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Permit CITY OF T' G A R D ELECTRICAL PERMIT PERMIT #: ELC2001 -00394 1j DEVE DEVELOPMENT Tigard. 1639 -4171 DATE ISSUED: 8/2/01 PARCEL: 2S 110AA -02800 SITE ADDRESS: 14055 SW PACIFIC HWY SUBDIVISION: ZONING: C -G BLOCK: LOT : JURISDICTION: TIG Project Description: Installation of (3) branch circuits for video poker. 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: 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: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 2 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: DANNA BROTHERS PROPERTIES ELECTRIC WORKS INC 9800 SE STARK ST 9122 SE 67TH AVE PORTLAND, OR 97216 PORTLAND, OR 97206 Phone: Phone: 774 -6444 Reg #: LIC 0048251 SUP 2960S ELE 26 -484C FEES Required Inspections Type By Date Amount Receipt Ceiling Cover PRMT CTR 8/2/01 $60.15 2720010000( Wall Cover Elect'I Final 5PCT CTR 8/2/01 $4.81 2720010000( Total $64.96 This Permit is issued subject to the regulations contained in the Tigard Muniapal Code, State of OR. SpedaltyCodes 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 -6699 or 1 -800- 332 -2344. f / Permit Signature: ( 66. , 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: n DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: .......&___C410-50.3---- DATE: LICENSE NO: ,99 (, Call 639 -4175 by 7:00pm for an inspection the next business day . _. Electrical PermitA ! I ' cation Date received: ��� Permit no. 1 _: ",/ — // 9 ,.� 1 City of Tigard CIP Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: OM Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory )4 Commercial/industrial ❑ Multi - family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration /replacement ❑ Other: O Partial JOB SITE INFORMATION Job address: /114.55 S 6(J PQ _i lc_ �1 j are Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: Block: 'Subdivision: / �J Project name: G //'nerds I Description and location of work on premises: C,- is r /// dam ,akCr Estimated date of completion/inspection: CONTRACTOR APPLICATION FEE SCI IEI)(1 E Job no: S796,3 Fee Max Business name: E /�. - � c _ 1 k . r C . Description Qty. (ea.) Total no. insp 1 New residential - single ormuld- family per Address: 9 /a 9 .S & 4,7 4 A ,e_. dwellingtmit Includes attached garage. City: fp02.7 -N6 I State:O/ I ZIP: G) 7 ZUt p Service htcluded: Phone: - 774 -to c/L/ 1 4 I Fax: 775'-65t/J I E -mail: &iec ty,k.s.C2Aa L m 1000 sq. ft. or less 4 a 2 s � _ (9 U y z � - Lit Each additional 500 sq. ft. or portion thereof CCB no.: Elec. bus. lie. no: y Limited energy, residential 2 City /metro lic. no.: 4. 4, E /0 -0/ -0/ Limited energy, non- residential 2 /J/ Clay y -7 10 ( Each manufactured home or modular dwelling Signature of su ising electrician (re hired) Date ( Service and/or feeder 2 Sup. elect. name (print): -7 print): 1 e rr (V cCar'tA License no: q .a , ry Seices or feeders — installation, alteration or relocation: PROPERTY OWNER 200 amps or less 2 Name (print): 201 amps to 400 amps 2 40(amps to 600 amps 2 Mailing address: 601 amps to 1000 amps 2 City: I State: I ZIP: Over 1000 amps or volts 2 Phone: 'Fax: I E -mail: Reconnect only Owner installation: The installation is being made on property I own Temporary services or feeders - . which is not intended for sale, lease, rent, or exchange according to Installation, alteration,orrelocation: ORS 447, 455, 479, 670, 701. 200 amps or less 2 201 amps to 400 amps 2 Owner's signature: Date: 401 to 600 amps 2 ENGINEER Branch circuits - new, alteration, or extension per panel: Name: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 2 City: I State: Fee for branch circuits without purchase I ZIP: B . of service or feeder fee, first branch circuit: I tk 85 L 2 . Phone: Fax: E -mail: Each additional branch circuit: a /,.