Permit CITY OF T'GARD ELECTRICAL PERMIT
PERMIT #: ELC1999 -00375
,0.04 DEVELOPMENT SERVICES DATE ISSUED: 6/23/99
13125 SW Hall. Blvd., Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S101AA -TTOOA
SITE ADDRESS: 12123 SW 69TH AVE
SUBDIVISION: TIGARD TRIANGLE OFFICE COMPLEX ZONING: MUE
BLOCK: LOT : OOA JURISDICTION: TIG
Proiect Description: Installation of temporary service, 200 amps or less. Job No. 99 -555.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNALIPANEL:
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: 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:
DONALD & J POLLOCK CAPITOL ELECTRIC CO INC
1834 SW 58TH AVE STE 202 12810 NE AIRPORT WAY
PORTLAND, OR 97221 UNIT 1
PORTLAND, OR 97230
Phone: Phone: 255 -9488
Reg #: LIC 048748
SUP 3132S
ELE 26 -496C
FEES Required Inspections •
Type By Date Amount Receipt Elect'I Service
PRMT DEB 6/23/99 $53.50 99- 316347 Elect'I Final
5PCT DEB 6/23/99 $2.68 99- 316347
Total $56.18
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 -0080. You may obtain •• • es of thes - • -s or direct questions to OUNC at (503)
246 -1987.
Permit Signature: ued By: / / ! / �� J ,
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: [" -a" - 7
LICENSE NO: 4:7We�`
Call 639 -4175 by 7:OOpm for an inspection the next business day
CITY OF TIGARD Plan Check #
13125 SW HALL BLVD. ELECTRICAL PERMIT APPLICATION Rec'd By
TIGARD. OR 97223 Date Recd 6,-A3 -9
PROrie (503) 639 -4171, X304 Date to P.E. -.---
Inspection (503) 639 -4175 Date to DST ---
Fax (503) 684 -7297 PRINT OR TYPE Permit # &(,C. 1 i C -60375
INCOMPLETE OR ILLEGIBLE WILL NOT BE ACCEPTED Called
1. Job Address: 4. COMPLETE FEE SCHEDULE BELOW:
Name of Development TIGARD CORPORATE CENTER Number of Inspection per permit allowed
Service Included: Items Cost Sum
Name (or name of business) BAUGH CONST. TRAILER 4a. Residential - per unit
1000 sq.ft.orless $117.75 $0.00 4
Address 12123 SW 89TH AVE. Each Additional 500 sq. ft.
or portion thereof $26.25 $0.00 1
City/State/Zip TIGARD, OR Limited Energy $60.00 $0.00
Commercial X Residential Each Manufd Home or Modular
Dwelling Service or Feeder $72.75 $0.00 2
2a. Contractor installation only:
(Attach copy of all current licenses) 4b. Service or Feeders
Electrical Contractor CAPITOL ELECTRIC CO., INC. Installation, alterations or relocation
Address 12810 NE AIRPORT WAY 200 amps or less $64.25 $0.00 2
City PORTLAND State OR Zip 97230 -1029 201 amps to 400 amps $85.50 $0.00 2
Phone No. (503) 255 -9488 401 amps to 600 amps $128.50 $0.00 2
Job No. 99 -555 601 amps to 1000 amps $192.50 $0.00 2
Elec. Contr. Lic. No. 28-496C Exp. Date 10/1/99 Over 1000 amps or volts $363.75 $0.00 2
OR State CCB Reg. No. 48748 Exp. Date 8 -22 -99 Reconnect only $53.50 $0.00 2
COT Business Tax or Metro No. 00004542 Exp. Date 9
`,9 4c. Temporary Services or Feeders
Signature of Supr. Elec'n �(/ Installations, alterations or relocation
200 amps or less 1 $53.50 $53.50 2
License No. 2865 -1 Exp. Date 10/1/01 201 amps to 400 amps $80.25 $0.00 2
Phone No. (503) 255 -9488 401 amps to 600 amps $107.00 $0.00 2
Over 600 amps to 1000 volts
see "b" above.
2b. For owner installations:
4d. Branch Circuits
Print Owner's Name New, alteration or extension per panel
Address a) The fee for branch circuits with
City State Zip purchase of service or feeder fee
Phone No. Each branch circuit $5.35 $0.00 2
b) The fee for branch circuits without
The installation is being made on property I own which is not purchase of service or feeder fee.
intended for sale, lease or rent. First branch circuit $37.50 • $0.00 2
Each add'nl branch circuit $5.35 $0.00 2
Owner's Signature
4e. Miscellaneous (Service or Feeder Not Included)
Each pump or irrigation circle $42.75 $0.00 2
3. Plan Review section (if required): * Each sign or outline lighting $42.75 $0.00 2
Signal circuit(s) or a limited energy
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $60.00 $0.00 2
4 or more residential units in one structure Minor Labels (10) $107.00 $0.00
Service & feeder 225 amps or more
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special the allowable In any of the above
occupancy as described in N.E.C. Chapter 5. Per inspection $50.00 $0.00
Per hour $50.00 $0.00
• Submit 2 sets of plans with application where any of the above apply. In Plant $59.00 $0.00
Not required for temporary construction services.
5. Fees:
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS 5a. Enter total of above fees $ $53.50
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK 5% Surcharge (.05 X total fees) $ $2.68
IS SUSPENDED OR ABONDONED FOR A PERIOD OF 180 DAYS AT ANY Subtotal $ $56.18
TIME AFTER WORK IS COMMENCED. 5b. Enter 25% of line 5a. for
Plan Review if required (Sec. 3) $
Subtotal $ $56.18
Trust Account #
Total balance Due $ 556.18
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
/ r qq BUP
Date Requested (' i ( / AM PM BLD
Location 12 ( 1'5 (o Aute Suite MEC
Contact Person Ca 1X*O Ph OS.S qgd PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC 1 q q q c D?)7S
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 f /�
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
�E�E TRTF�
Rough In
UG /Slab
Low Voltage
Fire Alarm
at ) 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 [ ] Please call for einspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date ' J `7 Ins Ext
Other
Final
PASS PART FAIL 0 NOT REMOVE this inspection record from the job site.