Permit CITY OF TI GA R D ELECTRICAL PERMIT
PERMIT #: ELC2000 -00699
4rA DEVELOPMENT SERVICES DATE ISSUED: 12/19/00
�' � � li 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 110 D C -02200
SITE ADDRESS: 15570 SW PACIFIC HWY
SUBDIVISION: WILLOW BROOK FARM ZONING: C -G
BLOCK: LOT : 011 JURISDICTION: TIG
Project Description: Western Union Sign
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: 1
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:
TIGARD, CENTER LP GALLAGHER ELECTRIC
9777 WILSHIRE BLVD #609 P.O. BOX 70
BEVERLY HILL, CA 90212 GRESHAM, OR 97030
Phone: Phone: 503 - 666 -8816
Reg #: LIC 13536
SUP 634S
ELE 26 -533C
FEES Required Inspections
Type By Date Amount Receipt
Elect'l Final
PRMT CTR 12/19/00 $53.40 2720000000(
5PCT CTR 12/19/00 $4.27 2720000000(
Total $57.67
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 ,y 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
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
C!TY TIGARD Electrical Permit Application Plan Check#
13125 SW HALL BLVD. Rec'd By
TIGARD OR 97223 CEWE Date Rec'd
Print of Type
Date to P.E.
r
Phone (503) 639 -4171, x304 � Date to DS
Inspection (503) 639 -4175 Incomplete or illegible will not bge MID Permit Da (o q9
Fax (503) 598 -1960 C[1MMUNT1 WIEIOPME " Called
1. Job Address: /55 S& PAe - Nwy 4. Complete Fee Schedule Below:
1 316 l!(2 , Number of Inspections per permit allowed
Name of Development Items Cost Total 4
M-
Name (or name of business) liUroLO U Nju4r c
Address 1 ! d S W 00 F t C h // Service included:
S� 4a. Residential - per unit
'� w� 1000 sq. ft. or less $147.15 4
City/State /Zip 1 r 2D 't2 v q 7 2- L 3 Each additional 500 sq. ft. or
portion thereof $33.40 1
Commercial 0 Residential ❑ Limited Energy $75.00
Each Manufd Home or Modular
Dwelling Service or Feeder $90.90 . 2
2a. Contractor installation only:
(Prior to permit Issuance; applicants must provide contractor license 4b. Services or Feeders
Installation, alteration, or relocation
information for COT data base).
200 amps or less $80.30 2
Electrical Contractor C--AR iA -C4462 Et 6T, A NC / 201 amps to 400 amps $106.85 2
i
Address o & X 1 () 401 amps to 600 amps $160.60 - 2
City Ge ,S141 f- State Zip 601 amps to 1000 amps $240.60 2
Phone No. 5-(5. ,p q (P (o ( p g I ( a Lbc- 5b3 6 to o- 72-9 do Over 1000 amps or volts $454.65 2
Job No. PE 4 gel '1 Reconnect only $66.85 2
Elec. Cont. Lice. No. .2 . 5 3 3C.. Exp.Date X9/0 / 4c. Temporary Services or Feeders
Reg. No. la - 1 tQ."7 Exp.Date L/ 6 2. 200 amps or less $66.85 2
Installation, alteration, or relocation
OR State CCB Re
9 C P /
COT Business Tax or Metro No. SS Exp.Date 4-/O I 201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2
Signature of Supr. Elec'n • Over 600 amps to 1000 volts,
t see "b" above.
License No. 634 -S G p /t / Exp.Date / bOA / 4d. Branch Circuits
Phone No. SD 3 (, f'i - O O ' New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Each branch circuit $6.65 2
Print Owner's Name b) The fee for branch circuits
Address without purchase of service
City State Zip or feeder fee. First branch circuit $46.85
Phone No. Each additional branch circuit $6.65
The installation is being made on property I own which is not 4e. Miscellaneous •
(Service or feeder not included)
intended for sale, lease or rent.
Each pump or irrigation circle $53.40
Each sign or outline lighting t $53.40 . 63
Owner's Signature Signal circuit(s) or a limited energy
panel, alteration or extension $75.00
3. Plan Review section (if required):* Minor Labels (10) $125.00
Please check appropriate item and enter fee in section 5B. the Each additional inspection over
the allowable in any of the above
4 or more residential units in one structure Per inspection $62.50
Service and feeder 225 amps or more Per hour $62.50
System over 600 volts nominal In Plant $73.75
Classified area or structure containing special occupancy as 5. Fees: �p
described in N.E.C. Chapter 5 5a. Enter total of above fees $d
* Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $ 4-----
Not required for temporary construction services. Subtotal $
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) $
Subtotal $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR ❑ Trust Account # n (,1
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS Total balance Due $ 1
AT ANY TIME AFTER WORK IS COMMENCED.
is \dsts \forms \electric rev.doc - 8/00
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested /— 0 -% AM PM BLD
Location l Ss 7U S � f « G 14, Suite MEC
MEC
Contact Person ) !� Ph 5(3 G PLM
Contractor Q Ph SWR
BUILDING Tenant/Owner I ELC 7 " –6
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 v/il VY1 On J L51 — rt ✓`S
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
PAS P 1 RT FAIL
CTRICAL
Rough In
UG /Slab
Low Voltag
Fire Alarm •
PART 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 [ J Please call for reinspection RE: [ ] Unable to inspect - no access
ADA aa
Approach /Sidewalk Date / / U / Inspe
Other ihiQ� Et
, x
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.