Permit CITY OF TIGARD ELECTRICAL PERMIT
! // . A\ DEVELOPMENT SERVICES PERMIT #: ELC99 -0111
1 4.-4 DATE ISSUED: 02/23/99
! J• .. 13 S W Hall Blvd., Tigard, OR 97223 (503) 639.4171
PARCEL: 2S11ODB -00703
SITE ADDRESS...:15348 SW PACIFIC HWY
SUBDIVISION •WILLOW BROOK FARM ZONING:
BLOCK • LOT :002 JURISDICTION: TIG
Project Description : Installation of limited energy panel. Job No. 11329
- -- 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 • 1
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/O SRVC OR FDR.: 0 PER HOUR • 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 0 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
LES SCHWAB TIRE CENTERS INC type amount by date recpt
PO BOX 667 PRMT $ 40.00 DEB 02/23/99 99- 313163
PRINEVILLE OR 97754 5PCT $ 2.00 DEB 02/23/99 99- 313163
Phone #:
Contractor:
ALLEN /FALK INC $ 42.00 TOTAL
9020 SW GEMINI
REQUIRED INSPECTIONS
BEAVERTON OR 97008 Elect'l Service
Phone #: 646 -0533 Elect'l Final
Reg #..: 47238
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 188
days of issuance, or if work is suspended for more than 180 days. ATTENTION: Ore.' . . .res you to follow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -0010 through OA' ' -001 -1987. You may obtain a copy
of these rules or direct questions to OUNC by callin (503)246 -1987. /
Permittee Signature: �� /�� U� Iss ed By: , _d 44,4 Vii,
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
SIGNATURE OF SUPR. ELEC' N:(7 LA CE' - t '��" ON—J DATE:
LICENSE NO: `j,5 V LF
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + ++ + + + + + + ++ + ++ + + + + + + + + + + ++
RECr7VEQ
�n TIGARD ,FEB 2 2 1999 Electrical Permit Application Plan Ch
13125 SW HALL BLV . Rec'd B
TIGARD OR 97223 (;QPllMlfl�i►►t u��tLOPMENT �2 Date Recd -
-
G 7i Date to P.E.
Phone (503) 639 -4171, x304 I � �
Print or Type Date to DST
Inspection (503) 639 -4175 Permit # ELL'9Y-0///
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development 11\11 `\ IDUO bV'00K Cq,Y MS Number of Inspections per permit allowed
Name (or name of business) L_e.S Service e included: Items Cost Sum
Address 153 -k9 sw P -% c . Mvv N 4a. Residential - per unit
1000 City/State/Zip T i 9a� t) (k ql 'D%--t J Each additional it or less 5 s $11 0.00 4
ty /S /Zi P I Each additional 500 sq. ft. or
Commercial ICI Residential El Limited thereof $25.00 1
Limited Energy $25.00
Lo + a Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current Iicpnses 4b. Services or Feeders
Electrical Contractor t tQ. n I VG ' y' _ Installation, alteration, or relocation
Q 200 amps or less $60.00 2
Address O' O S�f r�4.M■h. i r.\V4. 201 amps to 400 amps $80.00 2
City ONAaVQX'4r ve) State OR Zip 9 401 amps to 600 amps $120.00 2
Phone No. 5o3 - lo4ln - oS33 601 amps to 1000 amps $180.00 2
Job No. 1139.c1 Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. I4-a58C1.1: Exp.Date 10 / OR State CCB Reg. No. Lri a38 Exp.Date LI 95 4c. Temporary Services or Feeders
COT Business Tax or Metro No. 3555 E / •.Date 11 I '1 Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Supr. Elec'n /, % 201 amps to 400 amps $75.00 2
/ 401 amps to 600 amps 2
Over 600 amps to 1000 volts,
License No. g�3 Exp.Date (CYO see "b" above.
Phone No. 503 - 5 0 3 - C . 6 4 - 1 1 0 - 0 � 3
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circ $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circui
$5.00 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 limitedsnecay
panel, alteration or extension t $40.00 Li 0. 0 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: yo
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ 4 : O
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 # _ 1-1Q.00
Total balance Due $
I: \DSTS \ELC96.APP Rev 9196
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
•
Date Requested AM PM BLD
Location /5 3 / Suite MEC
Contact Person llv// Ph PLM
Contractor f/ Ph SWR
BUILDING ena Owner
ELC /
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 h /f'Y!! a C7 .I•2 101 y Sy �eI'Y) S� c.t� r
l !�
Firewall Cl / / / y
Fire Sprinkler L? h Y lilt. p( <j .
Fire Alarm
Susp'd Ceiling
Roof
Misc: /77[ �S�/ �� r� V11 S LTAOP4 Y Lr l!
Final / / /
PASS PART FAIL 4,O 1� C4 �7 d C ' N P —
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service 4 1— 7 S S
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam (�
Rough In
Gas Line
Smoke Dampers
Final d.1
FAIL
ELECTRICAL
•
a 1 J
Rough In U
UG /Slab
Low Voltage
Fi rm
S ART FAIL
SITE
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` — 4a ? —?Y /�
Inspector .Yi1yr D.� Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.