Permit CITY OF T PERMIT
PERMIT #: ELC2000 -00058
i DEVELOPMENT SERVICES DATE ISSUED: 02/11/2000
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 PARCEL: 1S136DA -00101
SITE ADDRESS: 11410 SW 68TH PKWY
SUBDIVISION: PERS SITE ZONING: MUE
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install 1 service /feeder 200 amps or Tess and 10 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: 1 W /SERVICE OR FEEDER: 10 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
OREGON, STATE OF PUBLIC CHRISTENSON ELECTRIC INC
EMPLOYEES' RETIREMENT FUND 111 SW COLUMBIA
11410 SW 68TH PKWY STE 480
TIGARD, OR 97223 PORTLAND, OR 97201
Phone: Phone: 241 -4812 N1A
.
Reg #: LIC 000458 0 R 1 G 1 L
SUP 3289S
PLM 2468S
ELE 26 -34C
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT KJP 02/11/200C $117.75 HANDRECF Elect'I Final
5PCT KJP 02/11/200C $9.42 HANDRECF
Total $127.17
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 N otification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rule direct questions to OUNC at (503)
246 - 1987. '� _
PERMITTEE'S SIGNATURE rnG ISSUED j_e
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: lM' c DATE:
J
LICENSE NO: 8 3
Call 639 -4175 by 7:OOpm for an inspection the next business day
CITY OF TIGARD Electrical Permit Application Plan Check #
13125_5W HALL BLVD. RECEIVED Rec'd By
TIGARD OR 97223 Date Recd
Date to P.E.
Phone (503) 639 -4171, x304 FEB 1 0 2000 Date to DST
Inspection (503) 639 -4175 Print of Tv Yo�e�� Permit # "FLC, 9 0 - ajO t
Fax (503) 598 - 1960 Incomplete or illegible f�i t1t'iV gega2R Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development P
P. E E. R . S S . Number of Inspections per permit allowed
Name (or name of business) P . E . R. S. Service included: Items Cost Sum 4'
Address 11410 SW 68TH PARKWAY 4a. Residential - per unit
City/State/Zip TIGARD OR 97281 1000 sq. ft. or less $ 117.75 4
Each additional 500 sq. ft. or
portion thereof 1
Commerciang Residential d Energy $ 60.00
El Lim e
QUESTIONS? CONTACT JON WIMBER Each Manufd Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders
- - - information for COT data base). Installation, alteration, or relocation
Electrical ContractorCHRI ELECTRIC, INC 200 amps or less 1 $ 64.25 64.25 2
Address 111 SW COLUMBIA, SUITE 480 201 amps to 400 amps $ 85.50 2
City PO RTLAND St ate OR Zip 97201 -5886 401 amps to 600 amps $ 128.50 2
ty p 601 amps to 1000 amps $ 192.50 2
Phone No. 503 241 -4812 Over 1000 amps or volts $ 363.75 2
Job No. 61 -09419 � Reconnect only $ 53.50 2
Elec. Cont. Lice. No. 26 -34C Exp.Date 10 /00 4c, Temporary Services or Feeders
OR State CCB Reg. No. 458 Exp.Da - /03 6 Installation, alteration, or relocation
COT Business Tax or Metro No. 1S 6 , •.D- e 12/00 200 amps or less $ 53.50 2
L 201 amps to 400 amps $ 80.25 2
401 amps to 600 amps $ 107.00 2
Signature of Sup • Over 600 amps to 1000 volts,
License No.
b 3 Exp.Da e b D 20c/ see "b" above.
Phone No. 4d. Branch Circuits
New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name Each branch circuit 10 $ 5.35 53.50 2
Address b) The fee for branch circuits
without purchase of service
City State Zip or feeder fee.
Phone No. First branch circuit $ 37.50
Each additional branch circuit $ 5.35
The installation is being made on property I own which is not 4e. Miscellaneous
intended for sale, lease or rent. (Service or feeder not included)
Each pump or irrigation circle $ 42.75
Owner's Signature Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy
if required):* panL alteration or extension $ 60.00
3. Plan Review section
( Minor Labels (10) $ 107.00
Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over
4 or more residential units in one structure the allowable in any of the above
Service and feeder 225 amps or more Per inspection $ 50.00
Per hour $ 50.00
System over 600 volts nominal In Plant $ 59.00 •
Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 5. Fees:
5a. Enter total of above fees $ 117.75
* Submit 2 sets of plans with application where any of the above apply. 5% Surcharge (.05 X total fees) 8% $ 9.
Not required for temporary construction services. Subtotal $ 127.17
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $ 127.17
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account #
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ 127.17
1: \dsts \forms \electric.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested c�, s ki ' O AM P BLD
Location I11 te I / 0 l D q 1 �& (i(�tJ Suite MEC
Contact Person Es / Ph 70(0 PLM
Contractor - • SWR
BUILDING Tenant/Owner ELC ZP)T) - CraS
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspectio Notes:
Slab SIT
Post & Beam p �
Ext Sheath /Shear 7 1- / tJ ci ,c
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
PASS PART FAIL
Ek-ECTRTCA
•
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
4111111 PART FAIL
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
Other Date /bu"27 Inspector �r Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.