ci.tigard.or.us R �N� bIVISI�IV Notified/Method: 7 ' ('. Supplemental Information
UILD `�
TYPE OF WORK PLAN REVIEW
❑ New construction (I Addition/alteration /replacement Please check all that apply:
['Service over 225 amps, comm'l ❑Hazardous location
❑ Demolition 0 Other:
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling El Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories ['Feeders, 400 amps or more
❑ Multi- family 0 Master builder 0 Other:
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
❑Health -care facility ❑Other:
Job no.: Job site address: Z 27 Z S . t�
Submit 2 sets of plans with any of the above.
City/State /ZIP: --T` The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name:,/l, a.".. FEE* SCHEDULE
Description I Qty. I Fee. 1 Total I ••
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
/&)^.■ez:44 dwelling, service and/or feeder 90.90 - 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER l ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
r 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
Phone: ( ) Fax: ( ) relocation
200 amps or less 66.85 I
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
❑ APPLICANT , ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 1 46.85 �� �� 2
Address: each branch circuit `
Each add'I branch circuit ' 7 6.65 4 4,,5 5 " 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) ( ) Pump or irrigation circle 53.40 2
Fax:
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
Q A extension. Describe: Page 2 2
Business name: 1`ae e-T- �t0,,c_vt,e.e_. ZN C
_ - � r// U Each additional inspection over allowable in any of the above
Address:
s S �� `e Per inspection 62.50
City/State /ZIP: pa O l e . 97 22_1 Investigation per hour (I hr min) 62.50
Phone: (so /) a Lrci = 7 t( Fax: (n33) . _05.66 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 1 Electrical Lie.:3 Suprv. Lie.: s gges S ub total 9
_ 3. a
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit
Print name: �f, n Date: fee) " - q 1
, ez gT-�T p�Cc)ta i q. ( 14 J �� TOTAL PERMIT FEE
1
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.
1: ,Building \Permits \ELC- PcrmitApp.doc 12'03 4404615T( 10/02/COM /WEB
r e.
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 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
c13uilding\Pcrmi [ s1ELC- PcrmiIApp.doc 03/03