Permit CITY ®F TIGARD ELECTRICAL PERMIT
PERMIT #: ELC1999 -00255
-(,l DEVELOPMENT I
O BMEN Tigard, SERVICES
O
SERV 2 (503) 639 -4171 CES DATE ISSUED: 4/28/99
13125 SW
PARCEL: 2S114D0 -00101
SITE ADDRESS: 17005 SW 92ND AVE
SUBDIVISION: COOK PARK ZONING: R - 4.5
BLOCK: LOT : JURISDICTION: TIG
Project Description: Electrical work for gazebo.
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: 6 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 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:
CITY OF TIGARD • ALLIED ELECTRIC •
13125 SW HALL BLVD PO BOX 6537
TIGARD, OR 97223 ALOHA, OR 97007
Phone: 639 -4171 Phone: 614 -8000 ORIGINAL
Reg #: LIC 00038538
SUP 3195S
• ELE 34 -112C
FEES Required Inspections
Type By Date Amount Receipt Elect'l Service
PRMT BON 4/28/99 $90.00 99- 314903 Elect'I Final
5PCT BON 4/28/99 $4.50 99- 314903
Total $94.50.
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 -011 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
Permit Signature — Issued By: D,,
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 -A DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
/
CITY OF.TIGARD TIGARD Electrical Permit Application Plan Chec ` :
1 SWN HALL BLVD. Rec'd By / /
TIGARD OR 97223 •
Date Rec'd 2/
Phone (503) 639 - 4171, x304 Date to P.E.
Date to DST
Inspection (503) 639 -4175 Print or Type
Incomplete or illegible will not be accepted Permit #Gc.G (�tbzSS�
Fax (503) 598 -1960 Called
1. Job Address: k 4. Complete Fee Schedule Below:
Name of Development (Y k / Number of Inspections per permit allowed
Name (or name of business) C. y LC'\ - t � � Service included: Items Cost Sum
I
Address Od 5 55(-L) Cf /
2- "'� -<. 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City /State /Zip 1 l� ∎, �fL 0 f Each additional 500 sq. ft. or
Commercial a Residential ❑ portion thereof $25.00 1
Limited Energy $25.00
Each Manufd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current licenses) - - ' 4b. Services or Feeders
Electrical Contractor /1--L t�� ttf �'c. '. Installation, alteration, or relocation C
Address CO _ $t) K • 1 b 4 b 20 amps to or less _ $60.00 2
201 amps to 400 amps - $80.00 2
City /J. P in State vYk Zip 91 / ? "3 401 amps to 600 amps - $120.00 2
Phone No. (a 14 -Coot; 601 amps to 1000 amps - $180.00 2
Job No. / /u I / Over 1000 amps or volts - $340.00 2
Elec. Cont. Lice. No. 5,4 /1 2C Exp.Date iC /' { {{ ! Reconnect only - $50.00 2
OR State CCB Reg. No. '85 3 v° Exp.Date `f / 20 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Su r. Elec'n 201 amps to 400 amps $75.00 2
9 P 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. ?j IG 6 S Exp.Date see "b" above.
Phone No. 4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or cc as
Print Owner's Name feederfee
Address Each branch circuit - $5.00 3c. 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
Each additional branch circuit - $5.00 2
The installation is being made on property I own which is not
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):*
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 $35.00
System over 600 volts nominal Per hour - $55.00
Classified area or structure containing special occupancy In Plant - $55.00
as described in N.E.C. Chapter 5
5. Fees: 45-1,- as
* Submit 2 sets of plans with application where any of the above apply. 5a. Enter total of above fees $ Not required for temporary construction services. 5% Surcharge (.05 X total fees)
Subtotal $
NOTICE 5b. Enter 25% of line 5a for
Plan Review if required (Sec.3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Subtotal $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY ❑ Trust Account # c(J t;
TIME AFTER WORK IS COMMENCED. Total balance Due $ l
I: \DST \ELEC98.DOC REV 4/98
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
G� BUP •
p
Date Requested D �- [ q AM PM BLD
Location () 00 5 q 2) /1-6(- Suite MEC
IL
Contact Person Ph (p I t ? PLM
Contractor /� Q P SWR
BUILDING (DOE- OE- Pa /L./f.- ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain ,�,_ -� ,���aa SGN
Crawl Drain Inspection Notes: C Ae.j 9 ?. �
Slab ✓ � SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing ' r ._ _i/ i / / . .L �� ■ - _
Firewall j
Fire Sprinkler � / .
Fire Alarm r
Susp'd Ceiling 441.(.1. C /4 9
Roof
Misc: _ -
Final
PASS PART FAIL t �
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
ECT
io �
Rough In
UG /Slab
Low Voltage
Fire Alarm
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
Other D • Inspector Ext
Final
PASS PART FAIL " O NOT REMOVE this inspection record from the job site.
10/7/99 Activities for Case #: ELC1999 -00255
2:27:55 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 4/28/99 BON DONE No Hold BON 4/28/99
ELCC003 Permit created 4/28/99 BON DONE No Hold BON 4/28/99
ELCC730 Elect'I Service 4/28/99 4/28/99 No Hold BON 4/28/99
ELCC799 Elect'I Final 4/28/99 4/28/99 4/29/99 CD PASS No Hold AKJ 4/29/99
ELCC500 (F)Issue permit 4/28/99 BON DONE No Hold BON 4/28/99
ELCC202 Hold Release to Issued Status 7/21/99 AKJ DONE No Hold AKJ 7/21/99
ELCC730 Elect'I Service 7/21/99 7/21/99 7/21/99 CD PASS No Hold AKJ 7/21/99 rough wiring of canopy only
ELCC799 Elect'I Final ' 8/5/99 8/5/99 8/4/99 CD PASS No Hold AKJ 8/5/99 service approved per restriction:
a) to be disconn during winter
season per PGE
b) to be reinsp annually before
. being re- energized by c.o.t. elec
inspector
ELCC800 Case Finaled 8/5/99 AKJ DONE No Hold AKJ 8/5/99
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