Permit j C I TY OF T PERMIT
PERMIT #: ELC2000 -00223
a;lj� DEVELOPMENT IiB
SERVICES I (503) 639 -4171 CE`S DATE ISSUED: 05/04/2000
PARCEL: 2S 101 AC -00600
SITE ADDRESS: 12600 SW 72ND AVE 120
SUBDIVISION: BEVELAND NO. 2 ZONING: MUE
BLOCK: LOT : 012 JURISDICTION: TIG
Project Description: Install 1 service /feeder and 8 branch circuits in existing commercial building.
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:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: 8 PER INSPECTION:
201 - 400 amp: 1st WIO 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:
ROTH, JACOB T JR + THERESA A ELECTRICAL CONSTRUCTION CO
12600 SW 72ND AVE PO BOX 10286
TIGARD, OR 97223 PORTLAND, OR 97296
Phone: Phone: 224 -3511
Reg #: LIC 049737 ORIG!NAL
SUP 2986S
ELE 26 -45C
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
5PCT KJP 05/04/200C $8.56 HANDRCPT Elect'I Final
PRMT KJP 05/04/200C $107.05 HANDRCPT
Total $115.61
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: A
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 " 7 c �• 'a' DATE:
LICENSE NO: / 3 / 4 5
Call 639 -4175 by 7:OOpm for an inspection the next business day
C934 4171 X 33q �-- -
C'fTY 'OF TIGARD pica! ica! Permit Application Plan # i
• 13125 SW HALL BLVD. Job No. l Recd By
TIGARD OR 97223 c T /rL • Date Recd T�yfc10
Phone (503) 639 -4171, x304 , ), - CC to: CC • Date to P.E. DST
4r Date Inspection (503) 639 -4175 z Print of Type Penn EL c.2.- OO2' 3
Fax (503) 598 -1960 • Incomil 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 business) 1:- rrrti manna <<o l: t tlmrrn Service Included: Items Cost Sum '
Address I'Z(oco SLc' ' 72. 1 .S , ; h , 1Z0 4a. Residential - per unit
City/State/Zip 7v' rc) Dom. 1000 sq. f. or less $ 117.75 4
Each additional 500 sq. ft. or
portion thereof 5 20.75 1
Commercial Residential ❑ Limited Energy $ 60.00
Each Manufd Home or Modular
. 2a. Contractor Installation only: Dweging Service or Feeder 3 72.75 .2
(Prior to permit Issuance, applicants must provide contractor license 4b. Services or Feeders
information for COT data base). Installation, alteration, or relocation
Electrical Contractor E C COMPANY 200 amps or less , $ 64.25 64 . 25' 2
Address PO BOX 10286 201 amps to 400 amps 3 85.50 2
C " N State O R Zi 9 7 7 9 h 401 amps to 600 amps 3 128.50 2
dY PoB TTA D p 601 amps to 1000 amps $ 192.50 2
Phone No. 5 01 Over 1000 amps or volts 3 363.75 2
Job No. 04 4/ Reconnect only $ 53.50 2
Elec. Cont. Lice. No. 26-45C Exp.Date 10-1-00 6 4 Temporary Servtees or Feeders
OR State CCB Reg. No. 49717 Exp. Date 1 -1 5 - 0 4 Installation, alteration, or relocation
COT Business Tax or Metro Noi 0 0 0 2 0 3 'icxp•Date -1 1 -.0 200 amps or less $ 53.50 2
� 201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n G` 401 amps to 600 amps $ 100.00 . 2
J Over 600 amps to 1000 volts,
License No. 1 A ° Exp.Date 10_ 01 - 01 see "b" above.
Phone No. 501-724-1511 t 4d. ,ranch 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 8 $ 5.35 42.. . i) 2
Address b) The fee for branch circuits
without purchase of service
City State Zp • or feeder fee.
Phone No. First branch circuit $ 37.50
Each additional branch dreult . $ 5.35
The installation is being made on property I own which is not 4e. I1Nscellaneous •
intended for sale, lease or rent (Service or feeder not 'minded)
Each pump or irrigation circle . 3 42.75
Owner's Signature Each sign or outline lighting 5 42.75
Signal circuit(s) or a limited energy
(if required):* * panel, e lsr t 0) or extension $ 00.00
3. Plan Review section
(- � J Minor Labels(10} $ 100.00
Please check appropriate item and enter fee In section 58. 4f. Each additional Inspection over
4 or more residential units in one structure the allowable in any of the above
Service and feeder 225 arms 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 ocarpancy as
described in N.E.C. Chapter5 5. Fees: .
5a. Enter total of above fees $ (07, O
* Submit 2 sets. of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $ Pi .r-)(n
Not required for temporary construction services. Subtotal $ _
5b. Enter 25% of Ilse 6a 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 # 1 '
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due I $ 115 .6,1
is \dsts \forms\electric.doe .
Y �,��• • .
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested cs i O"`t) AM PM BLD
Location /Z 5-1.J 7 2f, tiJe Suite /ZO MEC
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC yam- 1907, -?
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
Fire wall /f /J /f
Fire Sprinkler "7/..--p-L, p i(' .,Q_�
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 FAIL
CTRI
e
UG /Slab
Low Voltage
Fire Alarm
F i1.
Or PART FAIL
E
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 cc g (t2 Inspector xt
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.