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Permit (54) CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2005 -00506 Akalo. ,, In DEVELOPMENT SERVICES DATE ISSUED: 7/15/2005 ° 'f II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S115AB-01900 SITE ADDRESS: 16200 SW PACIFIC HWY D ZONING: C - SUBDIVISION: TIGARD TOWNE SQUARE LOT : JURISDICTION: TIG Project Description: Installation of (6) circuits for new "Take Care" health program. Job #400605 97370. 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: 5 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: BIT HOLDINGS LTD PARTNERSHIP BROADWAY ELECTRIC - COCHRAN INC BY FORUM PROPERTIES INC 626 SE MAIN FIVE CENTERPOINTE DR STE 290 PORTLAND, OR 97214 LAKE OSWEGO, OR 97035 Phone: Phone: 503 - 234 - 6564 FEES Reg #: LIC 72942 Description Date Amount SUP 3447S ELE 37 -547-54 6C [ELPRMT] ELC Permit 7/15/2005 $80.10 [TAX] 8% State Surcharge 7/15/2005 $6.41 REQUIRED ITEMS AND REPORTS Total $86.51 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 questions to OUNC at 503 - 246 -6699 or 1- 800 - 332 -2344. Issued By: Permittee Signature: .� c;)1.? 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 Application •-?, - FOR OFFICE USE ONLY . City of Tigard Received !" -a) .r!" PermitNo.: � _'� oj OJ50• 13125 SW Hall Blvd., Tigard, OR 97223 , " -- . Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Ayj - ...- � A Date/B : Omer Permit: Inspection Line: 503.639.4175 � =_ I Date Ready/By: IMI El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information <k- - ., ~ " �.! -..kr dFT ?i; .'� � ,.- 1� ° ? •' ; . "r.. :�.:_ ::- _" ..__ .".._.7 .- ..LAI!L .. __EW ❑ New construction ❑ Addition/alteration/replacement w Please check all that apply: ['Service over 225 amps, comm'l ❑Hazardous location ❑ Demolition ❑Other: ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., 1jTt GPr01' d .. -':',..L'..-'14-..-....f4, r ,i'° _ `��� -^ � � �_t = . ,•�ti rn�rr.eiYJra ., . r3r,- .3a:uww .. :.:�:::i; ' of 1 -and 2- family dwellings 4 or more new residential .< <._.. ❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi - family ❑Master builder 0 ['Building over three stories OFeeders, 400 amps or more T _._� �,y`^ ,,�_... ['Occupant load over 99 persons ['Manufactured structures or ,y�"., 71, Y . � ' 7 AZ - l' v n: t.l �S I u P ;7: t�+ : 't , ��rr.. *f Y E ess/lighting plan RV park r. Job no.: i S 3�0 site address: ` I Job sitddress: 1 b20o P ac c- ❑Health -care facility ['Other: Submit 2 sets of plans with any of the above. City/State/ZIP: a, J l8 ©R, The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: f j Project name: �l �Q / r� �, ` C a t i , �'' ' " 1 i1 D escr i pt i on I Qty. I Fee. I Total Cross street/directions t . ' e: New residential single- or multi - family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: _xx y Limited energy, non - residential 75.00 2 ,,, . �,:�� !! i Each manufactured or modular • l h C I . n e , ? A ' , "Take. ( a w it dwelling, service and/or feeder 90.90 2 J l`it t �tM Services or feeders installation, alteration, and/or relocation 't'fC__Q I ( \ a 200 amps or less 80.30 2 ,� I £ �� �� ,r ., .�,� �;�i - 1; �;�;�,y,,. 201 amps to 400 amps 106.85 2 G e._� -z rl', rl' . i� s4�# ;a � z -Y = 401 amps to 600 amps 160.60 2 Name: R k 601 amps to 1,000 amps 240.60 2 - Address: 1' D �(..- 3 f03 Over 1,000 amps or volts 454.65 2 2 Reconnect only 66.85 2 City/State /ZIP: m � b f / l 7 tG J Temporary services or feeders installation, alteration, and/or _ relocation 1 Phone: (1 fl ) 1 W i 1 2 . fo � I Fax: ( ) 200 amps or less 66.85 1 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 rE Wit :: 1 ;- t j e` °.' . ` 3 .V _.1 ,. fig c ^ .. - _: , E ;, r ,. A. Fee for branch circuits with °� � �''° ° �'# s - °` - . t.: service or feeder fee, each 6.65 2 Business name: a �/ d e c _ f y i (. branch circuit I B. Fee for branch circuits ys / Contact name: without service or feeder fee, D (CO � 1 �, _ t P) each branch circuit 46.85 Lib 2 Address: ( � Each add'I branch circuit S 6.65 3. 2�� 2 City/State/ZIP:I Oe.._, t 721 y Miscellaneous (service or feeder not included) Phone: (a 234 lip � - A .0 "1 I Fax : (aPi 2,3 2 L l g Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E-mail: fQ 0 t-1 j C(�[I1'1/ak" IYIG • ( (SY'\ Signal circuit(s) or limited - g g � n k „. ,,, . 1 ' � y_ 't� . ' 7; w , i energy panel, alteration, or . : r ''1 . ''' .*, 3 '� r " ya u= o" °�' yy . � '' C a- ...;.ter -', ,� - 8Y P r S lUM Q � � ` • extension. Describe: Page 2 2 Business name: < I ! C� C -�.` l 1 C Q Address: Each additional inspection over allowable in any of the above Per inspection 62.50 City/State/ZIP: Investigation per hour (1 hr min) 62.50 Phone: ( ) Fax: ( ) Industrial plant per hour 3+ 73.75 CCB Lic.: 12_9 ZCj y Z Electrical Lic.: 37' LCI Suprv. Lic.: L {l.liS Subtotal N' ~ g i p. 1 0 Suprv. Electrician signature, required: -.\ Plan review (25% of permit fee) Print name: Date: State surcharge (8% of permit fee) (p .14 I V. ems '^ e-� TOTAL PERMIT FEE 0. SI 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. i:\ Bui ldng\Perntits\ELC•PetmitApp.doc 12/03 440- 4615T(10/02/COM/WEB Elect Pe rmit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: 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: or '1 . FI di : i , �, ,��_,�. -�- $75.00 Fee for each commercial system (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 licensesare required. Licenses are required for all other installations i:\Building\Pe mi�s\El'GPemtitApP' 04/03 CITY OF TIGARD BUILDING DIVISION PERMIT #: ELC2005 -00506 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/15/2005 Phone: (503) 639 -4171 't Inspection Requests (24 Hrs.): (503) 639 -4175 y'Q "! Ji INSPECTION WORKSHEET FOR DATE: 8/18/2005 TIME: 7: 06AM PAGE: 115 SITE ADDRESS: 16200 SW P CIFIC HWY D CLASS OF WORK: SUBDIVISION: TIGARD TOWNE SQUARE LOT #: TYPE OF USE: PROJECT NAME: RITE AID DESCRIPTION: Installation of (6) circuits for new 'Take Care" health program. Job #400605.97370. OWNER: BIT HOLDINGS LTD PARTNERSHIP. PHONE #: CONTRACTOR: BROADWAY ELECTRIGCOCHRAN INC PHONE #: 503 -234 -6564 Inspection Request Scheduled For: , Date: 8/18/2005 Pour Time: Code # Ins. - .• • Description Confirm # Contact # Message 199 Electrical final 013745.01 503 - 260 -7912 N Corrections /Commen s nstructions: • [PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: C.i - NOB Date: 1 '1 Phone #: (503) 718 - 2}44"