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Permit CITY OF TIGARD ELECTRICAL PERMIT 1, DEVELOPMENT SERVICES PERMIT #: ELC99 -0123 � JL 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 03 / 03 / 99 PARCEL: 1S136AD -06506 SITE ADDRESS...: SW NO ADDRESS SUBDIVISION •WAY LEE ZONING:C —G BLOCK LOT "001 JURISDICTION: TIG Project Description : Traffic signal at Pacific Hwy. and 69th Ave. - -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS 1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0 EACH ADD'L 5O0SF...: 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 • 1 W /SERVICE OR FEEDER: 0 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 CITY OF TIGARD type amount by date recpt 13125 SW HALL BLVD PRMT $ 60.00 B 03/03/99 99- 313406 TIGARD OR 97223 SPCT $ 3.00 B 03/03/99 99- 313406 Phone #: Contractor: OREGON DEPT OF TRANSPORTATION $ 63.00 TOTAL 9200 SE LAWNFIELD RD REQUIRED INSPECTIONS CLACKAMAS OR 97015 -8585 Elect'1 Service Phone #: 986 -2706 Elect'1 Final Reg #..: 49292 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 188 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 b call' g (503)246 -1987. � I_,, Signature: ' Issued B Permittee Si MI4/l!['^- 9 Y 65tvvii Q 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: /91 f kri he.. DATE: LICENSE NO: ++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day ++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + ++ + + + + + + + ++ CITY OF TIGARD Electrical Permit Application Plan Check # ,, ` 13125 SW HALL BLVD. Rec'd By tON TIGARD OR 97223 Date Rec'd ?i''6 -r?9 Date to P.E. Phone (503) 639 -4171, x304 Date to DST n � t Inspection (503) 639 -4175 Print or Type Permit # .E��'1 - Di2� Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development I i. ( c gly Ir1 CJC Number of Inspections per permit allowed Name (or name of business) d C� ( Service included: Items Cost Sum Address ' ! m (.J Q 6 •f � -f� 1 A-v e - (s1 '3 li3I --- 4a. Residential - per unit (1 1000 sq. ft. or less $110.00 4 City/State/Zip ��G rc5� I O �� Each additional 500 sq. ft. or Commercial Residential El Limited thereof $25.00 1 Limited Energy $25.00 Each Manuf'd Home or Modular Dwelling Service or Feeder $68.00 2 2a. Contractor installation only: (Attach copy of all current II„_cgpses) 4b. Services or Feeders I nst allation, alteration, or relocation Electrical Contractor Cl � 0 ( , I a I I 200 amps or less $60.00 1U ` 2 Address 200 L _ t r� � 201 amps to 400 amps $80.00 2 City ! State U Zip WATC 401 amps to 600 amps $120.00 2 Phone No. 5'U'"), - 53 - Ai 2J( 601 amps to 1000 amps - $180.00 2 Job No. Over 1000 amps or volts - $340.00 2 Reconnect only $50.00 2 Elec. Cont. Lice. No. aq- I % c - Exp.Date / 0 - Of - 9 9 OR State CCB Reg. No. '-1') 24 Z Exp.Date l - fr- 4c. Temporary Services or Feeders COT Business Tax or Metro • . .. ate Installation, alteration, or relocation / 20 amps less $50.00 2 201 1 to amps to 400 amps $75.00 2 Signature of Supr. Ele • . . .. - Z.!. r! - 401 amps to 600 amps $100.00 2 Over 600 amps to 1000 volts, License No. 302 3 5 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 Print Owner's Name feeder fee. Address Each branch circ $5.00 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 The installation is being made on property I own which is not Each additional branch circui $5.00 2 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):* Signal circuit(s) or a limited energy panel, alteration or extension $40.00 2 Minor Labels (10) $100.00 Please check appropriate item and enter fee in section 5B. 4 or more residential units in one structure 4f. Each additional Inspection over Service and feeder 225 amps or more the allowable in any of the above System over 600 volts nominal Per inspection $35.00 Classified area or structure containing special occupancy Per hour $55.00 as described in N.E.C. Chapter 5 In Plant $55.00 * Submit 2 sets of plans with application where any of the above apply. 5. Fees: O p • o Not required for temporary construction services. 5a. Enter total of above fees $ 5% Surcharge (.05 X total fees) $ �• NOTICE • Subtotal $ ° 5b. Enter 25% of line 5a for pn PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $ r r NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $ IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. ❑ Trust Account # 4,3'.9-9- $ Total balance Due I: \DSTS\ELC96.APP Rev 9/96 7/27/99 Activities for Case #: ELC99 -00123 5:20:15 PM' . • Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes , ELCC001 Application received 3/3/99 B RECD BON 3/3/99 • ELCC003 Permit created • 3/3/99 B . DONE BON 3/3/99 ELCC730 Elect'I Service • 3/17/99 C PASS AKJ 3/21/99 ELCC799 Elect'I Final 3/17/99 CD PASS CD . 3/18/99 pass ELCC500 (F)Issue permit • 3/3/99 B PASS BON 3/3/99 ELCC920 Miscellaneous action 3/11/99 CD FAIL CD 3/11/99 could not locate service, left message for mike at odot to call with directions. ELCC800 Case Finaled - 3/21/99 AKJ PASS AKJ 3/21/99 -• • • • • • • • • • Page 1 of 1 • • • CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested 47 AM PM BLD Location 6 ,a�_ Suite MEC Contact Person /� Ph 7 e7S2 _ PLM Contractor .©407 -- Ph SWR BUILDING Tenant/Owner ELC 9? — OIL Retaining Wall ELR Footing Access: Foundation ^7 FPS Ftg Drain , r � �� C.-701)4--e'' SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final ∎ ^vim PASS PART FAIL PLUMBING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Final Drains a Final PASS PART FAIL l MECHANICAL V Post & Beam Rough In Gas Line Smoke Dampers Final P • - FAIL ICAL h In UG /Slab Low Voltage Fire Alarm ina � S 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 'a � Other Date "/7 - �! Inspector - Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.