Permit CITY OF T' G A R D ELECTRICAL PERMIT
PERMIT #: ELC1999 -00528
4 * DEVELOPMENT SERVICES DATE ISSUED: 8/25/99
t � - ' 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S1 11 AC -02700
• SITE ADDRESS: 14650 SW 97TH AVE
SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R -4.5
• BLOCK: LOT : 037 JURISDICTION: TIG
Project Description: Signal circuit or limited energy panel.
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: 1
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: 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:
UNION HIGH SCHOOL DISTRICT ADAMS ELECTRIC CO INC
NO.3JT 7980 SE 17TH AVE
PORTLAND, OR 97202
Phone: Phone: 234 -9651
Reg #: LIC 00000596
SUP 2056s
ELE 26 -5C
FEES Required Inspections
Type By Date Amount Receipt Elect'I Final
PRMT GEO 8/25/99 $60.00 99- 317944
5PCT GEO 8/25/99 $4.20 99- 317944 ORIGINAL
Total $64.20
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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. /f�
PERMITTEE'S SIGNATURE ISSUED BY: �I
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:
61-71J DATE: • LICENSE NO: o Z d �� - S
Call 639 -4175 by 7:00pm for an inspection the next business day
08/23/99 MON 10:46 FAX 503 598 1960 CITY OF TIGARD IJ 002
CITY OF TIGARD
"x3725 SW HALL BLVD. Electrical Permit Application Plan Check #
RECEIVED
TIGARD OR 97223 Date Rec'd
Phone (503) 639 -4171, x304 AUG 2 5 1999 Data to P.E.
Inspection (503) 639 -4175 bate DST
Fax (503) 598 -1960 . COMMUNITY DEVELOPMENT . . of Type Permit It # FCC 1499•a 05%2,8 ncomp ate or illegible will not be accepted --. Called
1. Job Address: 4. Complete Fee Schedul Below
Name of Development . 7 - 1... a L ii 4t tA.A k S -or t Number of Inspections per permit allowed
Name (or name of business) Service Included: Items Cost Sum 1
Address II-4 (o SO S. t.J ' 1 ti-- 4a. Residential - per unit
City/State /Zip t20 Oe.E. cl i 22_4 1000 sq. ft. or less $ 117.76 4
Each add(tlonal 500 sq. ft. or
portion thereof $ 26.76 1
Commercial Residential:❑ Limited Energy • - $ 80.00
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 kba ' Installation, alteration, or relocation
Electrical Contractor A AM n
S L�l£:or tc_, = G 200 amps or less S 64.25 2
AddrNss `TRIO S.E._ I 1 fi's- 201 amps to 400 amps $ 85.50 2
p �,� 401 amp t 80 amps
R�00.1 � State dQ�. hp P $ 128.50 2
City o
801 amps to 1000 amps $ 192.50 2
Phone No. X 23 4 0 (65 1, Over 1000 amps or volts $ 363.75 2
Job No. a t R 2.... Reconnect only $ 53.50 2
Elec. Cont. Lice. No. :c9.10 SC- Exp.Date IC) - i - 4c. Temporary Services or Feeders '
OR State CCB Reg. No. sq Exp.Date °t- 11 -0 l Installation, alteration, or relocation •
COT Business Tax or Metro No. /O 76 Exp.Date 7 c9 ID 200 amps or less $ 53.50 2
201 amps to 400 amps $ 80.26 2 •
Signature of Supr. Elec' • -� ��� ; _ 40i amps to 600 amps $ 107.00 2
Over 600 amps to 1000 volts,
License No. --Z-6 b 6 _ -- ' Exp.Date /0 f 0 see "b" above.
Phone No. 3 ' 9 S 1 4d. Branch Circuits
New, alteration or extension per panel
a) The fee for branch circuits <
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name Each branch circuit • $ 5.3I; 2
Address b) The fee for branch dreuits
without purchase of service
City State_ Zi p or feeder fee.
Phone No. First branch circuit _ $ 37.50
Each additional branch circuit $ 6.36
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 circuits) or a limited energy
3. Plan Review section (if required):* panel, alteration or extension _ I $ 60.00 (per . E>D
Minor Labels (10) $ 107.00
Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over
4 or more residential units to one structure the allowable in any . of the above
Service and feeder 225 amps or more Per inspection $ 50.00
Por hour $ 50.00
System over 800 volts nominal In Plant $ 59.00
Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 5. Fees: f �
Se. Enter total of above fees $ lr .0 a
* Submit 2 sets of plans with application where any of the above apply. 7% Surcharge (.05 X total fees) $ y . 2
Not required for temporary construction services. Subtotal $
NOTICE fib. Enter 25% of line Sa for
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 FORA PERIOD OF 180 DAYS ❑ Trust Account #
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ 64
is \dsts\forms\electrlc.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 - Business Line: 639 -4171
BUP
Date Requested ` 7 ( /o ® AM PM BLD
Location \ 4Lo 0 1") — /i'- . • Suite MEC
� 1
Contact Person 7-v l4,,n Ph 2-04 - (02-77 PLM
Contractor �T^ Ph SWR •
BUILDING' ° Tenant/Owner 1- �: r �$0,:,.. - Le. ��,G�!T � - - 1- i 4 of - c2--b
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: 7)1 1 € s .) ' SGN
000
Slab ' t
Post & Beam
\.)
SIT
Ext Sheath /Shear 1
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fire wall ' / de Sprinkler y � O e �^ S 1
Fire Alarm
Susp'd Ceiling .
Roof •
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab ,/ 1/J / 2 .S_�
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL I
Post & Beam
Rough In
Gas Line
Smoke Dampers •
Final (
PASS R
AT FAIL
Service
•
Rough In
UG /Slab
�w Voltage
I-ire Alarm
Fin
ASS PART FAIL
TE
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 [ 1 Please call for reinspection RE: [ ] Unable to inspect - no access
ADA / ?�
Approach /Sidewalk
Other Date / _ AL ' a a Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.