Permit - CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC1999 -00417
a l & DEVELOPMENT SERVICES DATE ISSUED: 7/12/99
A " I i 13125 SW Hall Blvd.. Tistard, OR 97223 (503) 639 -4171
PARCEL: 2S 101 AA -09108
SITE ADDRESS: 4 5 5 SW 69TH AVE /ass'
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT : 030 JURISDICTION: TIG
Project Description: Install a 200 AMP temporary service.
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: 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: 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:
PORTER, DENISE/ BENNETT, SUE VIKING ELECTRIC INC
7991 SW MOHAWK ST 4326 SE WOODSTOCK
TUALATIN, OR 97062 STE 518
PORTLAND, OR 97206
Phone: Phone: 775 -3479
Reg #: LIC 00056527
SUP 3088S
ELE 26 -569
FEES Required Inspections
Type By Date Amount Receipt Elect'l Service
PRMT GEO 7/12/99 $53.50 99- 316791 Elect'l Final
5PCT GEO 7/12/99 $3.75 99- 316791
Total $57.25
ORIGJNAL
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 thr.. • • •AR 952 - 001 - ;0. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987. I r
Permit Signature: Issued By: . //.
OWN : R INSTALLATION ONL
The installation is being made on property I own which not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: (52-- d' ` j� DATE: 7 -4 y
LICENSE NO:
30 ce5
Call 639 -4175 by 7:OOpm for an inspection the next business day
CITY OF TIGARD Electrical Permit Application
PlanCheck#
13125 SW HALL BLVD. Rec'd By
TIGARD OR 97223 Date Rec'd
Phone (503) 639 -4171, x304
11 Date to P.E.
`� Date to DST
Inspection (503) 639 -4175 Print of Type rmit #�Ll�° l `19 ?-55 y/�
Fax (503) 598 -1960 Incomplete or illegible will not be accepted Called
1. Job Address: , 4. Complete Fee Schedule Below:
Name of Development / Number of Inspections per permit allowed
Name (or name of • i : s) MEMO" or Service included: Items Cost Sum
Address _ Mira/ 1 4a. Residential - per unit
City /State /Zip / 1000 sq. ft. or Tess $ 117.75 4
✓ U Each additional 500 sq. ft. or
portion thereof $ 26.25 1
Commercial � Residential ❑ Limited Energy $ 60.00
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 d • r - e). r ,, C % Installation, alteration, or relocation
Electrical Co t actor V f <1 h C__ / QC 1 c„-/- _ 200 amps or less $ 64.25 2
-air , , . �� 201 amps to 400 amps $ 85.50 2
Address
City eireirrir S to .,! Zip VNINX. 401 amps to 600 amps $ 128.50 2
601 amps to 1000 amps $ 192.50 2
Phone No. - - g 5-1 Over 1000 amps or volts $ 363.75 2
Job No. /�5 s • / Reconnect only $ 53.50 2
Elec. Cont. Lice. No. • rr 1 Exp.Date 4c. Temporary Services or Feeders
OR State CCB Reg. No. 'ra"!�� Exp.Date Air U Installation, alteration, or relocation
C �, a 200 amps or less $ 53.50 '5 -5 2
COT Business Tax or Metro: N • ... xp. ate , / J � � amps to au mps $ 80.25 2
/` - J / / � / 401 amps to 600 amps $ 107.00 2
Signature of Supr. Elec'n . _ - i _,A,„ ..A__,, Over 600 amps to 1000 volts,
see "b" above.
License No. Exp.Date
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 $ 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
• 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: 5 /. ?. 5 ]
c
Enter total of above fees $
* Submit 2 sets of plans with application where any of the above apply. 7 sr. Surcharge (.05 X total fees) $ '3 , 7 �
Not required for temporary construction services. Subtotal $
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account # 4 1, - ,. 5-
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ J I' -
is \dsts \forms \electric.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
�
y y BUP
Date Requesteed q..�,� t'' ! / AM PM BLD
1 Location 1 _S lP 1 ` - ` '( Suite MEC
Contact Person Ph PLM
Contractor i� a Ph SWR Gq
BUILDING Tenant/Owner ELC 1 / p (/-- tO / d71 7
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: �� SGN
Slab Q— 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 &
Post & Beam
Under Slab
Top Out 1
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
�L- LECTRIA
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
F'-
PAO ART 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 reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date
Other Inspect Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.