(ps 1330 PLAN REYIENV (Please check all that apply) Misc. (Service or feeder not included): O Service over 225 amps-commercial O Health -care facility Each pump or irrigation circle 2 O Service over 320 amps -rating of 1&2 O Hazardous location Each sign or outline lighting 2 family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, 0 System over 600 volts nominal more residential units in one structure alteration, or extension' 2 O Building over three stories O Feeders, 400 amps or more *Description: O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional Inspection over the allowable In any of the above: ❑ Egress/lighting plan ❑ Other. Per inspection I I I Submit _ sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other - Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ ((7p` — 1 S ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ 1 +. X 1 Expires accepted as complete. TOTAL $ (04 , c l (p Name of cardholder as shown on credit card $ Cardholder signature Amount 440 -4615 (6/00/COM) • ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: " • • Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY /� Restricted Energy Fee $75.00 Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total `I' Check Type of Work Involved: • Residential - per unit 1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems` Each additional 500 sq. ft. or portion thereof $33.40 1 ❑ Burglar Alarm Limited Energy $75.00 • Each Manufd Home or Modular ❑ Garage Door Opener" Dwelling Service or Feeder $90.90 2 Services or Feeders n Heating, Ventilation and Air Conditioning System* Installation, alteration, or relocation 200 amps or less $80.30 2 ❑ 201 amps to 400 amps $106.85 2 Vacuum Systems` 401 amps to 600 amps $160.60 2 601 amps to 1000 amps $240.60 2 ❑ Other . Over 1000 amps or volts ' - $454.65 2 • Reconnect only $66.85 2 Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY Installation, alteration, or relocation Fee for each system $75.00 • 200 amps or less $66.85 2 (SEE OAR 918 -260 -260) . • 201 amps to 400 amps $100.30 2 401 amps to 600 amps $133.75 2 Check Type of Work Involved: . Over 600 amps to 1000 volts, . see "b" above. 11 Audio and Stereo Systems - Branch Circuits a • New, alteration or extension per panel Boiler Controls a) The fee for branch circuits • with purchase of service or . ❑ Clock Systems feeder fee. ` ' Each branch circuit $6.65 2 ❑ Data Telecommunication Installation b) The fee for branch circuits without purchase of service ❑ Fire Alarm Installation or feeder fee. First branch circuit I $46.85 gip . nn 15 Each additional branch circuit • , . $6.65 13 .3,0 ❑ HVAC Miscellaneous ❑ Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems Signal circuits) or a limited energy panel, alteration or extension $75.00 ❑ Landscape Irrigation Control' Minor Labels (10) $125.00 Each additional inspection over ❑ Medical the allowable In any of the above Per inspection • $62.50 ❑ Nurse Calls Per hour $62.50 In Plant $73.75 ❑ Outdoor Landscape Lighting* Fees: , ' . , I - ❑ Protective Signaling Enter total of above fees $ le ' 0. I G n Other 8% State Surcharge - $ 4, 8 I Number of Systems 25% Plan Review Fee See "Plan Review" section on $ _ No licenses are required. Licenses are required for all other installations front of application. . Fees: Total Balance Due , $ . Enter total of above fees $ ❑ Trust Account # 8% State Surcharge $ Total Balance Due $ i:'.dstskforms\elc- fees.doc 06/07/01 • • CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested AM PM BUD Location `t 375 I,a m Suite MEC / Contact Person � ll -- � �- � - h � � � 6 e-( PLM Contractor ,C /e VI C t,(�o r�'cS /4 C Ph SWR BUILDING Tenant/Owner ELC 0 2Z6 1 / 9' 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 J C I V' For V l d e p ke Y m Q c Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL >4,4 ,27 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 ELECTRICAL Service Rough In UG /Slab Low Voltage Fi - larm PASS 'ART 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: [ ] Unable to inspect - no access ADA Approach /Sidewalk Other Date F /b z)/ Inspector xt Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.