Permit CITY OF TI G A R D. ELECTRICAL PERMIT
_ PERMIT #: ELC2000 -00334
. iii4 DEVELOPMENT SERVICES DATE ISSUED: 06/16/2000
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S113AC -00101
SITE ADDRESS: 16655 SW 72ND AVE BLDG L
SUBDIVISION: COUNCIL VIEW ACRES NO. 2 ZONING: I -P
BLOCK: LOT : 029 JURISDICTION: TIG
Project Description: Install twelve (12) branch circuits.
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: 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: 11 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
PRMT GEO 06/16/200C $96.35 0003063 5PCT GEO 06/16/200C $7.70 0003063 ORIGINAL
Total $104.05
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:
OWNER INSTALLATION ONL i $
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: 64-7-J DATE: , 4O
LICENSE NO: 'Y( .2c-5
Call 639 -4175 by 7:OOpm for an inspection the next business day
,
CITY OF TIGARD Electrical Permit Application Plan Check#
131A SW HALL BLVD. Rec'd By
TIGARD OR 97223 Date Rec'd
Phone (503) 639 -4171, x304 Date to P.E.
Inspection (503) 639 -4175 4 ' � ' �= Print of Type Permit D #F -C-C "
Fax (503) 598 -1960 JuN 1 bec n ilete or illegible will not be accepted Called
1. Job Address: COME:iiiiY JE.E1.4;1");,,,:Ni 4. Complete Fee Schedule Below: •
Name of Development Number of inspections per permit allowed
Name (or name of business) RiErct SIAN Ir./TER-Co n►tecr Service included: Items Cost Sum 4'
Address /64 55 5m.) 72.,.,o 4a. "Residential - per unit
City/State/ZipT& 4 i OR 1000 sq. ft. or less $ 117.75 4
Each additional 500 sq. ft. or
portion thereof $ 26.25 1
Commercial 121 Residential ❑ Umfted Energy $ 60.00
Each Maned 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 STnw,,e tit ge-r i c_ •200 amps'or less $ 64.25 2
Address 19 e+4 SE OG4eco 201 amps to 400 amps $ 85.50 2
City 11 t Lwrtwc b E State &X. Zip 972.22.
401 amps to 600 amps $ 128.50 2
601 amps to 1000 amps $ 192.50 2
Phone No. 4(oZ -ii5o0 Over 1000 amps or volts $ 363.75 2
Job No. 36037 Reconnect only $ 53.50 2
Elec. Cont. Lice. No. Z g, l u Exp.Date lb /ado o "4c. Temporary Services or Feeders
OR State CCB Reg. No. 448Z3 Exp.Date o3 /zoio i Installation, alteration, or relocation
COT Business Tax or Metro No. 44 Uo Exp.Date 4 // O 200 amps or less $ 53.50 2
201 amps to 400 amps $ 80.25 2
�Ji . i , f� 401 amps to 600 amps $ 1 07.00 2
Signature of Supr. Elec'n
Over 600 amps to 1000 volts,
see 'b" above.
License No. 4o ZS's Exp.Date iojoiA1
Phone No. So3'�if(PZ'4 6 O 4d. Branch Circuits.
New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
Reeder 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 /1 $ 5.35 S8. ES
The installation is being made on property I own which is not 4e. Miscellaneous
intended for saie, lease or rent. (Service or feeder not included)
Each pump or irrigation drde $ 42.75
Owner's Signature Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy
panel, alteration or extension $ 60.00
3. Plan Review section (if required). .* Minor Labels (10) $ 107.00
Please check appropriate item and enter fee in section 513. 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 $ 94.55"
* Submit 2 sets of plans with application where any of the above apply. a% Surcharge (.08X total fees) $ 7. 7 0
Not required for temporary construction services. Subtotal $ _ 1
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) $ 15,
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $ /04. o6
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR .
WORK IS SUSPENDED OR ABANDONED FORA PERIOD OF 180 DAYS ❑ Trust Account #
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ /c4, o5
is \dsts \forms \electric.doc
CITYaOF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
D ate Requested // - AM PM BLD
Location .s-k! 7 Z= Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC ZB&C — cv D 37
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
Firewall
Sprinkler
Fire Alarm /A1
Susp'd Ceiling
Roof
Misc:
Final 1
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
IC
ice
Rough In
UG /Slab
Low Voltage
Fire Alarm
S 8 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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date dre) Inspector �� Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.