Permit 4 CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00079
4 -the' DEVELOPMENT SERVICES DATE ISSUED: 2/6/01
I 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S134BC-00500
SITE ADDRESS: 12388 SW SCHOLLS FERRY RD
SUBDIVISION: PP1993 -057 ZONING: C -G
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: Installation of 2 branch circuits. Job No. 5277.
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: 1 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:
MCDONALD'S CORPORATION ALL THINGS ELECTRICAL INC
036/0002 10004 NE 7TH ST
PO BOX 66207 VANCOUVER, WA 98664
CHICAGO, IL 60666
Phone: Phone: 360- 604 -0241
Reg #: SUP 3878S
LIC 132095
ELE 37-811C
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 2/6/01 $53.50 2720010000( Elect'I Final
5PCT CTR 2/6/01 $4.28 2720010000(
Total $57.78
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable Taws.
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 -0080. You may obtain copies of • ° - - es or direct questions to OUNC at (503)
246 -1987.
•
PERMITTEE'S SIGNATUR // SSUED Y:
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. ELE 'N: - /0--✓1 DATE:
LICENSE NO: 1 7 1 /P40
Call 639 -4175 by 7:00pm for an inspection the next business day
i
a Electrical Permit Application
� C �`��t�✓ • Date received: ,e1- 5 O/ Permit no.: C ,/ -GEV7?
„ Al, .1 i City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, e
, Ti �1�9� ® Date issued: By: I Receipt no.:
Phone: (503) 639 - 4171 t
Fax: (503) 598 -1960 r oEVE`OPM Case file no.: Payment type:
. Land use approval: rA�
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory )I Commercial/industrial O Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration /replacement ❑ Other: ❑ Partial
L ` JOB SITE INFORMATION
Job address: 0_38s 5%4 5c,b �S e,r(y Y , 1, Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: 'Subdivision:
Project name: m I Description and location of work on premises: Add (,' % rCu;6 a nee--
Estimated date of completion/inspection: • ) Je, " Due Qlte.
CONTRACTOR APPLICATION FEE SCIIEI)ULE
Job no: 5 V17 Fee Max
Business name: 1 % c� e t r j 6 6 � Description Qty. (ea) Total no. insp
Address: t t e New residential - single or multi - family per
'l`)04 I - ST dwellingtutk . Includes artaclted
City: \ (s-)couNIV F State: 1 I ZIP:' ( Service included:
Phone:3(pp -(6014- b4111 I Fax: () -( 4- I E -mail: 1000 sq. ft. or less 4
CCB no.: I Elec. bus. lic. no: 37- - $1 1, G Each additional 500 sq. ft. or portion thereof
7 J , ) Limit energy, residential 2
Limited ener non- residen 2
/ � ° k 1 Each manufactured home or modular dwelling
ature of supervising elect' ' t (required) DatA Service and/or feeder 2
Sup. elect. name (print): ,-,a x/11 - _ License no: 1. 5 s Services or feeders - installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): • 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - .
which is not intended for sale, lease, rent, or exchange according to Installation, alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am s 2
Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: • service or feeder fee, each branch circuit 2
City: I State: • I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: I 46.135 4.'65 2
Phone: Fax: E -mail:
Each additional branch circuit: I 6.65 (p,tfj
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
❑ Service over 225 amps - commercial ' ❑ Health-care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of 1 &2 0 Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories O Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable In any of the above:
• O Egress/lightingplan ❑ Other. Per inspection I I I
Submit sets of plans with any of the above. investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ 53, '30
O Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $ c1
' Credit card number: / / within 180 days after it has been State surcharge (8 %) $ , tl. 2$
Expires accepted as complete. TOTAL $ 5
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00/COM)
Electrical Permit Fees: Limited Energy Fees:
. TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total y Check Type of Work Involved: •
Residential - per unit .
1000 sq. ft or less $145.15 4 ❑ Audio and Stereo Systems •
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manuf'd Home or Modular --- Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2 n Vacuum Systems
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2
601 amps to 1000 amps , $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918- 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
•
Over 600 amps to 1000 volts, ❑
see "b" above. Audio and Stereo Systems
Branch Circuits .
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
. feeder fee.
Each branch circuit $6.65 _ 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit / $46.85 h 85 HVAC
Each additional branch circuit / _ $6.65 (o, 4,5
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) _ $125.00 0
Medical
Each additional inspection over
the allowable in any of the above . Nurse Calls
Per inspection $62.50
Per hour $62.50 ❑
In Plant $73.75 Outdoor Landscape Lighting
Fees: c,., ❑ Protective Signaling
Enter total of above fees $ 53 .5 n Other
8% State Surcharge $ 4,23 Number of Systems
25% Plan Review Fee " No licenses are required. Licenses are required for all other installations
See - Plan Review" section on $
front of application.
Fees:
Total Balance Due $ 51,78
Enter total of above fees $
•
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
•
i:\dsts\forms\elc- fees.doc 10/09/00 •
* . .
CITY OF TIGARD BUILDING INSPECTION DIVISION MST:, . %%, '
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
L
BUP
Date Requested - AM PM BLD
Location / 2, 3 e5 5 w 5L6//) r � Suite MEC
Contact Person / Ph 57 z° G G / 7 PLM
Contractor ,4 .- 7Gi,,� j Ph SWR
BUILDING Tenant/Owner C paytl71-Laf ELC je.4/ GU 77
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler % _ A / ./ � A ,f41_,
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
RT FAIL
c f..A.S8--.EA
ECTRICtL)
Rough In v /vA C v ✓.�t�
UG /Slab
Low Voltage
Fire Alarm
Final
PP PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: , Unable to inspect - no access
ADA
Approach /Sidewalk Date Z Ins ector � Ext
Other p
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION -
MST:
24 -Hour Inspection Line: 639 -4175 B iness Line: 639 -4171
� BUP
L .
� ' - = .3
Date Requested -�� ACM PM BLD
Location 2g8 w ? 7 Suite MEC
Contact Person m I (it h VQ- ti? SC PLM
Contractor / 7 (A ff )/ Ph SWR
BUILDING Tenant/Owner ( v � c. Alt//9-40}" ELC 2dO (^ 62 0924
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear ' _ — = / _ / ,�, �• ,
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
FAIL
ELEC L
ervice
Rough In
UG /Slab
Low Voltage
�� PART FAIL .
51?�
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: ] Unable to inspect - no access
ADA Ale
Approach /Sidewalk
Other Date _ / Inspector AIL__ / Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.