Permit CITY OF TIGARD ELECTRICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: ELC98 -0715
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/07/98
PARCEL: 2S1O2BD -00100
SITE ADDRESS...:12645 SW PACIFIC HWY
SUBDIVISION :NO. TIGARDVILLE ADDITION AMEND ZONING:R -12
BLOCK LOT :052 JURISDICTION: TIG
Project Description: Add five (5) branch circuits. Job *23199.
- -- 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 • 0 W /SERVICE OR FEEDER: 0 PER INSPECTION • 0
201 — 400 amp ° 0 1st W/0 SRVC OR FDR.: 1 PER HOUR • 0
401 — 600 amp ° 0 EA ADD'L BRNCH CIRC: 4 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
ST ANTHONY'S SCHOOL type amount by date recpt
12645 SW PACIFIC HWY PRMT $ 55.00 GEO 12/07/98 98- 311320
TIGARD OR 97223 SPCT $ 2.75 GEO 12/07/98 98- 311320
Phone #:
Contractor:
GRAND ELECTRIC $ 57.75 TOTAL
PO BOX 12253
REQUIRED INSPECTIONS
PORTLAND OR 97212 Elect'1 Service
Phone #: 234 -9329 Elect'1 Final
Reg #..: 64378
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- %1 -'x'10 through OAR 952-001 -1987. You may obtain a copy
of these rules or direct questions to OUNC by callinT461987
Permittee Signature: 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 QQ
SIGNATURE OF SUPR. ELEC' N : DATE: /i2
LICENSE NO: 3 "/ �? S
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY 13F TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By
TIGARD OR 97223 Date Recd
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print or Type Permit # F-e! t95 -0 715
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development '/� Number of Inspections per permit allowed
Name (or name of business) Sit (4 v 1 S
1'10 1 �' '1[)n Service included: Items Cost Sum
Address ( 2. y ` c 5W o_ci a C '4 ht' l A 4a. Residential - per unit ;
City /State/Zip I 1000 sq. ft. or less $110.00 4
1 CNC, C) Each additional 500 sq. ft. or
Commercial LJ El Limited thereof $25.00 1
Limited Energy $25.00
G C. Ui) i Residential C.`�eO tk. ref -" 0 l\ grQcC Each Manuf d Home or Modular
J Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all cmrrent Ilcens ) 4b. Services or Feeders
Electrical •ntractor CT 0Y0. C.i sac kr- ; c Installation, alteration, or relocation
Addre 7 ( Mo ("Z:2- 200 amps or less $60.00 2
201 amps to 400 amps $80.00 2
City . State n r Zip 2 401 amps to 600 amps $120.00 2
Phone No. - q 3 2cj 601 amps to 1000 amps $180.00 2
Job No. 3 ) ' ' Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. P(e Exp.Date • - :/
OR State CCB Reg. No. (oaf %.7€ Exp.Date 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
�� 201 amps to 400 amps $ 2
2
Signature of Supr. Elec 'n '� if 401 amps to 600 amps $100.00
-
+ ( l Over 600 amps to 1000 volts,
License No. 3(K \ 2 - S Ex D to /0 D / see "b" above.
Phone No. 2, 4 9 ` 1 /
4d. Branch Circuits
New, alteration or extension per panel
213. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit 1 $35.00 '3C
2
The installation is being made on property I own which is not Each additional branch circuit $5.00 Z 0 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:
55
Not required for temporary construction services. 5a. Enter total of above fees $ 0Z...75-
5% Surcharge (.05 X total fees) $
NOTICE • Subtotal $
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
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 # �
$ s /. 7S
Total balance Due
I: \DSTS \ELC96.APP Rev 9/96
• 05/15/2000 Activities for Case #: ELC98 -00715
2:54:57 PM •
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 12/07/1998 • GEO MAIL GEO 12/07/1998
ELCC003 Permit created 12/07/1998 GEO DONE GEO 12/07/1998
ELCC730 Elect'I Service GEO 12/07/1998
ELCC799 Elect'I Final 04/21/2000 CD PASS AKJ 04/24/2000
ELCC500 (F)Issue permit 12/07/1998 GEO PASS GEO 12/07/1998
ELCC800 Case Finaled • 04/24/2000 AKJ DONE No Hold AKJ 04/24/2000
•
Page of
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Rquested TO AM PM BLD
Location . 0-(0q 1 p GZ C Suite MEC
Contact Person Ka Ph PLM
Contractor c� Ph SWR
BUILDING Tenant/Owner �` -11(V0 Qa �i
( S ELC X067 / S
Retaining Wall ELR
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
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
(ELECTRIC
Service
Rough In
UG /Slab
Low Voltage
Fi - Alarm
60 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 r inspecti. RE: [ ] Unable to inspect - no access
ADA
•
Approach /Sidewalk Date Inspector iL _ _ _ / — Ext
Other
Final
PASS PART FAIL • 0 NOT REMOVE this inspection record from the job site.
L