Permit _ _ _
CITY OF TIGARD
• DEVE SERVICES ELECTRICAL PERMIT -
13125 SW RESTRICTED ENERGY
PERMIT #: ELR99 -0010
DATE ISSUED: 01/22/99
PARCEL: 2S102:CB -01805
SITE ADDRESS...: 10400 SW PARK ST
SUBDIVISION • ZONING:R -3.5
BLOCK • LOT - JURISDICTN: TIG
Project Description : Installation of 2 lisited energy panels, 1 security and 1
fire.
A. RESIDENTIAL B. COMMERCIAL --
AUDIO & STEREO...: AUDIO & STEREO..: INTERCOM & PAGING..
BURGLAR ALARM • BOILER • LANDSCAPE/ IRRIGAT..:
GARAGE OPENER • CLOCK • MEDICAL
HVAC • DATA /TELE COMM...: NURSE CALLS •
VACUUM SYSTEM • FIRE ALARM •X OUTDOOR LANDSC LITE:
OTHER: .• HVAC • PROTECTIVE SIGNAL..:X
INSTRUMENTATION.: OTHER..:
TOTAL # OF SYSTEMS: 2
Owner: -- - - - -- FEES - -- -- --
CHILDREN'S VILLAGE type amount by date recpt
10400 SW PARK ST PRMT $ 80.00 DEB 01/22/99 99- 312379
TIGARD OR 97223 5PCT $ 4.00 DEB 01/22/99 99- 312379
Phone #:
Contractor: - - - - -- - - -- --
DAVE BURNETT $ 84.00 TOTAL.
364 SE 45TH AVE
- - -- -- REG.0 I RED INSPECTIONS - -- - - - ---
PORTLAND OR 97215 Low Voltage Insp
Phone #: 233 -9328 Elect'1 Final
Reg #..: 000795
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. 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 rule adopted by the
Oregon Utili ' • tion Center. Those rules are set forth in OAR 952- 001-0010 through OAR 952- 001 -0080. You may obtain copies of
these ru s or direct qu tions to OUNC at (503)246 -1987.
Iss red by _ Permittee Signature ,� ��vi ,/
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:
++4++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + ++ + + + + + ++ ++ + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + ++ + + + + + + + ++++ + + + + + +++ ++
CITY' OF TIGARD Electrical Permit Application Plan C :ck #
13125 SW HALL BLVD. 11'1 Rec'd :y . _ 3 11 6 ,, • TIGARD OR 97223 (kit) Date Rec'. - i�rS
V Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print or Type Permit # .0
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development 'J Number of Inspections per permit allowed
•
Name (or name of business)/ / /.CD &A.'S Pi ita....16- Service included: Items Cost Sum
I
Address /09D D d , Pbet g. /..- .- R 4a. Residential - per unit
, � 1000 sq. ft. or less $110.00 4
City /State /Z --, �T -' 1=1 Li / /t Each additional 500 sq. ft. or
Commercial l2 Residential portion thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current, tenses) 4b. Services or Feeders
Electrical Co t ractor ; VcS ! , _ - t . . / 4 , Installation, alteration, or relocation
Addre s . ln �� 200 amps or less $60.00 2
7 , 201 amps to 400 amps $80.00 2
City State _ �2_ Zip ' 7 2 J `5 401 amps to 600 amps $120.00 2
Phone No. J� 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. ` ' = Exp.Date 6 `r ., Reconnect only $50.00 2
OR State CCB Reg. No. 6 Exp.Date ... d Zi 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date 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 $100.00 2
�p Over 600 amps to 1000 volts,
5
License No. 7 -A4 - Exp.Date /Oh /19 see "b" above.
Phone No.
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 circuit $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 limited energy
panel, alteration or extension $40.00 pan 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: 4D, bd
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ a U
NOTICE Subtotal $ , r
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 #
Total balance Due $
1:\DSTS \ELC96.APP Rev 9/96
8/8/99 Activities for Case #: ELR99 -00010 •
3:19:03 PM I .
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By . Updated Notes
ELRC001 APPlication Received 1/22/99 DEB RECD DST 1/22/99
ELRC003 Permit Created 1/22/99 DEB DOPE DST 1/22/99
ELRC725 Low Voltage Inspection 2/2/99 BRP PASS CD 2/2/99 •
ELRC799 Elect'I Final 5/6/99 BRP FAIL AKJ 5/6/99 See ELC98 -00740 final notes
ELRC500 (F) Issue permit 1/22/99 DEB DONE DST 1/22/99
ELRC799 Elect'I Final 5/24/99 5/24/99 5/24/99 BRP FAIL No Hold AKJ 5/24/99 No access
ELRC799 Elect'I Final 5/24/99 5/24/99 5/14/99 BRP PASS No Hold , AKJ 5/24/99
ELRC800 Case finaled 5/24/99 AKJ DONE No Hold AKJ 5/24/99
•
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested S/ AM PM BLD
Location / t ‘40 0 e 57 Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR 99 - b O O / D
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab /tid SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
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
•
ART FAIL
ELECTRICAL >
Service
Rough In
UG /Slab
Low Voltag
Fire Alarm
in
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 ` �' P 9 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
L