Permit „e,' -- CITY OF TIGARD ELECTRICAL PERMIT
Ams i DEVELOPMENT SERVICES PERMIT #: ELC99 -0135
DATE ISSUED: 03/08/99
- '!+L ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 1S136AD -05901
SITE ADDRESS...: 11455 SW PACIFIC HWY
SUBDIVISION • ZONING:C —G
BLOCK • LOT • JURISDICTION: TIG
Project Description : Installation of a 200 AMP service /feeder, 42 branch circuits
and 1 signal circuit. Fire damage.
- -- 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..: 1
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 - 1 W /SERVICE OR FEEDER: 42 PER INSPECTION • 0
201 — 400 amp • 0 1st W/0 SRVC OR FDR.: 0 PER HOUR • 0
401 — 600 amp : 0 EA ADD'L BRNCH CIRC: 0 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
DAY'S INN type amount by date recpt
11455 SW PACIFIC HWY PRMT $ 310.00 GEO 03/08/99 99- 313503
TIGARD OR 97223 SPCT $ 15.50 GEO 03/08/99 99- 313503
Phone #:
Contractor:
FRIBERG ELECTRIC CO $ 325.50 TOTAL
4636 N WILLIAMS AVE
REQUIRED INSPECTIONS
PORTLAND OR 97217 Ceiling Cover Underground Cove
Phone #: 288 -5161 Wall Cover Elect'l Service
Reg #..: 000013
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 -001 -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling (503 46 -1987. / /
Permittee Signature: /•-A -C �/ 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:
CONTRACTOR INSTALLATION ONLY ��j
SIGNATURE OF SUPR. ELEC'N: w DATE: 3 �”
LICENSE NO: R, - 1, --s
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
'4 ' R ECEIVED community Development '`. ELECTRICAL PERMIT APPLICATION
0 8 1999 13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
' A piR
` { TY DEVELOPME I,�i. I �r Permit # 0 LC f?'-- 0/3 7
�
f 1' shone (503) 639 -4171 Date Issued
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by
Inspection (503) 639 -4175
1. Job Address: F *Z, 4. Complete Fee Schedule Below:
r ....+
Name of Development 004-ys --1-IvN Number of Inspections per permit allowed
Address / /I/5S - Z-e2 / % f4G gAi Service included: Items Cost(ea) Sum
City/State/Zip /LLD , Q/e 4a. Residential - per unit 4
1000 sq. ft. or less $110.00
E a dditi o nal 500 s ft or
Name. (or_ name of busin 1 -
��-�yy portio thereof $25.00 -
Commercial qf�-- Residential Limited Energy $25.00
Each Manul'd Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only:
4b. Services or Feeders
Installation, alteration, or relocation 2
Electrical Contractor lBEdeg 1 tee -tie ,‹ 200 amps or less / $60.00 4,V �" 2
'g 2 ./
Address 4 4 A Ott c 4101X 201 amps to 400 amps $80.00 2
401 amps to 600 amps $120.00 2
City State0•4 Zip Ws2,/9
601 amps to 1000 amps $180.00 2
Phone No. - .574p/ Over 1000 amps or volts $340.00 2
-
Contractor's License No. -0.6 -SIC Reconnect only $50.00
Contractor's Board Reg. No. , /3,s 4c. Temporary Services or Feeders
1 41 4F ' Installation, alteration, or relocation 2
Signature of Supr. Elec'n 200 amps or less $50.00 2 -
License No. Z Phone /'e. 'ZS$ -SW' 201 amps to 400 amps $75.00
-
401 amps to 600 amps $100.00
• Over 600 amps to 1000 volts
2b. For owner installations: see - b - above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per panel
Address a) The lee for branch circuits with
Ci ty State Zip purchase or service or feeder lee. 0 2 ` e� 5 2
City p Each branch circuit i 2 $5.00 r
Phone No. b) The lee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder fee. 2
First branch circuit $35.00
not intended for sale, lease or rent.
Each additional branch circuit $5.00
Owner' 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 40
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 P er i nspec t ion $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 $ . /0
5% Surcharge (.05 X total fees) $ 7.c; S �
NOTICE
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. ❑ Trust Account # $
Balance Due $ 325
woadbomda \.4sc m.app
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
q p(� BUP
Date Re uested 7 / l ! AM PM BLD
Location I 1 "t S5 ?&( Suite MEC
Contact Person ( . . x J 6 t 4 Ph Z 'S I (O I PLM
Contractor Ph SWR Q
BUILDING Tenant/Owner Pa)S T/Y)) \ ELC g / --(
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear ,,,,,, AA
Framing /ru le FD r (v v cJ
Insulation
Drywall Nailing
Firewall
Fire Sprinkler /7 S 6 Y - C t/- a _ 4 - -
Fire Alarm 1
Susp'd Ceiling 4' t %. �1A�■1 = T A ,o // • / , A 4.
Roof / / /
Misc: (4 ) !> s�1 c/ f t/� �/ e L' l- Y!) d e 6y ,S' /'e YVI .
Final J
PASS PART FAIL /
PLUMBING l- /0QVPYI ➢` oL// �i � / 9 c ii < &Pr) )'e /94/ ve cli J
Post & Beam �^ /
Under Slab ! e_ k .S' /9 p e/i 4 YC e_[ el' /Y/ eq / Se YL' /CP ,
Top / I
Water Service So t4 A n P . l S - 1'YA hG A cl r v t /` s Q ✓1 C / Gj l/
Sanitary Sewer /
Rain Drains t✓ �. r ■ OC e c- w re_ , • • /A / •
Final
PASS PART FAIL
MECHANICAL ` (/
Post 8 Beam M y b 5'e. Y liq I l 0 1 , 7 ! S' / s h e ( Sy 6 i P YYl CO y y i/ e 5
Rough In (,t/ 1-1/"A » j y 1 W1 u Yvt no d °e 6 144 `L O( e7 se Q/s ,
Gas Line
Smoke Dampers
Final /
PASS PART FAIL l ' ' / (J , e _A Q� i /j ,ar i e . Air, i
Service 1 C ALI-WiNFALIIIIIIMSWIWOhad •■
Rough In
UG /Slab
Low Voltage
Fire • larm Y1 - ` / 4' S' S '_ ir A _ 1 ' 4. k - / AlL'1t
die jr
iy
PAS PART FAIL
E • - ■ I .4...
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 (y 9 c�
Other ach /Sidewalk Date ` _ b L ^ C ? Inspector 0.4.1 a d aiL__, Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.