Permit CITY OF TI GARD ELECTRICAL PERMIT
PERMIT #: ELC1999 -00657
.A 4101 & DEVELOPMENT SERVICES DATE ISSUED: 11/03/1999
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 103 D D -00400
SITE ADDRESS: 13727 SW PACIFIC HWY 400
SUBDIVISION: ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Electrical for two 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: 2
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:
PETER STIVEN VITAL SIGNS INC
1300 SW 5TH AVE 14413 NE 10TH AVE
STE 2600 C -105
PORTLAND, OR 97201 VANCOUVER, WA 98685
Phone: 503 - 221 -4810 Phone: 360- 573 -3686
Reg #: LIC 119801
ELE 37- 735CLS
FEES Required Inspections
Type By Date Amount Receipt
Elect'I Service
PRMT BON 10/28/199c $85.50 99- 319408 Elect'l Final
5PCT BON 10/28/199 $6.84 99- 319408
Total $92.34 ORIGINAL
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 I SSUED BY:
eve < < cec .— g mxe
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:
CONTRACT R INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: � - 1l DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
CITY OF TIGARD Plan Check #
• Electrical Permit Application
13125 SW HALL BLVD. Recd By
Date Rec'd /6 $ 1
TIGARD OR 97223 Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print of Type Permit # t a Z 7
Fax (503) 598 -1960 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 bu gne s) j Loc zL �dlffv>. Service included: Items Cost Sum
Address /2 7 2:7 Pe .7r.i }t c, t-W y #$ 4-oo 4a. Residential - per unit
1 1000 sq. ft. or less $ 117.75 4
City /State /Zip I leta,. _ (7,r Each additional 500 sq. ft. or
1 portion thereof $ 2675 1
Commercial p 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 data e). Installation, alteration, or relocation
Electrical Contractor -6.\ Cl ks fir. 200 amps or less $ 64.25 2
Address /444 3 NC is 4A. u e., a,- IaC 201 amps to 400 amps $ 85.50 2
401 amps to 600 amps _ $ 128.50 2
City V,�vtp State a .. Zip 9 cg b g S- 601 amps to 1000 amps $ 192.50 2
Phone No. 3 foo - 73` 3(08 c., Over 1000 amps or volts $ 363.75 2
Job No. Reconnect only $ 53.50 2
Elec. Cont. Lice. No. .i7 ` 13 c . Exp.Date IGL I 1 oc) 4c. Temporary Services or Feeders
OR State CCB Reg. No. 119 8 I Exp.Date 13 00 Installation, alteration, or relocation
COT Business Tax or Metro No. �`7 2Z. Exp.Date Z II ••• 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. • CV Gr h;Ka., 05 9oC- Fxp.Date ISIea
Phone No. O -57 3 - 3(08(0 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 ' ‘t4
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 . 5 $ 42.75 5 `^ - "'
Signal circuit(s) or a limited energy
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 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:
5a. Enter total of above fees $ ' J ,
* Submit 2 sets of plans with application where any of the above apply. � 1 0 5 o Surcharge (.05 X total fee $
Not required for temporary construction services. ���JJJ Subtotal $ ,'
5b. Enter 25% of line 5a for p
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 # ' r
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $
i:\dsts\forms\electric.doc
CITY OF TIGARD 24 -Hour
BUILDING „ Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/ BUP •
Received Date Requested f ?I ` AM PM BUP
Location i < Suite -' MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner a^ €l t�� ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
°W Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA ` T /�'Z
Approach /Sidewalk D 41 m oa_ Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL