Permit •
CITY OF TI G A R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00137
ni DEVELOPMENT SERVICES DATE ISSUED: 3/9/01
,.� 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: Tenant Improvement
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: 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 J + J ELECTRIC INC
036/0002 PO BOX 813
PO BOX 66207 ALBANY, OR 97321
CHICAGO, IL 60666
Phone: Phone: 541 - 928 -7695
Reg #: SUP 3252S
LIC 322
ELE 22 -3C
FEES Required Inspections
Type By Date Amount Receipt
Ceiling Cover
PRMT CTR 3/9/01 $46.85 2720010000( Wall Cover
5PCT CTR 3/9/01 $3.75 2720010000( Elect'I Service
Elect'I Final
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Spedalty 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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURt ISSUED BY:
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
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SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
Date received: Permit no.: tez, 20291 pD / 37
.4
l d.l' :I'I'' rCity of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
MAR 5 2Max: (503) 598 -1960 Case file no.: Payment type:
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COMMUNITY UEVEL01'd use approval:
TYPE 01: I'illNl11'
O 1 & 2 family dwelling or accessory IBI Commercial/industrial O Multi - family O Tenant improvement
O New construction 0 Addition/alteration /replacement O Other: 0 Partial
Job address: J, 98 ,5" 1 £'ed/oi4_,s 4, egii Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: (Subdivision: //
Project name: "%n a a /R (. n 5 I Description and location of work on premises:
Estimated date of completion/ins tion:
Job no: c ,7 0 / ,02 / Fee Max
Business name: ,�f�f iLF rg/ Description Qty. (ea) Total no. trip
Address: nn New residential - single or multi- family per
1'• 0, 4 ., e4 L3 thtelllngtmlt Includes attached garage.
City: / / , f v I State: Ot I ZIP: 973 Service included:
E -mail: 1000 sq. ft. or less 4
Phone:31// 9,7,g. I Fax: f(/ /. 69gpI Each additional 500 sq. ft. or portion thereof
CCB no.: 32.2_ I Elec. bus. lic. no: 21 e_
Limited energy, residential 2
City /metro lic. no.: Limited energy, non- residential 2
03- of - 0 I Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect name (print): U License no: S Services or feeders — installation,
alteration or relocation:
200 amps or less 2
Name (print): 201 amps to 400 amps 2
Mailing address: 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: '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 llatlon, 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: .s 2
ENGINEER 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 .
Phone: Fax: E -mail; of service or feeder fee, first branch circuit: 1 N(. g{ yLgs 2
Each additional branch circuit:
P1 AN N RI•;VIE1V (Please check all that appl)) Misc. (Service or feeder not included):
O Service over 225 amps-commercial O 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 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension' - 2
0 Building over three stories Cl Feeders, 400 amps or more *Description:
O Occupant load over 99 persons O Manufactured structures or RV park Each additional Inspection over the allowable In any of the above:
Cl Egress/lightingplan 0 Other. Per inspection I 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 eocept credit cards, please call Jurisdretion for more information. Notice: This permit application
Permit fee $ 4 /G .85
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ 3. 7s
Expires accepted as complete. TOTAL $ SD. 60
Name of cardholder as shown on credit card '
Cardholder signature Amount 440-4615 (6R) OM)
Electrical Permit Fees: Limited Energy Fees: • '....
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p 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 Manufd Home or Modular ID Garage 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 ID 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 sy • $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 n Boiler Controls
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 Alami Installation
or feeder fee. � S
First branch circuit / $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous El 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
Each additional inspection over ❑ Medical
the allowable In any of the above
Per inspection $62.50 El Nurse Calls
Per hour $62.50
In Plant $73.75 El Outdoor Landscape Lighting'
•
Fees: El Protective Signaling
Enter total of above fees • $ yG .R5 I I Other
8% State Surcharge . $ 3.74 Number of Systems
25% Plan Review Fee •
See - Plan Review" section on $ ' No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $ 504 o Enter total of above fees $
•
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i:\dsts \forms\eic- fees.doc 10 /09/00
//• L 3A
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
r BUP
Date Requested 3- le AM PM BLD
Location / Z S' S GAG // f'vr y a -e Suite MEC
Contact Person / Ph % f) PLM
Contractor Ph SWR � "
BUILDING Tenant/Owner o,.l( 495 ELC uea-GU /3 7
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 /tjf.L
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
PASS—PART FAIL
LECTRIC
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
ART 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 r inspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date 2-C2 Inspector __ _L� _ E
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.