Permit CITY OF T I GA R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00349
P r 'DEVELOPMENT SERVICES DATE ISSUED: 07/05/2001
- ! I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 110DC -02200
SITE ADDRESS: 15532 SW PACIFIC HWY C -1 B
SUBDIVISION: WILLOW BROOK FARM ZONING: C -G
BLOCK: LOT : 011 JURISDICTION: TIG
Project Description: Install of (1) branch circuit for sign lighting.
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: 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:
J.J. SIGN
5715 SW PASADENA
r - PORTLAND„ OR 97219
pptj'= Phone: 503 - 246 -0284
. , Reg #:
FEES Required Inspections
Type By Date Amount Receipt Elect'l Final
PRMT CTR 07/05/2001 $53.40 2720010000(
5PCT CTR 07/05/2001 $4.20 2720010000(
Total $57.60
This Perm 'i s i ssued 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 0' - =52- 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246-66990r..1 -800-33
Permit Signature Issued By:
�.:_ ��,�►_ �,I: / ___t / _ . %L �
OWNER INSTALLATION ONLY
The installation is be •g 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: '1 & a DATE:.
LICENSE - NO: C—
Call 639 -4175 by 7:00pm for an inspection the next business day
r
. . - • . `Electrical Permit Ap plication
Datereceived: (/ /8 p I Permit no.�[ / _ 60�jc�q
AI,' ° .I I I' City of Tigard Project/appl. n o.. Expire date:
•
C Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: BR") I Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598-1960 • Case file no.: Payment type:
Land use approval: wadnt - CJO I b? .
TYPE OF PERMIT
❑ I & 2 family dwelling or accessory Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction / 55-3 y Addition/alteration/replacement CI Other: ❑ Partial
JOB SITE INFORMATION
Job address: — _.......-,'" ,St4-i ' ' pt= , • --LCfy Bldg. no.: Suite no. .8 / Tax map /tax lot/account no.:
Lot: I Block: 'Subdivision:
Project name: I Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: i ' — Oe t" ) r l o'l ' Description Qty. (ea.) Total no. Max
Business name: J , J, l /(, ' //U C . insp
New residential - single or multi- family per
Address: 5g4- -'rj(J ,9i OP.-)& 0/2 dwelling unit. Inchades attached garage.
City: Fin/L. /...-At...) I State:p/Z,.ZIP: q'72.1q Service included:
Phone:5 1 Fax: 6ikkie I E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
90.()-/- CCB no.: / 0 ( -/ 7 3 I Elec. bus. lic. no.
Limited energy, residential 2
Cit metro ic. no.: 6 ,' ,. & : — /C) _ C. S Limited energy, non- residential 2
,',_ /0 — 1 Each manufactured home or modular dwelling
Si¢ture of supervising electrici • • Service and/or feeder 2 (required) Date(O �(S' — U '
Sup. electname (print): License no: Services or feeders — installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: 'State: I ZIP: Over 1000 amps or volts 2
Phone: 'Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary senices or feeders - .
which is not intended for sale, lease, rent, or exchange according to Installation, alteration, or relocation:
200 amps or less 2
20
ORS 447, 455, 479, 670, 701. 201 1 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am s 2
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: • I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E-mail: of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps- rating of 1&2 ❑ Hazardous location I Each sign or outline lighting _ i 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons 0 Manufactured structures or RV pant Each additional Inspection over the allowable in any of the above:
0 Egress/lightingplan ❑ 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 -
Permit fee $ 5 . Vv
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ �r,10
' Credit card number. / / within 180 days after it has been State surcharge (8%) $
Expires accepted as complete. TOTAL $ _ ' 6o
Name of cardholder as shown on credit card .
ard r t 60
$ /
Cardholder signature Amount 440 -4615 (6/00/COM)
ELECTRICAL PERMIT FEES: . LIMITED ENERGY PERMIT FEE
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 4, 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 Manned Home or Modular
Dwelling Service or Feeder $90.90 2 ❑ Garage Door Opener
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. ❑ • Audio and Stereo Systems
Branch Circuits
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 0 Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 ❑ ,
Each additional branch circuit $6.65 HVAC •
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle
Each sign or outline lighting $53.40 • ❑ Intercom and Paging Systems
Signal circuit(s) 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: ❑ Protective Signaling
Enter total of above fees $ ❑ Other
8% State Surcharge .. $ 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 $ 5e. `t r (
❑ Trust Account # 8% State Surcharge $ ` . & v -
Total Balance Due $ 5 &O
i:\dsts\forms\elc- fees.doc 06/07/01
1/16/02 Activities for C. : - #: ELC2001 -00349
7:43:19 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 7/5/01 BB DONE No Hold BB 7/5/01 •
ELCC003 Permit created 7/5/01 BB DONE No Hold BB 7/5/01
ELCC799 Elect'I Final No Hold BB 7/5/01
ELCC500 (F)Issue permit 7/5/01 BB DONE No Hold BB 7/5/01
•
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 - 41710/_ Mi/
Date Requested AM PM pp�� FPS) — N CIA-e—
Location 53 G. Suite — iQ/ 6 J - 00 /0.4
Contact Person / / Ph Jr N Snit C r .r)
Contractor Ph SWR
BUILDING Tenant/Owner (vie. FA AI - (rr)
Retaining Wall E Q
Footing • Access: O5 + FPS IL Foundation
Ftg Drain � /- V �h� o ' )
Crawl Drain Inspection Notes: ''`` ,, ' /
Slab � dal.; SIT
Post & Beam
Ext Sheath /Shear / y�� /, �'
Framing hath /Shear / �(.J0� - 00 9 � % ��'_ ! s) -4e_ Az D ywal * 5 on /� J ", '� /� 7
Drywall Nailing ( I Cr T�' �d-�
Firewall �` /� J _ ' -4 /� 7 - Fire Sprinkler 'C_ (.!�/ 72g- 'rW
Fire Alarm y� ,C•3"-'
("k- A / � L e r � (Z •
Susp'd Ceiling ^^ 7 � ` / J�-� ► � "�
Roof 2 ( ao f / 0 • _ ' f ./•
Final
PASS PART FAIL c-6/Q>00)-00/6 7 J C C. ,
PLUMBING ® E� - 77 -e.- e... ( 1--7) 2e 5-7> / dC Ay
Post & Beam
Under Slab eit C ; 4--- (/J/l S l � P -V - _
Top Out
Water Service 3) � CM r� � �7.
Sanitary Sewer Sewer / / / �" ��� f�
Rain Drains l-e_...4 /CM �� Z(./�V'�_
Final
PASS PART FAIL O i< •cA4 / ALe rC.�,i ,_ j d 5 MECHANICAL ��� p 1.---1 ll
Post & Beam ��C S e-e---t...al
Rough In
Gas Line
Smoke Dampers Nigge ; rr)E1 4)-o a /- d V I1 / A 4 f -,.1
Final n
PASS PART FAIL 7Y\ a— '4 4 ie./ 4, / i/a/
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART 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
Other Date Inspector E
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.