Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00028
. 4 ` � l l n
- 13125 DEVE 639 -4171 DATE ISSUED: 01/20/2000
4,1 PARCEL: 2S 101 AA -09100
SITE ADDRESS: 12259 SW 69TH AVE
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT : 030 JURISDICTION: TIG
Project Description: Installation of a signal ciruit or limited energy panel.
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: 1
MANF HM/ SVCI 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:
TIGARD CORPORATE CENTER LP STONER ELECTRIC
15400 SW MILLIKAN WAY 2701 SE 14TH
BEAVERTON, OR 97006 PORTLAND, OR 97202
Phone: Phone: • 233 -3631
Reg #: LIC 00044823
SUP 4025S
ELE 26 -122C
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT GEO 01/20/200C $60.00 00- 321268 Elect'l Final
5PCT GEO 01/20/200C $4.80 00- 321268
Total $64.80 ORIGINAL
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 copies of these rules or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE ISSUED BY: ,,,dv
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: 6 DATE: I- --63 O
LICENSE NO: 3
Call 639 -4175 by 7:OOpm for an inspection the next business day
CITY OFRTIGARD Electrical Permit Application
PlanChedc#
13125 SW HALL BLVD. Rec'd By
TIGARD OR 97223 RECEIVED Date Rec'd
Phone (503) 639 -4171, x304 Date to P.E.
Inspection (503) 639 -4175 Print of Type JAN 1 8 2000 Date to DST Permit # �%�GC�i - C
Fax (503) 598 -1960 Incomplete or illegible will not �19WIgWgVELOPMENT Called
1. Job Address: 4. Complete Fee Schedule Below: •
Name of Development -G„4, ...0 Number of Inspections per permit allowed
Name (or name of business) Service included: Items Cost Sum 4 '
Address et..v4, S /22.59 SW 69 1 = 1 - - 4a. Residential - per unit
City/State/ i ir e t o4 97223 1000 sq. ft. or less $ 117.75 4 1 Each additional 500 sq. ft. or
portion thereof $ 26.25 1
Commercial 0 Residential ❑ Limited Energy $ 60.00
Each Manuf'd 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). -----447--1 Installation, alteration, or relocation
Electrical Contractor - 5-7as�l�X ' c 200 amps or Tess $ 64.25 2
Address Z70 1 5-E -I4FZa. 201 amps to 400 amps $ 85.50 2
401 amps to 600 amps $ 128.50 2
City �o,2rcfiiva State e3-.0 Zip 972 Z 601 amps to 1000 amps $ 192.50 2
Phone No. ,_...12 --233 36 / Over 1000 amps or volts $ 363.75 2
Job No. /.'S4,� Reconnect only $ 53.50 2
Elec. Cont. Lice. No. 21,-7'z Z- Exp.Date /V / en 4c. Temporary Services or Feeders
OR State CCB Reg. No. hoe Z3 Exp.Date D zo o' Installation, alteration, or relocation
COT Business Tax or Metro No.c f-1 /' Exp.Dateo, a 0,0 200 amps or less $ 53.50 2
/ 201 amps to 400 amps $ 80.25 2
401 amps to 600 amps $ 107.00 2
Signature of Supr. Elec'n // . ,` . 4 . Ate_
Over 600 amps to 1000 volts,
see "b" above.
License No. 3.49Z s Exp.Date /e4//v/
Phone No. 233 336 3 / 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 $ 5.35 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 ,
f required):* panel, alteration or extension / $ 60.00 l °-
3. Plan Review section i� re w Q ired J 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 $
* Submit 2 sets of plans with application where any of the above apply. OA Surcharge (.05 X total fees) $ .1.80
Not required for temporary construction services. Subtotal $ z.466.
5b. Enter 25% of line Sa for
NOTICE Plan Review if required (Sec. 3) $ 'e
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $ �/. 80
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 $ ,4•Bc
1 : \dsts \forms \e l ectri c. doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested S(3%3 AM PM BLD
Location 1 / Li q' '„ �� Suite //�� MEC
Contact Person /2Z V) Ph NO "C�/ Ca PLM
Contractor _ E 2 x / e.._ - 7^r_e Ph SWR
BUILDING Tenant/Owner ELC 7.e i9 - DOC ) a
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 ,n
Firewall / jT LJj
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
•ca'B --
Service
LGt 1141
UG /Slab
Low Voltage
Fire Alarm
Fi 4 , 4 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 Date 5/3 V /0D Ins Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.