Permit ELECTRICAL PERMIT
'iN OF TIGARD DATE I ISSUED: 06/12/96
COMMUNITY DEVELOPMENT DEPARTMENT
13126 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171 PARCEL: 1 S 136CA -01601
SITE ADDRESS...: 11665 SW PACI HWY
SUBDIVISION • ZONING:C —G
BLOCK • LOT •
Project Description: Outline lighting for two signs
- -- 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..: 2
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.: 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
KEY BANK type amount by date recpt
11665 SW PACIFIC HWY PRMT $ 80.00 B 06/05/96 96- 280233
SPCT $ 4.00 B 06/05/96 96- 280233
TIGARD OR 97223
Phone #:
Contractor:
HEATH NORTHWEST INC $ 84.00 TOTAL
4644 SE 17TH AVE
REQUIRED INSPECTIONS
PORTLAND OR 97202 Ceiling Cover Elect'1 Service
Phone #: 503 -232 -2620 Wall Cover Elect' 1 Final
Reg #.. : 64263
This permit is issued subject to the regulations contained in the 01'\ edlr `
Tigard Municipal Code, State of Dre. Specialty Codes and all other Perm i tt ee' gn at ure
9
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 OMAA/0 A qlkl---
than 180 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:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' N : af A.IVT\ DATE: lU ( Z — l (/
LICENSE NO:
Call for inspection — 639 -4175
v1CL'A & -5-1L
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Permit # - 1.-0... t7(p -U ,VD
,�* V II I I � Date Issued (2 - t 2- - 6 1 (.Q
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 Key Bank Number of Inspections per permit allowed
Address 11665 SW Pacific Hwy Service included: Items Cost(ea) Sum
City /State /Zip Tigard OR 97223 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
Name (or name of business) Key Bank Each additional 500 sq. ft. or
portion thereof $25.00
Commercial ® Residential 111 Limited Energy $25.00 1
Each Manurd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
Electrical Contractor Heath Signs (Heath N.W.) Installation, alteration, or relocation $60.00 2
200 amps or less
Address 4644 Se 17th Ave. , 201 amps to 400 amps $80.00 2
City Portland State OR Zip 97202 401 amps to 600 amps $120.00 2
232 -2620 601 amps to 1000 amps $180.00 2 -
Phone No. Over 1000 amps or volts $340.00 2
Job NO. 106379 Reconnect only $50.00 2
contractor's license NO. 37 -45 C 4c. Temporary Services or Feeders
Contractor's Board Reg. No. 64263 / Installation, alteration, or relocation
Signature of Supr. Elec' a M. 7 200 amps or less 2
� ► � � - 201 amps to 400 amps $50.00
License No. 411si P e No. 2620 2
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
not intended for sale, lease or rent. First branch circuit $35.00
Each additional branch circuit $5.00
•
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 , 7 $40.00 80
Signal circult(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
Chapter 5 Per inspection $35.00
as described in N.E.C. Cha
p 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 $ 80.
NOTICE 5% Surcharge (.05 X total fees) $ 4.0
Subtotal $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5b. Enter 25% of line A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF Plan Review if required (Sec.3)
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. ..a eieo- ❑ Trust Account #
$
prm.epp
Balance Due $ 84.00
•
7/26/99. Activities for Case #: ELC96 -00368
1:37:14 PM •
Assigned Hold Updated
• Activity Description Date 1 Date 2 Date 3 - To Done By Disp. Level . By • Updated Notes
ELCC001 Application received 6/12/96 6/5/96 B RECD BON 6/12/96
ELCC003 Permit created 6/12/96 6/12/96 B PEND BON 6/12/96
ELCC700 Ceiling Cover 6/12/96 BON 6/12/96
ELCC720 Wall Cover . 6/12/96 • BON 6/12/96
ELCC730 Elect'I Service • 6/12/96 BON 6/12/96
ELCC799 Elect'I Final 6/12/96 5/5/99 CD PASS AKJ 5/5/99
ELCC500 (F)Issue permit 6/12/96 B PASS BON 6/12/96
ELCC920 Miscellaneous action 4/26/99 AKJ DONE No Hold AKJ 4/26/99 inactivity letter sent
ELCC800 Case Finaled 5/5/99 AKJ DONE No Hold AKJ 5/5/99
•
•
Page 1 of 1 .
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
Q BUP
Date Requested 44,0 S - S - 1 AM PM BLD
Location ) 1(9(0S P GLC Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
BUILDING 4arra wner �� , 4 _ . _ �� ELC 9 36, g
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Slab
Crawl Drain Inspection Notes: Sl , S
Post & Beam g SIT
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler G ∎ee.
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
TR ,
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
:ia
•'AS 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: [ I Unable to inspect - no access
ADA
Approach /Sidewalk SA/99 ( �� �i`—�
Other Date Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.