Permit CITY OF TIGARD ELECTRICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: ELC97 -0791
, : I DATE ISSUED: 12/03/97
�� ' ' I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 6394171
PARCEL: 2S101AA- 09800
SITE ADDRESS...:12570 SW 69TH AVE #102
SUBDIVISION •MLP95 -0013 ZONING:MUE
BLOCK • LOT •001 JURISDICTION: TIG
Pro.j ect Description : Installing first branch circuit and two add'l branch
circuits
- -- 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/0 SRVC OR FDR.: 1 PER HOUR : 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 2 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
J T ROTH PARTNERS type amount by date recpt
12600 SW 72ND AVE. #B PRMT $ 45.00 B 12/03/97 97- 301401
TIGARD OR 97223 5PCT $ 2.25 B 12/03/97 97- 301401
Phone #:
Contractor:
DON RIFE RIFE ELECTRICAL CONTRACTORS $ 47.25 TOTAL
1901 NE 134TH PL
REQUIRED INSPECTIONS
PORTLAND OR 97230 Ceiling Cover Elect'1 Service
Phone #: 293 -8243 Wall Cover Elect'1 Final
Reg #..: 000723
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 not started within 180
days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001-0010 through OAR 952-001 -1987. You may obtain a copy
of these rules or direct questions to 11.'- calling ( 246 -1987.
Permittee Signature: X l c7 _ Issued By:
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:
CONTRACT NSTALLATI1N ONLY
SIGNATURE OF SUPR. ELEC'N: ♦ • DATE:,>C
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY .QF TIGARD Electrical Permit Application Plan Check #
•
13125 SW HALL BLVD. Rec'd By fij
TIGARD OR 97223 Date Rec'd 12 -7r�
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print or Type Permit it ELCii 07°
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development !') , �Q , W, Alit b s n 1 5 Number of Inspections per permit allowed
Name (or name of business) St) f TE / 6 °Z Service included: Items Cost Sum
Address tc S 7 0 SW • 6 7 4a. Residential - per unit
rG /i?) 1000 sq. ft. or less $110.00 4
City/State/Zip Each additional 500 sq. ft. or
Commercial Residential ❑
portion 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 I enses _ 4b. Services or Feeders
Electrical Contractor "'FE
j'F .---2 C / Installation, alteration, or relocation
NE / 3 / L 1
200 amps to or less $60.00 2
Address / ler
/ / � 201 amps to 400 amps $80.00 2
City 97L4) State O i. Zip 99-230 401 amps to 600 amps $120.00 2
Phone f :r - ‘P i' 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.o0 2
Elec. Cont. Lice. No. - 76 .'� Exp.Date /, � Reconnect only $50.00 2
OR State CCB Reg. No. Exp.Date 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation
200 amps or Tess $50.00 2
Signature of Su Elec Rrene%_ 2 01 amps to 400 amps $5.00 2
9 P 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. 3 7/9_5"' Exp.Date /I Pr see "b" above.
Phone No. r2 7?- 7,24/3 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 $35.00 ' 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 6 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 $
5% Surcharge (.05 X total fees) $
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 FORA PERIOD OF 180 DAYS AT ANY t # t Account ��
❑Trus
TIME AFTER WORK IS COMMENCED. $ '41 , Z
Total balance Due
I:\DSTS \ELC96.APP Rev 9/96
� t�'lo L, _ 61/=-7-7 /z/i-M p 7
/
• CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: t 2.- — 04-- g � 77 ^ A.M. P.M. MST:
Location: 12 5 70 S eA) (O [ 714 A BUP:
Tenant: VLOTH- - IZVI/ Suite: 102 Bldg: MEC:
Contractor: DO IJ (ZI Phone: 2.9 3- F 2 y-3 PLM:
Owner: Phone: ELC: C r 7-07c1
ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL 4' _ -' CTRIC .1• SITE
Site Post/Beam Post/Beam Post/Beam r /4LLCov- - . Service Sewer /Storm
Footing - Roof UndFl/Slab Rough -In - ' 1: 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 Lo • It
Approved Approved Approved Approved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved ..roved Not Approved
FINAL FINAL FINAL FINAL FINAL
lt/A- i L ADvcc I -I l Al — pig-5S
O Call for reinspection inspection fee of $ required before next inspection D Unable to inspect
Inspector: Date: /'• - D �' ? 7 Page of
tA)-(j\'1-1/1/ 0)22 42..C)-(±-e--4-i2
CITY OF TIGARD BUILDING INSPECTION DIVISION
24- Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: l ■D Z" 1 A.M. P.M. MST:
Location: /L 9 1 T' V BUP:
Tenant: Suite: )6,..?.— Bldg: MEC:
Contractor: ! _ 1 i V , . • ` %j 'hone:��3j P PLM:
if
Owner: Phone: ELC: q7 d7crt
ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL • . ' CTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Coy- Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceilin Water Line
Slab Framing Top Out Gas Line Ro : -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 A y. oved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved 4' of ... ov =. Not Approved
FINAL FINAL FINAL ` : w FINAL
Isecv vo4.r 1✓o r ci ET
-_• A• hy -_\ — __i• wv a 8 E
cu
1J4 L. A P i 4 c L E S— 0 A-s S
Call for rein .: • , 4 R einspection fee of $ required before next inspection O Unable to inspect
• /Z � -Z 9.. tor: / Date Page of •
CITY OF TIGARD BUILDING INSPECTION DIVISION
?
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: /c l 4'7 A.M. P.M. MST:
Location: /?-, 5 7 1) 6 7L7 /L- BUP:
Tenant: Suite: `O Z Bldg: . MEC:
Contractor. }-cam •r \-- il.–e
( �,_i . Phone: ? 3 g� 9 PLM:
Owner !` `� Phone: r � � ELC: 97 ) 7 ?/
/ A - /_ / , .r %1 , ' L! / '' , J
`7 2 l ELR:
i .47 P` ` d SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL E CTRICAL SITE
Site Post/Beam Post/Beam Post/Beam ov- Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In - 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 . •w o
Approved Approved Approved Approv a Approved
Appr /Sdwlk Not Approved Not Approved Not Approved . ru,.proved Not Approved
FINAL FINAL FINAL FINAL FINAL
C -e. i I l h S Co r o ve_ c pp rD ve_d .
• L i 5 — • ♦ . D GA1 ar I ' T
/L e_c-) 4 r/C-q / /n p_
O Call for reinspection Cl einspection fee of $ 'J required before next inspection O Unable to inspect
.–. l
Inspector: Date: / ^
� 7 — 97 Page of