Permit C OF T I G A R D ELECTRICAL PERMIT
P ERMIT #: ELC2000 -00003
" ,,1 DEVELOPMENT SERVICES DATE ISSUED: 1/4/00
13125 SW HaII Blvd.. Tigard. OR 97223 (500 PARCEL: 2S101B6 -00301
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SITE ADDRESS: 11834 SW PACIFIC HWY NA
SUBDIVISION: TIGARD ROAD GARDENS ZONING: C -G
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: Temporary service of 200 amps or less for use during construction. Job No. 0I -5361.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 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: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 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: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
EQUIVA SERIVCES/TEXACO T W E INC
3800 ST HELENS RD PO BOX 781
PORTLAND, OR 97296 13731 SE 312TH
BORING, OR 97009 .
Phone: 503 - 225 -4223 Phone: 668 -6711
Reg #: LIC 00064400
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SUP 2604S
PLM 2640S
ELE 26 -252C
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FEES Required Inspections
Type By Date Amount Receipt
Elect'l Service
PRMT DEB 1/4/00 $53.50 00- 320871 Elect'l Final
5PCT DEB 1/4/00 $4.28 00- 320871
Total $57,78
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 s - • - • in 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rule = • opted by the • regon Utility Notification Center. Those
rules are set forth in OAR 952-001-001 rough OAR 952 - 001 -0080. You may obtain •• pies of these rules ‘r direct question • OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE 4 , ISSU • I BY: 1 � I / , ? �' /� ` , l
/ OWNER INSTALLATION ONLY
The installation. is being made :n property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: V-P-e i r DATE:
LICENSE NO: C960
Call 639 -4175 by 7:00pm for an inspection the next business day.
D1 c - -99 02:52P PNECORP - PORTLAND 503 684 7894 P.
CITY OF TIGARD Electrical Permit Application Plan
13125 SW HALL BLVD. E3y
TIGARD OR 97223 Date Recd k-_
Date to P.E.
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Phone (503) 639 - 4171, x304
Date to DST
Inspection (503) 639 -4175 Print of Type Permit# E! e- :6/ -C
Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below.
Name of Development TEXACO Number of Inspections per permit allowed
Name (or name of business)Equiva Services/TEXACO Service included: Items Cost Sum
Address 11834 SW Pacific I lwy 4a- Residential - per unit
C /51;3terl Tigard, 1004 sq. A. or less $ 117.75 4
p OR 97223 Each additional 500 sq. ft. or _
Commercial portion thereof $ 26.25 1
Co
Res idential ❑ Limited Energy $ 60.00
Each Manuf. 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 base). Installation, alteration, or relocation
Electrical ontract r id T L 1 v c. 200 amps or less _ a.... • $ 64.25 r 2
Addre � C) c m
• . ha I 201 amps to 400 amps $ 85.50 �`' '� 2
City 0Y V‘5 _ State Zip 4 o o 401 amps to 600 amps : $ 128.50 2
Phone No. 5_O: (.4e $ - •.R L I 601 Over 1000 to 1000 amps $ 162.50 _
Over 1000 amps or volts $ 363.75 2
Job No. a 1- - ;7)(.c. I Reconnect only - $ 53.50 2
Elec. Cont. Lice. No. ce -rZ Sa C Exp.Date I O'O1 - 06 4c. Temporary Services or Feeders
OR State CCB Reg. No. 6 4( U 00 Exp. D - OR .(31 C I Installation, alteration, or relocation 2 D
COT Business Tax or Metro No. I4 Q E /,D - .te 4 I - C 200 amps or less i $ 53.50 53' 2
lik 201 amps to 400 amps $ 86.25 2
Signature of Supr. Elec'n '' 7 , J r, or 401 amps to 600 amps $ 107.00 2
Over 600 amps to 1000 volts,
License No. ote 0 4 s Exp.Date i o . O I.6 1
see "b" above.
Phone No. 11%• b 3 4 2- 4d. Branch Circuits
New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
.
Print Owners Name Each branch circuit - � $ 5.35 , _ 2
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 circul(s) or a limited enemy
* panel, alteration or extension $ 60.00
3. Plan - Review section (if required): Minor Labels (10) - - $107.00
Please check appropriate item and enter fee in section 58. 4f. Each additional Inspection over
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
_ over 600 volts nominal In Plant $ 59.00 .
Classified area or structure containing special occupancy as 5 -. 3 , SO
described in N.E.C. Chapter 5 5. Fees:
. 5a. Enter total of above fees $ �---
Submit 2 sets of plans with application where any of the above apply. 7°4 Surcharge (.05 X total fees) $ y • if
Not required for temporary construction services. Subtotal $ - - - • '
5b. Enter 25% of line 5a for `
NOTICE Plan Review if required (Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS. OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PEI2100 OF 180 DAYS El Trust Account #
AT ANY TIME AFTER WORK IS COMME CED. Total balance Due b ? 2. $ ,5--2.7.g
04/07/2000 Activities for Case #: ELC2000 -00003
2:52:34 PM
Assigned Hold Updated
Activity Description • Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 APPlication received 01/04/2000 DEB DONE No Hold DEB . 01/04/2000
ELCC003 Permit created 01/04/2000 DEB DONE No Hold DEB 01/04/2000 •
ELCC730 Elect'I Service 01/04/2000 01/04/2000 No Hold DEB . 01/04/2000 .
ELCC799 Elect'I Final 01/04/2000 01/04/2000 01/05/2000 BRP PASS No Hold AKJ 01/05/2000
ELCC500 (F)Issue permit 01/04/2000 DEB DONE No Hold . DEB 01/04/2000
ELCC800 Case Finaled • 01/05/2000 AKJ DONE No Hold AKJ 01/05/2000
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Page 1 of 1 •
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested . 1/5jOD AM PM BLD
S Location 1 D 3 Lj Pa C Suite MEC
Contact Person .'0/l 14 Ph (.P& ' L 7 /1 PLM
Contractor Ph
V SW
BUILDING Tenant/Owner ELC Z�OIO O�
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGT
Slab f � � v C. SIT
Post & Beam /
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof reZ YY1/� S�r1// �, SS
Misc: �f �
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab fl L -- Q �
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
R
ervice
UG /Slab
Low Voltage
m
OPErfilir
�tS • ART FAIL
SIT
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 Date
Other n Inspector � .. 4/ / Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
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