Permit CITY OF TIGARD
iu ELECTRICAL PERMIT
,,,r. A. ;, DEVELOPMENT SERVICES PERMIT # : ELC97 -0523
� DATE ISSUED: 08/05/97
=_-. 13125 SW Hall Blvd., Tigard, OR 97223 (503)639
PARCEL: 25101AA -09800
SITE ADDRESS... : 1 2570 SW 69TH AVE #104
SUBDIVISION.... : MLP95- 0013 ZONING : MUE
BLOCK..........: LOT •001 JURISDICTION: TIG
1 Pro.j ect Description : Tenant improvement: Bellanca Ent. - -
- -- RESIDENTIAL UNIT - - -- -- -TEMP' SRVC /FEEDERS - - -- ------- -MISCELLANEOUS- - -- ---
1000 SF OR LESS....:. 0 0 - 200 amp 0 PUMP /IRRIGATION • 0
I 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/O SRVC OR FDR.: 1 PER HOUR • 0
401 - 600 amp......: 0 EA ADD'L BRNCH CIRC: 5 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: -- --- -- -- -
J T ROTH JR type amount by date recpt
12600 SW 72ND STE 200 PRMT $ 60.00 JSD 08/05/97 97- 297940
TIGARD OR 97223 SPCT $ 3.00 JSD 08/05/97 97- 297940
Phone #:
Contractor: -- -- ,
DON RIFE RIFE ELECTRICAL CONTRACTORS $ 63.00 TOTAL
1901 NE 134TH PL
- -- REQUIRED INSPECTIONS - - - ---
PORTLAND OR 97230 Ceiling Cover Elect'l Service
Phone ##: 293 -8243 Wall Cover Elect'l 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 OUNC by calling (503)246 -1987.
I Permittee Signature: '' U p+-- � ` Issued By: __
1
- - - OWNER INSTALLATION ONLY --
The installation is being made on property I on 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 639 -4175 by 6:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + ++ + + + + + + ++ +++ + + ++ + + +++
CITY OFTIGARD Electrical Permit Application Plan Check# /��)
13125 SW HALL BLVD. Rec'd B
TIGARD OR 97223 Date Rec'd C,e-
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print or Type Permit # L i---C L i` ? -OSC`3
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development / . (A), /� . 1 0,i 1),A/5 Number of Inspections per permit allowed
Name (or name of business) FX 0.7 - ) /CA Service included: Items Cost Sum
Address /0 u 7 t S u/ «, 7 A 1/6- %I'1 Of 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
Clt�/ /State/Zlp / I G 6 6 ° . ' 7 Each additional 500 sq. ft. or
El Limited thereof $25.00 1
Commercial ❑ Residential
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 licenses1 4b. Services or Feeders
Electrical Contractor /?j'FL LEC / Installation, alteration, or relocation
- Address /9a / N E / 3v PL , 200 amps or less $60.00 2
201 amps to 400 amps $80.00 2
City P7 L ) State d Zip 9 72 36 401 amps to 600 amps $120.00 2
Phone No. 01 9'3 - P.1 93 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
/S /, f 9 7 Reconnect only $50.00 2
Elec. Cont. Lice. No. � 747C
-Exp.Date - 77Exp.Date / C
OR State CCB Reg. No. d 7,13V2 Exp.Date Co i /'P 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
$75.00 Signature of Supr. Elec'n 54-err.- al Q 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. 3 7J 1i /S Exp.Date /o ii`ri" see "b" above.
Phone No. a) 9 3 - PoZ r9 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. / , 0 0
First branch circuit $35.00 2
The installation is being made on property I own which is not
Each additional branch circuit $5.00 as . OD 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:
I gi• V'
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 FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account #
-LP--
Total balance Due $
1: \DSTS\ELC96.APP Rev 9/96
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested ?i,P. AM PM BLD
Location (� (D Suite ( MEC
Contact Person Ph PLM
Contractor Ph SWR �,n
BUILDING Tenant/Owner q - SZ
Retaining Wall ELR
Footing
Foundation Access:, , _/ ti C r A A s , C FPS
Ftg Drain �(�] l Ut V 7p • SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm l Q
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
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
C:FFED
PASS PART FAIL
SITE
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
Other Date Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
• CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: D i 1 ( 19 A.M. P.M. MST:
Location: / : S 7 U (e, A BUP:
Tenant: Suite: Bldg: MEC:
it_ ontracto • Q.-- Phone: — 3 PLM:
Owner: Phone: ELC: 7 a SL_:5
Wiwi ' </ !ice • a NMI- Q= ELR:
ift /� ' , . /' / At--.1111.
SIT:
BUILDING : Pi 1 on't) PL I 1; ING MECHANIC • i � � E . ' CTRICAL SITE
Site Post/Beam Post/Beam Post/Beam W Cov=+ • 'ce Sewer /Storm
Footing Roof UndFl/Slab Rough -In w't • 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
Approved Approved Approved • . s • ved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved • . :.roved Not Approved
FINAL FINAL FINAL FINAL FINAL
plc 1 1 /f CO 0�f -or 5r `
O Call for reinspection O Reinspection fee o $ required before next inspection O Unable to inspect
Inspector: Al" 60 •e ( A , Date: F-/(----77 Page / of /
1 I
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: O — ' / ` 9 7 A.M. P.M. MST:
Location: 125 �G{16 a P , BUP:
Tenant: f� 7(-/Q:1146)1 J T Suite: /0) Bldg: MEC:
C o n t r a c t o r . Phone: /� o - r - L _ 02 93 — O p c53 PLM:
Owner: Phone: ELC
_. 4 2 'IA . . •.I.1 sd4 .
_� . A " ' / ELR:
l„ , Ism % X04 q7 -b5�.3 / co It /6c� SIT:
BUILDING BLDG con't) PLUMBING MECHANICAL LECTRICAL> SITE
Site Post/Beam Post/Beam Post/Beam Cova Sewer/Storm
• _
Footing Roof UndFI/Slab Rough -In Water Line
Slab Framing Top Out Gas Line o 14� - , UG Sprinlder
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
Approved Approved Approved l Ap. oved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved`_ .. o ed Not Approved
FINAL FINAL FINAL `? : ' riJ FINAL
Ais, \ \ __ 1 / �. 4� i / tom /
.Sn7 -'1( c9 i (c -P e 'i cete GI P,-LS / 5 6c4
r) e
/. <`'e- �/
2 .ter _ -- lio v -e_9( - _
1
0 Call for reinspection 0 Reinspection fee of $ required before next inspection 0 Unable to inspect
Inspector: 7*6 e ( , Lccie4 Date: /J r'„2 ?- 7 Page ( of 7