Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00684
DEVELOPMENT SERVICES DATE ISSUED: 11/19/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S134BC -00300
SITE ADDRESS: 12282 SW SCHOLLS FERRY RD
SUBDIVISION: ZONING: C -
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install 23 branch 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: 22 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 KEC ELECTRIC INC
BY BURNHAM PACIFIC PROPERTIES 1281 NE 25TH AVE UNIT K
ATTN: JOHN WATERS HILLSBORO, OR 97124
SAN DIEGO, CA 92101
Phone: Phone: 503 - 439 -0904
Reg #: LIC 99267
SUP 4489S
FEES ELE 34 -426c
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 11/19/03 $193.15
[TAX] 8% State Surcharge 11/19/03 $15.45 Rough -in
Elect'I Final •
Total $208.60
This Permit is issued subject to the regulations contained in the Tigard Muniapal 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 or
1- 800 - 332 -2344.
Issued By: , , Permit 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: x li DATE:
LICENSE NO:
Call 639 -4175 by.7:00pm for an inspection the next business day
Electrical Permit Application FOR OFFICE USE ONLY
RDat 419 a_ :; / eceived Electrical Permit No. �O3 - 0a (4 /
City of Tigard Planning Approval Sign
13125 SW Hall Blvd. Date/By: Review Permit
Other No.:
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503 -639 -4171 Fax: 503 - 598 -1960 Plan Post - Review Land Use
Internet: www.ci.tigard.or.us ;jli Date/By: Case No.:
24 -hour Inspection Request: 503 -639 175 Contact Juris.: Su See Page 2 for
Name/Method: I Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction I ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
E Addition /alteration/replacement ❑Other: commercial ❑ Hazardous location
CATEGORY OF CONSTRUCTION 0 Service over 320 amps - rating of 0 Building over 10,000 square feet,
I & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling E'C ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder Other: p
❑ ❑ Egress lighting plan 0 Other
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
Job site address: / � . s - p l /1 / The above are not applicable to temporary construction service.
Suite #: � FEE* SCHEDULE
Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Pizza ,S - 'hire iz2Q Tc. al Description Qty Fee(ea.) Total
Cross street/Directions to job site: J New residential - single or multi - family per 1
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 1
Subdivision: Lot #: Limited energy, residential 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
1 / /' J ^4 SC n -� . •
Services or feeders - installation,
, S alteration n 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 1 ❑ 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 G S
Phone: service or feeder fee, first branch circuit 46.85 4 / ( - " 2
Fax: Each additional branch circuit
ol.t 6.65 / � 30 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Job No: Each sign or outline lighting 53.40 2
03 -i I t o 3 Signal circuit(s) or a limited energy panel,
Business Name: VVG EC CT72.1 G alteration, or extension Page 2 2
Address: fag 1 N E Description:
j o� �'A�tl2 Oh t le—
City /State /Zip: N CIS b0 20_ q- la Each additional inspection over the allowable in any of the above:
Per inspection per hour (min. I hour) 62.50
Phone:(503) 1/39 -ogoy Fax:(.503 )Co 1 ,/13-- 38 Investigation fee:
CCB Lic. #: 99a(o Lic. #: 34{-- 41,2(40< Other:
Supervising electrician Electrical Permit Fees*
!/ � Subtotal $ 19. 3, .r
signature required: Plan Review (25% of Permit Fee) $
Print Name: 944A/ Comi../Ij Lic. #: 1 -/gga State Surcharge (8% of Permit Fee) $ (5, 4/
Authorized J TOTAL PERMIT FEE $ 076 3. 6,0
Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
•Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts \Permit Forms \ElcPermitApp.doc 01/03
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
Li Burglar Alarm
0 Garage Door Opener
0 Heating, Ventilation and Air Conditioning System
0 Vacuum Systems
Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
El Audio and Stereo Systems
EI Boiler Controls
El Clock Systems
El Data Telecommunication Installation
Fire Alarm Installation
HVAC
El Instrumentation
El Intercom and Paging Systems
a Landscape Irrigation Control
Medical
El Nurse Calls
Outdoor Landscape Lighting
0 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 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171
Received Date Requested 1 I 1 AM v BUP
Location / - a– - -- Suite MEC
Contact Person � � Ph ( ) `?la S — 7 4 /1 `J PLM
Contractor Ph ( ) SWR o
BUILDING Tenant/Owner � . _ �i -: �i & � __ ELC 3 - 0 d 4 o y
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Sh
Int Sheath/Shear
Framing 1 �� /1111,_ 1 S Gp.�>�'E. CI It'� \L ' A
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: -
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Drains
Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fi = r arm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
, PART FAIL
SITE Please call f• r reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO OT REMOVE this inspection r rd from the job site.
PASS PART FAIL