Permit T/` V CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC1999 -00210
-44 13125 N DEVE SERVICES 639 -4171 DATE ISSUED: 4/9/99
PARCEL: 2S113AD-01700
SITE ADDRESS: 16920 SW 72ND AVE
SUBDIVISION: ROSEWOOD ACRE TRACTS ZONING: C -G
BLOCK: LOT : 030 JURISDICTION: TIG
Proiect Description: Commercial electrical alteration
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: 1 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: el e* CO 1� '
BRIDGEPORT LAND LLC l
3939 NW ST HELENS RD 1 4012- Z � �U .
PORTLAND, OR 97210
7,3,-(4,v4 012 )172
Phone: Phone:
1 C01
Reg #: �ID1 7
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
Ser Service
ice
PRMT BON 4/9/99 $40.00 99- 314378 Elect'l Final
5PCT BON 4/9/99 $2.00 99- 314378
Total $42.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laves.
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.
Permit Signature: CIA T1 (44-10y) illg Issued B
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: < "L 07/N DATE:
LICENSE NO:
Call! 639 -4175 by 7:OOpm for an inspection the next business day
" CITY OF TIGARD RECEIVED Plan Check #
Electrical Permit Application �1
13125 SW HALL BLVD APR 0 9 1999 R ecd By r� 4 -1-441 .)
Date Rec'd
TIGARD OR 97223
Phone (503) 639 -4171, x3Q4 MUNITY DEVELOPMENT Date to P.E.
Print or Type Date to DST q
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit # L� ! I�fZ-
Fax (503) 684 -7297 Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed •
Name (or name of business d V & V t S f I'LLiJ// ( Service included: Items Cost Sum
Address t b q)-0 .S .U l24tI • • 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City/State/ZIP T A.,va Each additional 500 sq. ft. or
Commercial M Residential El Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy went licens= . ) 4b. Services or Feeders
I
0 Installation, alteration, or relocation
Electrical Contractor __ • _ _ y C V
'
200 amps or less _ $60.00 2
a , - SS Uv I - 1.- 1 11�� WIF= ;4 • 201 amps to 400 amps $80.00 2
Ci t& AI t , • i State L3,7 Zip i 401 amps to 600 amps $120.00 2
Phone No. €4 - (e q 601 amps to 1000 amps - $180.00 2
Job No. I l 2 e' k Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No.c2 1 I C , Exp.Date U Reconnect only - $50.00 2
OR State CCB Reg. No. 22 Exp.Date 1 I 4c. Temporary Services or Feeders
COT Business Tax or Metro ► .. .., Exp.Date l VD Installation, alteration, or relocation
200 amps or less $50.00 2
SigriatreSsipElee'nA ■Ji I11IL! 401 amps to 600 amps $100.00 2
• Over 600 amps to 1000 volts,
License No. �1�7 Exp.Date 4.41/0 I see "b" above.
Phone No. ' 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 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. ! J
First branch circuit $35.00 J 2
The installation is being made on property I own which is not Each additional branch circuit / $5.00 �ZJ 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: 4
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 4 1 00
TIME AFTER WORK IS COMMENCED. ❑ Trust Account #
Total balance Due $
I:\DSTS \ELC96.APP Rev 9/96
CITY OF JGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested ePtV00 AM PM BLD
Location 1 2 0 2, 14-4 AVC. Suite MEC
Contact Person /02/.< Ce d Ph _2 �l ? - U6(1 PLM
Contractor Ph SWR
BOLDING Tenant/Owner
&O ( znc ELC iv 9 -era
Retaining Wall ELR
Footing
nda Access: �- �Y l J�` C , , ,,, FPS
Foundatio
Ftg Drain SGN
Slab
Crawl Drain Inspection Notes: r � yvv I zs iu th q
SIT
Post & Beam
Ext Sheath /Shear t-4-ap
Int Sheath /Shear
Framing
Insulation � p� /
Drywall Nailing •.�-�T 64J, '� , £ (' Z2‘,_r�.�
Firewall
Fire Sprinkler — A/ lief s ' -
Fire Alarm r
Susp'd Ceiling ! r Z -5 c_ -P _
Roof
Misc: •
Final / /
PASS PART FAIL 1 -) '� , Ge
PLUMBING / �� ' , / e / �,� _
Post & Beam
Under Slab ilifir
Top Out .
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
I~- MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS P T FAIL
TRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
a
S 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 r 2-4 OD Inspector Ext
L Othe Date
Final
ASS PART FAIL DO NOT REMOVE this inspection record from the job site.