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Permit
CITY OF TIGARD �,xnn,,,,a,,, a, :, DEVELOPMENT SERVICES ELECTRICAL PERMIT � i l � i 13125 SW Hall Blvd., Ti ard, OR 97223 503 639 -4171 PERMIT S : D / 9 DATE ISSUED: : 1 2 2/ 23 c.:,/96 PARCEL: 16136AD -06400 SITE ADDRESS...: 11440 SW PACIFIC HWY SUBDIVISION • ZONING: BLOCK • LOT - Project Description: Installing first branch circuit and five add'1 branch circa its - -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC/FEEDERS---- MISCELLANEOUS 1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0 EACH ADD'L 500SF...: 0 201 — 400 amp 0 SIGN /OUT LINE LTG..: 0 LIMITED ENERGY.....: 0 401 — 600: amp.......: 0 SIGNAL /PANEL • 0 MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0 - - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- - 0 — 200 amp ° 0 W /SERVICE OR FEEDER: 0 PER INSPECTION • 0 201 — 400 amp : 0 1st W/0 SRVC OR FDR.: 1 PER HOUR : 0 401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 5 IN PLANT • 0 601 — 1000 amp • 0 PLAN REVIEW SECTION 1000+ amp /volt • 0 > =4 RES UNITS > 600 VOLT NOMINAL..: Reconnect only • 0 SVC /FDR >= 225 AMPS..: CLASS AREA /SPEC OCC.: Owner: - - -- •-- FEES BP SERVICE STATION type amount by date recpt 11440 SW PACIFIC HWY PRMT $ 60.00 B 12/23/96 96- 288062 5PCT $ 3.00 B 12/23/96 96- 288062 TIGARD OR 97223 Phone #: Contractor: — MT HOOD ELECTRIC INC $ 63.00 TOTAL 8900 SW BURNHAM #F -7 REQUIRED INSPECTIONS TIGARD OR 97223 Elect' 1 Service Phone #: Elect'1 Final Reg #. : 113641 This persit is issued subject to. the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other Perm it tee Si gnat ure applicable laws. All work will be done in accordance with approved plans. This pereit will expire if work is not started �.. ^' within 180 days of issuance, or if work is suspended for yore 61\A /U2 fkA �t/a' than 18M days. Issued 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: CO "IT0" INSTAL ATION ONLY SIGNATURE OF SUPR. ELEC'N: 440 011115167 DATE:, LICENSE NO: f- 312 2 N Call for inspection — 639 -4175 \ Community Development ELECTRICAL PERMIT APPLICATION 13125 SW Hall Blvd. at-0- / Q Tigard, OR 97223 Permit # EL -' ` ND 6 Al■ �� Date Issued 1Z- 2.3 "NV " ii Phone (503) 639 -4171 FAX (503) 684 -7297 CITY OF TIGARD TDD No. (503) 684 -2772 Inspection (503) 639 -4175 1. Job Address: 4. Complete Fee Schedule Below: Name of Development rt1 G/--� V' SEEL, /j Ct Number of Inspections per permit allowed Address k 1. 4y 0 S (1 QA-C..1 r L 41 Service included: Items Cost(ea) Sum City /State /Zip 1 \ 6 / / 0 a 4a. Residential - per unit 1000 sq. ft. or less $110.00 4 Name (or name of business) Each additional 500 sq. ft. or portion thereof $25.00 Commercial R Residential El Limited Energy $25.00 1 Each Manul'd Home or Modular Dwelling Service or Feeder $68.00 2 2a. Contractor installation only: 4b. Services or Feeders .,c� Installation, alteration, or relocation Electrical Contractor fro �-FaoC� mac �Ff C. 200 amps or less $60.00 2 Address 3'l� .f ,tr f3_ is .s i4r9 r - j td- FZ7 201 amps to 400 amps $80.00 2 Cit 401 amps to 600 amps $120.00 2 y ] '' j , y 6-z_ ('� St ©P Zip 601 amps to 1000 amps $180.00 2 Phone No. (p t -4 Over 1000 amps or volts $340.00 2 Job NO. Reconnect only $50.00 2 contractor's license NO. 3.