Permit CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC2000 -00128
Nr DEVELOPMENT SERVICES DATE ISSUED: 04/10/2000
I 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 110 C D -00104
SITE ADDRESS: 11735 SW QUEEN ELIZABETH ST 105
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT : • JURISDICTION: KIN
Project Description: Electrical work for commercial TI.
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: 3 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:
MEDAK, JOHN D + ON ELECTRIC CO
VIUHKOLA, JENNIFER JOHN CUSACK
4029 NE SANDY BLVD 1005 CRESTVIEW DR
PORTLAND, OR 97213 NEWBERG, OR 97132
Phone: Phone: ORIGINAL
538 -7970
Reg #: LIC 93997
ELE 36 -57C
SUP 4035S
FEES Required Inspections
Type By Date Amount Receipt
Elect'I Service
PRMT KJP 04/10/200C $53.55 0001276 Elect'' Final
5PCT KJP 04/10/200C $4.28 0001276
Total $57.83
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 x ISSUED BY: 42:4A,.,,,42.,) 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: OZ1 DATE:
LICENSE NO: / 2 35 s
Call 639 -4175 by 7:00pm for an inspection the next business day
CITY OF TIGARD Electrical Permit Application Recd B # .' .
13125 SW HALL BLVD.
TIGARD OR 97223 Date Rec ®00
Date to P.E. .------- Al
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print of Type Permit# eGGol000 pfjfag
Fax (503) 598 -1960 Incomplete or illegible will not be accepted Called
1.. Job Address: 4. Complete Fee Schedule Below:
Name of Development m.e to%g x gi � DM.0 Number of inspections per permit allowed
Name (or name of business) Service included: Items Cost Sum 4 '
Address 111 3 S S w Q b KN t.=U iR6C- " 5"6-17 ' 4a. Residential - per unit
< CC 1000 sq. ft.'or less $ 117.75 4
City/State /Zip K /N6 CIi , U /t:CC.?•• Each additional 500 sq. ft. or
portion thereof $ 26.75 1
Commercial 121 Residential ❑ Limited Energy $ 60.00
Each Manufd Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders
information for COT data base). Installation, alteration, or relocation
Electrical Contractor I 'UN ' ? CLC -C72IC co • '3"o j ,i c 4.1,4 cif 200 amps or less $ 64.25 2
Address I a i S C /Z E "Tv 1 a. D a , 201 amps to 400 amps $ 85.50 2
-City A/FwuE2c State 04C- ✓r- Zip _Y7 /5 ? 401 amps to 600 amps $ 128.50 2
601 amps to 1000 amps $ 192.50 2
Phone No..) -7 9 70 . 7/9 - 7 9 2 5 CcEcc) Over 1000 amps or volts $ 363.75 2
Job No. N Reconnect only $ 53.50 2
Elec. Cont. Lice. No. 3 6'-J 1aC--' Exp.Date /40-/ O 4c. Temporary Services or Feeders .
A i OR State CCB Reg. No. 9 399'7 Exp.Date ? -aa-oo Installation, alteration, or relocation
ir - __,!,:41.Ta�411 a ,,, :, . Ewe 200 amps or less $ 53.50 2
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n 401 amps to 600 amps $ 100.00 2
Over 600 amps to 1000 volts,
!/ . /6- /_ r✓ see "b" above.
License No.
7 n 3 Ex p.Date
Phone No. 3 8 q 4d. Branch Circuits
7 New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Na i Each branch circuit $ 5.35 2
Address b) The fee for branch circuits
without purchase of service
City State Zip or feeder fee. �7 SO
Phone No. First branch circuit / $ 37.50
Each additional branch circuit . 3 $ 5.35 / (Q • O 5''
The installation is being made on property I own which is not 4e. Miscellaneous
intended for sale, lease or rent. (Service or feeder not included)
Each pump or irrigation circle $ 42.75
Owners Signature Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy
(if required):* pane alteration or extension $ 60.00
3. Plan Review section
( Minor Labels (10) $ 100.00
Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over
4 or more residential units in one structure the allowable in any of the above
Service and feeder 225 amps or more Per inspection $ 50.00 -
Per hour $ 50.00
System over 600 volts nominal In Plant $ 59.00
Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 5. Fees: - 5T
5a. Enter total of above fees $ '
* Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $ a
Not required for temporary construction services. Subtotal $
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account #
El
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ 5
i:\dsts\formslelectric.doc
05/15/2000 Activities for Case #: ELC2000 -00128
3:55:00 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 03/21/2000 DEB RECD No Hold DEB 03/22/2000 To be processed with the
building TI permit.
ELCC003 Permit created 03/22/2000 DEB DONE No Hold DEB 03/22/2000
ELCC400 (F)Ready to issue 03/22/2000 • DEB DONE No Hold DEB 03/22/2000
ELCC730 Elect'I Service No Hold DEB 03/22/2000
ELCC799 Elect'I Final 05/11/2000 CD PASS No Hold AKJ 05/11/2000
ELCC500 (F)Issue permit 04/10/2000 KJP DONE No Hold KJP 04/10/2000
ELCC720 Wall Cover • 04/14/2000 CD PASS No Hold AKJ 04/16/2000
ELCC700 Ceiling Cover 04/14/2000 CD PASS No Hold AKJ 04/16/2000
ELCC800 Case Finaled 05/11/2000 AKJ DONE No Hold AKJ 05/11/2000
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Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 5 /i i O O AM X/ PM BLD
Location (I 1 S i ?t1u tt Suite
/ O S MEC
Contact Person (TCt j Ph S1(, 7,(p PLM
Contractor Ph 7 S I SWR
BUILDING Tenant/Owner ELC 'L{tO - 7)( Y ) (�
Retaining Wall ELR 006 C
Footing Access: fJ
Foundation `[ S ( 7 FPS
Ftg Drain ` SGN
Crawl Drain Inspection Notes: 6 L� n , '��
Slab 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
PASS PART FAIL
OECTRICL)
Service
Rough In
UG /Slab
Low Voltage
Fire arm
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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date // Inspector L_ Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.