Permit - CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00065
rn DEVELOPMENT SERVICES DATE ISSUED: 02/15/2000
�� II 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171
PARCEL: 25101 BB -00301
SITE ADDRESS: 11834 SW PACIFIC HWY
SUBDIVISION: TIGARD ROAD GARDENS ZONING: C -G
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: .Permit for three signs
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: • SIGN /OUT LINE LTG: 3
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 SERVICES/TEXACO BLAZE SIGNS OF OREGON
3800 ST HELENS RD PO BOX 23910
PORTLAND, OR 97296 PORTLAND, OR 97281 -3910
Phone: 503 -225 -4223 Phone:
639 -3262
Reg #: SUP 524SIG
LIC 000643
ELE 26380CLS
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT BON 02/10/200C $128.25 00- 321658 Elect'I Final
5PCT BON 02/10/200C $10.26 00- 321658
ORIGINAL
Total $138.51
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 started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987. .
PERMITTEE'S SIGNATURE ` . A 1 �� / ISSUED BY: 0., M
A' �.� /r J.
OW = R INSTALLATION ONLY
The installation is being made on property I own whi • is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
f 1
SIGNATURE OF SUPR. ELEC'N: 01/■ 1 ( A}1\ DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
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CITY OF TIGARD 4 P lan Check #
13125 S W HALL BLVD. Electrical Permit Application Re ar
cd By
TIGARD OR 97223 Date Recd a /d'aO
Date to P.E.
•
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print of Type Permit #4 Fl C26) - c5/
Fax (503) 598 -1960 Incomplete or illegible will not be accepted Called 2- 15
1. Job Address: 4. Complete Fee Schedule Below: -
Name of Development Number of Inspections per permit allowed
Name (or name of business) 'T .,�v Service included: Items Cost Sum
Address I I' g S (.J 4a. Residential - per unit
City/State /Zip �hc�( �a , S 2 ' 1000 sq. ft. or less $ 117.75 4
r,
Each additional 500 sq. ft. or
portion thereof $ 26.5 1
Commercial 4 Residential ❑ Limited Energy $ 60.00
Each Manufd 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 da se). Installation, alteration, or relocation
Electrical Contractor 200 amps or less $ 64.25 2
Address 0 c--- e,--,t_. /, V S 9 Jt 201 amps to 400 amps
401 amps to 600 amps $ 85.50 2
City State /r . Zip 9 7 a-G� $ 128.50 2
ty P O 601 amps to 1000 amps $ 192.50 2
Phone No. 4 q • - a 6 Z Over 1000 amps or volts $ 363.75 2
'Job No. al O C) - 7 4. Reconnect only $ 53.50 2
Elec. Cont. Lice. No. 3O6LSExp.Date, - Z' - 00 .4c. Temporary Services or Feeders
OR State CCB Reg. No. C..43 a Exp.Date/E- / - O 1 Installation, alteration, or relocation
COT Business Tax or Metro No. a D 1 3 Exp.Date f - v t 200 amps or less $ 53.50 2
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n 401 amps to 600 amps $ 107.00 2
Over 600 amps to 1000 volts,
see "b" above.
License No. /S 5 I G Exp.Date /0 0a_
Phone No. (. / .S2 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 Owner's 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 3 $ 42.75 i Z R' • ) S-
Signal circuit(s) or a limited energy .
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panel, alteration or extension $ 60.00
3. Plan Review section (if required): * Minor Labels (10) $ 10.00
Please check appropriate item and enter fee in section 5B. 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
System over 600 volts nominal In Plant $ 59.00
Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 5. Fees:
6a. Enter total of above fees $ / aS- .2_1S
* Submit 2 sets of plans with application where any of the above apply. . Surcharge (.9frXtotal fees) $ .; () _ G
Not required for temporary construction services. vrvSubtotal OO�f $
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 PERIOD OF 180 DAYS ❑ Trust Account #
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ ) F. 57
` is \dsts \forms \electric.doc
R 1
04/07/2000 Activities for Case #: ELC2000 -00065
2:52:56 PM
Assigned Hold Updated
. Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
. ELCC001 Application received 02/10/2000 GEO RECD No Hold BON 02/15/2000
ELCC003 Permit created 02/15/2000 BON DONE No Hold BON 02/15/2000
ELCC117 DST Post - Review complete 02/15/2000 BON DONE No Hold BON 02/15/2000
ELCC400 (F)Ready to issue 02/15/2000 BON DONE No Hold. - BON 02/15/2000
ELCC730 Elect'l Service 02/15/2000 02/15/2000 No Hold BON 02/15/2000
ELCC799 Elect'1 Final • 02/15/2000 02/15/2000 04/06/2000 CD PASS No Hold AKJ 04/06/2000
ELCC500 (F)Issue permit 02/15/2000 BON DONE No Hold BON 02/15/2000
ELCA800 Case finaled 04/06/2000 AKJ DONE No Hold AKJ 04/06/2000
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CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 - Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested q1 A M PM p /00 / BLD
Location ii . (l 44 G E-Lo tA Suite MEC
Contact Person Pw L Ph LOW r / PLM
Contractor -� Ph SWR
BUILDING Tenant/Owner t IMLL,6Q q
Retaining Wall E TC 2®0o - (.GULPS
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing /1.4
Firewall
Fire Sprinkler
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
E CTRICgh
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
S PART FAIL
S E
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
Other Date Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.