§ 2.St- 4c. Temporary Services or Feeders Contractor's Board Reg. Installation, alteration, or relocation 2 Signature of Supr. Elec'n 200 amps or less 2 �y,�, r� 3 201 amps to 400 amps $50.00 2 License No. �77CJI S Phone No. t/n 35 - . � _ 401 amps to 600 amps $75.00 Over 600 amps to 1000 volts $100.00 2b. For owner installations: see "b" above. 4d. Branch Circuits Print Owner's Name New, alteration or extension per pane Address a) The fee for branch circuits with purchase of service or feeder fee. 2 City State Zip Each branch circuit $5.00 Phone No. b) The fee for branch circuits withou The installation is being made on property I own which is purchase of service or feeder fee. 2 First branch circuit , $35.00 3 not intended for sale, lease or rent. Each additional branch circuit T $5.00 J °t/ Owner's Signature 4e. Miscellaneous (Service or feeder not included) 2 3. Plan Review section (if required): Each pump or irrigation circle $40.00 2 Each sign or outline lighting $40.00 Signal circuit(s) or a limited energy 2 Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40.00 4 or more residential units in one structure Minor Labels (10) $100.00 Service and feeder 225 amps or more System over 600 volts nominal 4f. Each additional inspection over Classified area or structure containing special occupancy the allowable in any of the above as described in N.E.C. Chapter 5 Per inspection $35.00 Per hour $55.00 In Plant $55.00 Submit 2 sets of plans with application where any of the above apply. Not required for temporary construction services. 5. Fees: / 5a. Enter total of above fees $ 6o .41° NOTICE 5% Surcharge (.05 X total fees) $ 5 .Ob PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $ A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $ COMMENCED. word \comdeWeko- ❑ Trust Account # $ prm.app Balance Due $ h3 . op 7/27/99 Activities for Case #: ELC96 -00806 2:42:11 PM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes ELCC001 Application received 12/23/96 12/23/96 B RECD DST 12/23/96 ELCC003 Permit created 12/23/96 12/23/96 B PEND DST 12/23/96 ELCC730 Elect'I Service 12/23/96 12/23/96 MJR UND MJR 12/26/96 underground cover approved bond conduits fill openings ELCC799 Elect'I Final 12/23/96 2/17/99 BRP PASS B*P 2/19/99 ELCC500 (F)Issue permit 12/23/96 B PASS DST 12/23/96 ELCC800 Case Finaled 2/19/99 JT 2/19/99 • Page 1 of 1 CITY OF TIGARD BUILDING INSPECTION DIVISION MST A& ► II 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 �, : , r BUP �� Date Requested AM PM BLD Location I I 1-1-1-to fct e ft_., Suite MEC Contact Person Ph PLM Contractor /14 4 40.0 • (� - Ph 639- 5Y33 SWR / BUILDING Tenant/Owner 3 o S f, . ELC '(LO ° 0g04 Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: ,) Slab r rD � e-c S -C- cc1-J1 SIT Post & Beam Ext Sheath /Shear _ Int Sheath /Shear 56-61 9q Framing i • • / ir I ' � 1 / ! f _' ° Insulation Drywall Nailing 6'1_, II " Fire wall r 9 ,( X _k �i - / 4i / J 4LC_ 02 Fire Sprinkler f Fire Alarm ? r 4 � �..� X _ 942-0 "O Ev0 Susp'd Ceiling ' Roof Misc: - Final PASS PART FAIL PLUMBING Post & Beam / Under Slab 8 ' k AQ cJ arS' n 0 /D 141 P Y e°�j S ,� Top Out / /� Water Service -/ G e c...9 c7 rz / S�,/s Y J S V -e len ' 4 ,0, e_ r I a y'YI ea f Sanitary Sewer Rain Drains a f / C'Q c142_ " 1 / 1 Si n ti 6' Final PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL C9 Service Rough In UG /Slab Low Voltage Fire Alarm PASS 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 �J —/ �j �+ Other Date Date /`` —` / - ! i Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.