Permit i
A3 CITYOFTIQARD
1 DEVELOPMENT SERVICES ELECTRICAL PERMIT
"a n I j PERMIT #: ELC97 -0236
' �.. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 6:194171 DATE ISSUED: 04/16/97
PARCEL: 2S1O1AA -09800
SITE ADDRESS...:1257O SW 69TH AVE
SUBDIVISION •MLP95 -0013 ZONING:MUE
BLOCK • LOT • •001 JURISDICTION: TIG
Project Description : R.W. Building
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD'L 5O0SF...: 0 201 — 400 amp • 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY : 0 401 — 600 amp • 0 SIGNAL /PANEL • 0
MANF. HM/ SVC /FDR..: O 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
----SERVICE/FEEDER-77— - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 — 200 amp -3 W /SERVICE OR FEEDER: 21 PER INSPECTION : 0
201 — 400 amp. . y Z.: 0 1st W/0 SRVC OR FDR.: 0 PER HOUR • 0
401 — 600 amp-''
mp • 1 EA ADD'L BRNCH CIRC: 0 IN PLANT • 0
601 — 1000 : 0 PLAN REVIEW SECTION
1000+ amp /volt • 0 )=4 RES UNITS ) 600 VOLT NOMINAL..:
Reconnect only • 0 SVC /FDR >= 225 AMPS..:X CLASS AREA /SPEC OCC.:
Owner: FEES
J T ROTH JR type amount by date recpt
12540 SW 68TH AVENUE #B PRMT $ 405.00 JSD 04/16/97 97- 293315
TIGARD OR 97223 5PCT $ 20.25 JSD 04/16/97 97- 293315
Phone #:
Contractor:
DON RIFE RIFE ELECTRICAL CONTRACTORS $ 425.25 TOTAL
1901 NE 134TH PL
REQUIRED INSPECTIONS
PORTLAND OR 97230 Ceiling Cover Underground Cove
Phone #: 293 -8243 Wall Cover Elect'l Service
Reg #..: 072343
This permit is issued subject to the regulations contained in the US
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permit : - =' • • -ture
applicable laws. Q11 work will be done in accordance with
approved plans. This permit will expire if work is not started 4111111W`.M
within 189 days of issuance, or if work is suspended for more
than 189 days. Issued ,'
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 for inspection — 639 -4175
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd. LC T , O�
Tigard, OR 97223 Permit # T - 3 6
, ��, l l , � .,+ Date Issued oil �
Phone (503) 639 -4171
- I I FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: /� 4. Complete Fee Schedule Below:
Name of Development A . to, ISIl ILA ;A15 Number of Inspections per permit allowed
Address / c 5- 7i) Sl✓ r 7 4 V Service included: Items Cost(ea) Sum
City /State /Zip 2 ' C4/9 - 4 ° b 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
Name (or name of business) Each additional 500 sq. ft. or
portion thereof $25.00
Commercial xi Residential ❑ Limited Energy $ 1
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders ���
e Installation, alteration, or relocation ' 5 (1
Electrical Contractor �6 �z T 2 0 0 amps or less $60.00 2
Address / .2 / /1/.6" / 3 V AZ- + 201 amps to 400 amps $60.00 2
City /' 7 State c12 Zip 9 72 3,e) 401 amps to 600 amps T $120.00 2
601 amps to 1000 amps $160.00 .
Phone No. )t. 73 - 2 ( 44/2, Over 1000 amps or volts $340.00 2
Job NO. Reconnect only $50.00 2
contractor's license NO. 4c. Temporary Services or Feeders
Contractor's Board Reg. No. 79. 3 .3 Installation, alteration, or relocation
Signature of Supr. Elec'n (per"... 200 amps or less 2
License No. 3 71 'y .5 Phone No. y 3R2 93 401 amps to 600 amps $75.00 2
Over 600 amps to 1000 volts $100.00
. 2b. For owner installations: See "b" above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee for branch circuits with
purchase of servke or feeder fee. 2
City State Zip Each branch circuit ,� $5.00 / G S/ of
Phone No. b) The fee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder fee. 2
not intended for sale, lease or rent. First branch circuit $35.00
Each additional branch circuit $5.00
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40.00
4 or more residential units in one structure Minor Labels (10) $100.00
X Service and feeder 225 amps or more
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.E.C. Chapter 5 Per inspection $35.00
Per hour $55.00
In Plant $55.00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees:
5a. Enter total of above fees $ d "
NOTICE 5% Surcharge (.05 X total fees) $ vU e S
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. �/cz.f s /�J w f , 4 ❑ Trust Account # *X(
/ WS/1 B alance Due $
CITY OF TIGARD BUILDING INSPECTION DIVISION
- 24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: — 1 2 - 2-S -- k — 1 A.M. P.M. MST:
Location: 1 57 U 1p g BUP:
Tenant: Suite: Bldg: MEC:
Contractor: A . I i C . . Q . _ J Phone: c 9 3 2 PLM:
Owner: Phone: ELC: ? d 2..-3
ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL F..F ICAL,, SITE
Site Post/Beam Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved rm ---- ; -- j> Approved
Appr /Sdwlk Not Approved Not Approved Not Approved Not Amoved Not Approved
FINAL FINAL FINAL FINAL
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A ll for reinspection O Reinspection c:3) ..PIA fee of $ required before next inspection O Unable to inspect
hispector��, C' '1 , � � Z e � Date: �— j Page of 7
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: 41/ - I 9 7 A.M. P.M. MST:
Location: /�S 7 0 S-(4) "7 at-e_ BUP:
Tenant: Suite: Bldg: MEC:
Contractor: Phone: �J ., / PLM: /
Owner. (4 OY1 I Phone: a_[ 3 - ?d 7" 3 ELC: c 7 — e),-3 C�
.1 V e- 6- &(kJ /J c A -ti-eA _ ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ' -, :. SITE
Site Post/Beam Post/Beam Post/Beam Cov-'ar 1� // Sewer /Storm
Footing Roof UndFl/Slab Rough -In el ing t - ' Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Ahn Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
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El Call for reinspection O Reinspectio -f of $ required before next inspection O Unable to inspect
Inspector: i G Gt i 'f' S Rt Date: 1 7 Page i of _(_____
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