Permit A , CITY OF TIGARD ELECTRICAL PERMIT
'i�,,,, 11 DEVELOPMENT SERVICES PERMIT #: ELC97 -0790
I DATE ISSUED: 12/03/97
'� I ,,, 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171
PARCEL: 2S113AA -01000
SITE ADDRESS...:16550 SW 72ND AVE #B -09
SUBDIVISION •ROSEWOOD ACRE TRACTS ZONING:I —L
BLOCK . LOT •OOC JURISDICTION: TIG
Project Description: Copy change for a freestanding sign
- -- 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..: 1
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.: 0 PER HOUR • 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 0 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
PACIFIC REALTY ASSOC type amount by date recpt
15350 SW SEQUOIA PKWY PRMT $ 40.00 DRA 11/26/97 97- 301280
STE 300 0 5PCT $ 2.00 DRA 11/26/97 97- 301280 \) TIGARD OR 97224 D
Phone #:
Contract or:
E S & A INC $ 42.00 TOTAL
1210 OAK PATCH RD
REQUIRED INSPECTIONS
EUGENE OR 97042 Ceiling Cover Elect'1 Service
Phone #: 541- 485 -5546 Wall Cover Elect'1 Final
Reg #..: 001112
This peruit 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 per.it will expire if work is not started within 1:
days of issuance, or if work is suspended for •ore than 180 days. ATTENTION: Oregon law requires you to follow th ules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952491 -0010 through OAR 952-001 -1987. f may obtain a copy
of these rules or direct questions to OUNC by calling (503)246 -1987.
Permittee Signature: U U4.4"(a^ 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 : DATE:
1
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By V
TIGARD OR 97223 Date Recd i 1 -uo'gl
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Print or Type
Inspection (503) 639 -4175 - 9 " J - 0190
Incomplete or illegible will not be accepted Permit # t =
Fax (503) 684 -7297 Called
1. Job Address:
/� • y l 4. Complete Fee Schedule Below:
Name of Developmenere9GY - � 1 AS 1 (e 4
S - !()4 Number of Inspections per permit allowed
•
Name (or name of business IS I f eSS r f� Service included: Items Cost Sum
Address) 05)( S( 1J 7Z - A U 4a. Residential - per unit
City /State2i t ' Or 9 2 Each additional it or less $110.00 4
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 curren licenses) ,... Services or Feeders
Electrical C ntractor E, S 0. Installation, alteration, or relocation
Address HMO V 200 amps or less $60.00 2
201 amps to 400 amps $80.00 2
City rid State Zip q '701,_2 401 amps to 600 amps $120.00 2
Phone No. • 1 P 1 4 7 601 amps to 1000 amps - $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Reconnect only - $50.00 2
Elec. Cont. Lice. No.L0
OR State CCB Reg. No. 11 1 L R • Exp.Date - Z - q 4c. Temporary Services or Feeders
COT Business Tax or Metro No.' - ..... E Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Supr. Elec'n ! / - 401 amps to 600 amps $ 2
n Over 600 amps to 1000 volts,
License No. ' ¢ Exp.Date it ) - ) "'7 g see °b^ above.
Phone No. (0 4 1 - . • 7 -
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 tee.
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 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 f $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: it ' 0
Not required for temporary construction services. 5a. Enter total of above fees $ ` Z
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 ❑Trust Account # 4Z
TIME AFTER WORK IS COMMENCED.
Total balance Due $
I: \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 5 _CP -- 7 AM PM BLD
Location t(50 72° , Suite t ' MEC
Contact Person A:Laildi j Ph W(D 28S- Rcq7 PLM
Contractor Ph SWR T�
BUILDING Tenant/Owner ELC q? -t -/gv
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 V4:461 , Q. z�X.�e��
Fire wall / S ^�
Fire Sprinkler ( � A � r7
Fire e
Susp'd Ceiling
Roof
Misc:
Final VOlg - �� , t 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
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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk
Other Date Jam_ 9 `l Inspector � .�c.��.� Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.