Permit CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC1999 -00759
Afk DEVELOPMENT SERVICES DATE ISSUED: 12/27/1999
rI 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171
PARCEL: 2 S 113AB -01201
SITE ADDRESS: 16505 SW 72ND AVE BLDG F 16505 -16035
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -L
BLOCK: LOT : JURISDICTION: TIG
Project Description: Electrical TI
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: SIGNAUPANEL:
MANF HM/ SVCI 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: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 23 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:
PACIFIC REALTY ASSOCIATES STONER ELECTRIC
15350 SW SEQUOIA PKWY #300 -WMI 2701 SE 14TH
PORTLAND, OR 97224 PORTLAND, OR 97202
Phone: Phone: 233 -3631
Reg #: LIC 00044823
SUP 4025S
ELE 26 -122C
FEES Required Inspections
Type By Date Amount Receipt
Elect'l Service
PRMT BON 12/27/1990 $160.55 99- 320664 Elect'I Final
5PCT BON 12/27/1990 $12.84 99- 320664
Total $173.39
ORIGINAL
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 co (am _wlwLkC(�I 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:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: (9V G (L"�' ` \ DATE:
LICENSE NO:
Call 639 -4175 by 7:OOpm for an inspection the next business day
•
CITY OF TIGARD Electrical Permit Application
Plan CheckQQ#,,I --,��
13.125 SW HALL BLVD. Rec'd By eD
•
TIGARD OR 97223
RECEIVERECEIVED Date Rec'd ( - 2-1 - /1
Phone (503) 639 -4171, x304 Date to P.E.
Inspection (503) 639 -4175 DEC t 2� 7 • • •
Yf jft 0 Date to DST • e Permit # g.4.4011 to 757
Fax (503) 598 - 1960 Cu4ncomPitifalitkigikitenjMot 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) ��L/ R. Service included: Items Cost Sum 4 '
Address ) LSO 6 S V I J 720 D 4a. Residential - per unit
City /State /Zip P•, - 1Zrlkt4ll b� 97224 1000 sq. ft. or less $ 117.75 4
/ Each additional 500 sq. ft. or
(� portion thereof $ 26.25 1
Commercial ID 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 data base). Installation, alteration, or relocation
Electrical Contractor -S 2 c_._ 200 amps or Tess $ 64.25 2
Address 7Z.e4sKD
ss 2.7o t S ---/e-i±‹- 201 amps to 400 amps $ 85.50 2
f- 8� State - - Zip 9 7 2d - 401 amps to 600 amps $ 128.50 2
City P 601 amps to 1000 amps $ 192.50 2
Phone No. 3 - 233 -3e.3/ Over 1000 amps or volts $ 363.75 2
Job No. -370 Z•Its Reconnect only $ 53.50 2
Elec. Cont. Lice. No. 24;,-/ 22- Exp.Date /o /'A ' 4c. Temporary Services or Feeders
OR State CCB Reg. No. 448323 Exp.Date 3 /2a /e. 0 Installation, alteration, or relocation
COT Business Tax or Metro No. 44 /4 Exp.D -te , i o 200 amps or less $ 53.50 2
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n /i . ; , lj /,. 401 amps to 600 amps $ 107.00 2
r r Over 600 amps to 1000 volts,
License No. �'
�a ' Exp.Date /d i see "b" above.
a
Phone No. ...12 / 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 / $ 37.50 375
Each additional branch circuit 23 $ 5.35 /23. 4.5
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:
5a. Enter total of above fees $ /IGQ5:5
* Submit 2 sets of plans with application where any of the above apply. ei/o Surcharge (.l ( total fees) $ 12'84
Not required for temporary construction services. Subtotal $ /73
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) $ - e3*-
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $ `9
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account #
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $
is \dsts \forms \electric.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
4 1/ 2 1/00
Date Requested AM P M BLD
Location ) LO S — MEC
Contact Person ' � Ph - 70(p k PLM
l
Contractor £.e_L Ph SWR aG
BUILDING Tenant/Owner 1r 7 ELC�Ig7 7 _ OD S 9
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Slab
Crawl Drain Inspection Notes: �� { �) I _ e' D
U L L.t�'e— SIT
Post & Beam /_ /4/ 5
Ext Sheath /Shear ° 'CU �
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
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PAS s_ PART FAIL
ECTRICA
Service
Rough In
UG /Slab
Low Voltage
FirAAl
y PART FAIL
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 1/71?
Other
Date D 0 Inspector ` - _ Ext
Final
• PASS PART FAIL DO NOT REMOVE this inspection record from the job site.