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Permit CITY OF TIGARD ELECTRICAL PERMIT /4,4, ; DEVELOPMENT SERVICES PERMIT #: ELC98 -0354 ! � M 13125 SW Hall Blvd., Tigard, OR 97223 (503)6394171 DATE ISSUED: 06/29/98 PARCEL: 2S101DA -00104 SITE ADDRESS...:13333 SW 68TH PKWY SUBDIVISION :GTE ZONING:MUE BLOCK • LOT • JURISDICTION: TIG Project Description: Farmers Insurance TI - -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS 1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION : 0 EACH ADD'L 500SF...: 0 201 — 400 amp • 0 SIGN /OUT LINE LTG..: 0 LIMITED ENERGY • 0 401 — 600 amp • 0 SIGNAL /PANEL • 0 MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0 - - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- - 0 — 200 amp • 0 W /SERVICE OR FEEDER: 0 PER INSPECTION.. • 0 201 — 400 amp • 0 1st W/O SRVC OR FDR.: 1 PER HOUR • 0 401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 9 IN PLANT • 0 601 — 1000 amp • 0 PLAN REVIEW SECTION 1000+ amp /volt • 0 > =4 RES UNITS • ) 600 VOLT NOMINAL..: Reconnect only • 0 SVC /FDR >= 225 AMPS..: CLASS AREA /SPEC OCC.: Owner: FEES FARMERS INSURANCE type amount by date recpt 4600 WILSHIRE BOULEVARD PRMT $ 80.00 JSD 06/29/98 98- 306915 LOS ANGELES CA 90010 5PCT $ 4.00 JSD 06/29/98 98- 306915 Phone #: Contractor: OREGON ELECTRIC CONST /GROUP $ 84.00 TOTAL 1010 SE 11TH AVE REQUIRED INSPECTIONS PORTLAND OR 97214 Ceiling Cover Elect'1 Service Phone #: 234 -9900 Wall Cover Elect'1 Final Reg #..: 203 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty, Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is .t started within 180 days of issuance, or if work is suspended for more than 1: ". days. ATTENTION: Oregon law requires you to fol he rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 801 -0010 through OAR 952 •�'i You may obtain a copy of these rules or direct questions tor,,'!! by calling (503)246 -1987. I Permittee Signature: rK / mss _ ' Issued By: ggnr 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 639 -4175 by 7:00 p.m. for an inspection needed the next business day ++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ CITY OF TIGARD Electrical Permit Application Plan Ch- . • ,AI, • 13125 SW HALL BLVD. Rec'd : _ TIGARD OR 97223 Date Rec'd '�� Date to P.E. Phone (503) 639 -4171, x304 Date to DST Inspection (503) 639 -4175 Print or Type Permit #_ 0351/ Fax (503) 684 - 7297 Incomplete or illegible will not be accepted Called e/r7Z_ 1. Job Address: 4. Complete Fee Schedule Below: Name of Development Farmers Insurance Number of Inspections per permit allowed Name (or name of business) Farmers Insurance Service included: Items Cost Sum Address 13333 SW 68th 4a. Residential - per unit Tigard, OR 1000 sq. ft. or less $110.00 4 City/State /Zip Each additional 500 sq. ft. or Commercial © Residential El Limited thereof $25.00 1 Limited Energy $25.00 Each Manuf'd Home or Modular Dwelling Service or Feeder $68.00 2 2a. Contractor installation only: (Attach copy of all current licenses) 4b. Services or Feeders Electrical Contractor Oregon Electric Group Installation, alteration, or relocation Address 1010 SE 11th Ave. 200 amps or less $60.00 2 201 amps to 400 amps $80.00 2 City Port land State nR Zip 97214 401 amps to 600 amps $120.00 2 Phone No. 234 -9900 601 amps to 1000 amps $180.00 2 Job No. 76489 Over 1000 amps or volts $340.00 2 Reconnect only $50.00 2 Elec. Cont. Lice. No. 26 -95C Exp.Date OR State CCB Reg. No. 203 Exp.Date 4c. Temporary Services or Feeders COT Business Tax or Metro No 1995 Exp.Date Installation, alteration, or relocation 200 amps or less $50.00 2 201 amps to 400 amps 75.00 Signature of Supr. Elec'n 401 amps to 600 amps $100.00 2 Over 600 amps to 1000 volts, License No. 2841S Exp.Date see "b" above. Phone No. 234 -9900 4d. Branch Circuits New, alteration or extension per panel 2b. For owner installations: a) The fee for branch circuits with purchase of service or Print Owner's Name feeder fee. Address Each branch circuit $5.00 2 - b) The fee for branch circuits City State Zip without purchase of Phone No. service or feeder fee. First branch circuit 1 $35.00 35.00 2 The installation is being made on property I own which is not Each additional branch circuit $5.00 45.00 2 intended for sale, lease or rent. 4e. Miscellaneous (Service or feeder not included) Owner's Signature Each pump or irrigation circle $40.00 2 Each sign or outline lighting $40.00 2 3. Plan Review section (if required):* Signal circuit(s) or a limited energy panel, alteration or extension $40.00 2 Minor Labels (10) $100.00 Please check appropriate item and enter fee In section 5B. 4 or more residential units in one structure 4f. Each additional inspection over Service and feeder 225 amps or more the allowable In any of the above System over 600 volts nominal Per inspection $35.00 Classified area or structure containing special occupancy Per hour $55.00 as described in N.E.C. Chapter 5 In Plant $55.00 - Submit 2 sets of plans with application where any of the above apply. 5. Fees: $ Not required for temporary construction services. 5a. Enter total of above fees $ .00 0 0 .00 5% Surcharge (.05 X total fees) $ 84.00 NOTICE Subtotal $ 5b. Enter 25% of line 5a for PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $ NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $ IS SUSPENDED OR ABANDONED FOR A PENT AT A Y ❑Trust Account # TIME AFTER WORK IS COMMENCED. $ 84.00 g Total balance Due pe g-_, 0 1-75 I: \DSTS \ELC96.APP Rev 9✓96 r CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 (Igi BUP Date Requested l ` AM PM BLD Location 1`3 l� X T. Suite MEC Contact Person - ! y Ph Irk( 897r PLM Contractor Ph 4 -(-47 swR BUILDING t/Owner t/1 ELC o 4 ( 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 , . ✓ /_.ii ,.�_� �I/ Firewall Fire Sprinkler -- LU•r�..s Z� 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 ELECTRICAL Service L4 62/./( 114 Rough In UG /Slab / , Low Voltage � Fir- Alarm AS PART FAIL Backfill /Grading Sanitary Sewer Storm Drain [ 1 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk Date Other ?� ' /1 " y � Ins &Er/ - - /X/ Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. 05/19/2000 Activities for Case #: ELC98 -00354 9:16:18 AM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes ELCC001 Application received 06/29/1998 JSD PASS JSD 06/29/1998 ELCC003 Permit created 06/29/1998 JSD PASS JSD 06/29/1998 ELCC700 Ceiling Cover 07/27/1998 BRP PASS B'P 07/27/1998 South wing ceiling. ELCC500 (F)lssue permit 06/29/1998 JSD PASS JSD 06/29/1998 ELCC700 Ceiling Cover 07/21/1998 CD PASS B*P 07/27/1998 east wing ELCC799 Elects Final 08/11/1998 CD PASS CD 08/11/1998 ELCC800 Case Finaled 08/26/1998 CD PASS J'H 08/26/1998 Page 1 of 1