Permit • - CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00271
DEVELOPMENT PMENT r S O ERVICES ) 639 -4171 DATE ISSUED: 5/25/00
PARCEL: 2S 104AC -R -O -W
SITE ADDRESS: SW NO ADDRESS
SUBDIVISION: ZONING:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of one 200 amp service or feeder and 1 branch circuit to power pole on southeast corner of
132nd & Walnut.
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: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
BROADWAY ELECTRIC - COCHRAN INC
626 SE MAIN •
PORTLAND, OR 9721 1
Phone: Phone: 234 -6564 11110R
•
Reg #: LIC 00072942
SUP 3148S
•
ELE 37 -546C
•
• FEES • Required Inspections
Type By . Date Amount Receipt
Elect'I Service
PRMT DEB 5/25/00 $69.60 0002444 Elect'I Final .
5PCT DEB 5/25/00 $5.57 0002444
Total $75.17
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 worts 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 rule -• opted bylrteQregon•Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0080. You may obtain p• pies of these rules or direct questions to OUNC at (503)
246 -1987. /
PERMITTEE'S SIGNATURE ISS D 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: a-, • DATE:
LICENSE NO: 3/ l`7 5
Call 639 -4175 by 7:00pm for an inspection the next business day
CITY OF TIGARD Electrical Permit Application
PIanC•eck#
1: SW HALL BLVD. Rec'd :y AO,
TIGARD OR 97223 Date Rec'd
Date to P.E. ---- • ' _
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print of Type Permit # Ge...G.'O- G17a7/
Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called
1. Job Address: Y 4. Complete Fee Schedule Below:
Name of Development IL)03 o 1u i Number of Inspections per permit allowed
Name (or name of business) P / At- Service included: Items Cost Sum
Address P(.te cr,� )''? °1-44 it CIA) VI,C,()/� at 4a. Residential - per unit
City /State /Zip (� 1000 sq. ft. or less $ 117.75 4
• Each additional 500 sq. ft. or
portion thereof $ 26!5 1
Commercial 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 • . se). Installation, alteration, or relocation S
Electrical Contractor '_�_LI CJI.tJ�tJ e 200 amps or less
/ $ 64.25 (J - 2
Address at . , 4 r 201 amps to 400 amps $ 85.50 2
401 amps to 600 amps $ 128.50 2
City r diAl% State . Zip - rriZ 601 amps to 1000 amps $ 192.50 2
Phone No. 7j - Over 1000 amps or volts $ 363.75 2
Job No. Reconnect only $ 53.50 2
Elec. Cont. Lice. No. 37 - '(oCExp.Date f0 / / / > Ol7 -- 4c. Temporary Services or Feeders
OR State CCB Reg. No. -- -- 42-Exp.Date 3 WO I Installation, alteration, or relocation
COT Business Tax or Metro No. Exp.Date 200 amps or less $ 53.50 2
_ 201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n -. ` �br� - 401 amps to 600 amps $ 107.00 2
Over 600 amps to 1000 volts,
License No.
8 1 z 4- S Exp.Date f 0 /b) lb / see "b" above.
4d. Branch Circuits
Phone No. oR3 Co Cj{Q� New, alteration.or extension per panel
----
t hip,
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 6, 2
b) The fee for branch circuits
Address without purchase of service
City State Zip or feeder fee.
Phone No. First branch circuit $ 37.50
Each additional branch circuit $ 5.35
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
3. Plan Review section (if required):* panel, alteration or extension $ 60.00
Minor Labels bels (10) $ 49?90
MAO d
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
Per inspection $ 50.00
Service and feeder 225 amps or more 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: G p
5a. Enter total of above fees $ /
* Submit 2 sets of plans with application where any of the above apply. aOv�l Surcharge (. total fees) $ lillif
Not required for temporary construction services. O Subtotal g $
5b. Enter 25% of line 5a 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 #
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ 75_17
i:\dsts\forms\electric.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 - 4175.. Business Line: 639 -4171 3
BUP
Date Requested S /Ov > � AM PM
( .0 2. 4' BLD
Location 13'4 1 d" Suite MEC
Contact Person (_ gi ' Y L ' ' Ph PLM
Contractor Ph SWR
•
BUILDING • Tenant/Owner ELC C .( xv,
- 002, -
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: n ) `"`I SIT
N
Slab / v /
Post & Beam Sheath /Shear l
Int C P Int Sheath /Shear
Framing
Insulation
Drywall Nailing SielLux .. J
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 n „ f7,
Post & Beam '�� � C
Rough In
Gas Line
Smoke Dampers V /217 D 7) 1 E$S
Final
PAS PART FAIL •
LECTRICA •
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
4) PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other D ate 5 Inspector JL Ext
Final
PASS PART FAIL 0 NO REMOVE this inspection record from the job site.