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Permit CITY OF T I G A R D ELECTRICAL PERMIT PERMIT #: ELC1999 -00766 AN I DEVELOPMENT SERVICES DATE ISSUED: 01/10/2000 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL : 1S126DC-04500 SITE ADDRESS: 09575 SW LOCUST ST SUBDIVISION: LEHMANN ACRE TRACT ZONING: C -P BLOCK: LOT : 007 JURISDICTION: TIG Project Description: Electrical for 45 room addition 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: 4 W /SERVICE OR FEEDER: 172 PER INSPECTION: 201 - 400 amp: 7 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: 1 > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: X CLASS AREA/SPEC OCC: Owner: Contractor: VIPS MOTOR INNS INC CITY ELECTRIC + SUPPLY CO 29757 SW BOONES FERRY RD 8070 SW NIMBUS AVE WILSONVILLE, OR 97070 BEAVERTON, OR 97008 • Phone: • Phone: 641 -8012 Reg #: SUP 3592S Q R I GINAL LIC 42422 ELE 26 -289C • FEES Required Inspections Type By Date Amount Receipt Ceiling Cover PRMT KJP 01/10/200C $2,139.45 00- 321041 Wall Cover PLCK KJP 01/10/200C $534.86 00- 321041 Underground Cover 5PCT KJP 01/10/200C $171.16 00- 321041 Elect'I Service Elect'I Final Total $2,845.47 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 ct questions to OUNC at (503) 246 - 1987. ' / • PERMITTEE'S SIGNATUR k ' / , / ISSUED BY: OWNE 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: DATE: / /d /do LICENSE NO: " ?AS Call 639 -4175 by 7:00pm for an inspection the next business day I ' CITY OF TIGARD Electrical Permit Application Plan Check # �G 13125 SW HALL BLVD. Recd By CI TIGARD OR 97223 Date Recd i -Z - 19 Date to P.E. 12. -. W 9 Phone _(503) 639 -4171, x304 Date to DST - Inspection (503) 639 -4175 Print of Type Permit # t '0c7( Fax (503) 598 - 1960 �jl Incomplete or illegible will not be accepted Called 1- (9 -Zq� 1. Job Address: , ddress: rr-- �Y l an 4. Complete Fee Schedule Below: Name of Development �nte(�►!�t till ii.5 �.j 1v Si /ewe Number of Inspections per permit allowed Name (or name of business) LT; ' Service included: Items Cost Sum ��� , l n�/v 1 ,t Address 1 1 4 , 74 -Sm a, 4a. Residential - per unit , �, 112 Eac additional it o l 5 s $ 117.75 4 City/State/Zip C d � Each additional 500 sq. ft. or portion thereof $ 26.75 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 ba e). Installation, alteration, or relocation � i An cc) Electrical Contractor Ut elQ.i.lrn.c., c "� ( 200 amps or less '1 $ 64.25 2 Address go-76 51,13 NIA r�v1 � l I2 + 201 amps to 400 amps '� $ 85.50 tj 6O 2 401 amps to 600 amps $ 128.50 2 City , e-Ira n State Qr Zip 417008 7 601 amps to 1000 amps $ 192.50 2 Phone No. 5O3•-4'4i -FOl Z Over 1000 amps or volts I $ 363.75 `31 2 Job No. or , Reconnect only $ 53.50 2 Elec. Cont. Lice. No. - 2.KiC Exp.Date '0 01 4c. Temporary Services or Feeders . OR State CCB Reg. No. 41242.2. Exp.Date 0 0 S'' Installation, alteration, or relocation COT Business Tax or Metro No --.d Exp.Date l�l pt 200 amps or less $ 53.50 2 201 amps to 400 amps $ 80.25 2 Signature of Supr. Elec'n 401 amps to 600 amps $ 100.00 2 Over 600 amps to 1000 volts, • r see "b" above. License No... 33 5125 Exp.Date /0 J 1 10 I 4d. Branch Circuits Phone No. fax (79.i-S5-p, 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 112 $ 5.35 9 a,O. 102 Address b) The fee for branch circuits 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) $ 100.00 Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over i 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 $ 139 ' 5 * Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $ . 1 Not required for temporary construction services. Subtotal $ '_ 5b. Enter 25% of line 5a for ' , 7 [, , NOTICE Plan Review if required (Sec. 3) $ - Ai , PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $ , 1,� , IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FORA PERIOD OF 180 DAYS ❑ Trust Account # , � j AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ r 6fie is \dsts \forms \electric.doc V -t CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested - Gu AM PM BLD Location l 7 S Sc Go C u"2 f S � Suite MEC Contact Person C l 17 -e Ph '/t(,, / PLM Contractor Ph SWR BOOING,' , `y. °r ., Tenant/Owner ELC 0 — c u Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain Crawl Drain Inspection Notes: 0 SGN Slab '4� 2�. Jf _9 /4-.---(Z- i {� C.2r1 SIT Post & Beam , l � n ,, e Ext Sheath /Shear q � C . Int Sheath /Shear Framing Insulation Drywall Nailing Fire wall 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 Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ECTRICAL eouc Rough In UG /Slab dei )- Low Voltage iV � Firearm / . ��� 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 Other Date Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. • CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 9-4171 BUP Date Requested AM PM BLD Location 7S �,� %— GG-i!- Suite MEC Contact Person Ph � ?` PLM Contractor Ph 6 SWR BUI j J��"J`'� ELC / 99? 2 2e LDING Tenant/Owner �� `` Retaining Wall ELR Footing Access: Foundation 35‘1, Ftg Drain SGN Crawl Drain Inspection Notes: _ ��� Slab < SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation w Drywall Nailing / /' 's - ` f-/S A/AJ 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 Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough In UG /Slab Low Voltage Fi - • Iarm PA 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 W Ext Other Date r Inspector Final - PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested Le. 4 -- VC AM PM BLD Location ` 5i L rr 5 / - Suite MEC Contact Person Ph 7'- (4 r PLM Contractor Ph SWR BUILDING a Tenant/Owner P/i,c-,i i .x. ELC 197r c )7C 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 Fire Sprinkler Z�Q 1 c. ' (,./ 4- 1� 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 Post & Beam Rough In Gas Line Smoke Dampers Final S PART FAIL ELECTRICAL rvt�e Rough In UG /Slab Low Voltage Fire Alarm ma �� �. ,g 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 - inspection RE: able to inspect - no access ADA Approach /Sidewalk Date e% Inspector �- ��� Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.