Permit CITY OF TIGARD ELECTRICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: ELC99 -0089
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 0` / 16 / 99
PARCEL: 25110DB -00200
SITE ADDRESS...:15292 SW ROYALTY PKWY #D
SUBDIVISION •WILLOWBROOK FARM /ARBOR HEIGHTS ZONING:R -25
BLOCK • LOT -008 JURISDICTION: TIG
Project Description: Add four (4) branch circuits for sump pumps.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS : 0 0 — 200 amp 0 PUMP /IRRIGATION 0
EACH ADD'L 500SF...: 0 201 — 400 amp • 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY • 0 401 — 600 amp - 0 SIGNAL /PANEL : 0
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.: 1 PER HOUR • 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 3 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
SECURITY CAPITAL PACIFIC TRUST type amount by date recpt
SUITE 201 PRMT $ 50.00 GEO 02/16/99 99- 312920
330 112TH AVE., NE SPCT $ 2.50 GEO 02/16/99 99- 312920
BELLEVUE WA 98004
Phone #: F206- 451 -2692
Contractor:
NORTH VALLEY ELECTRIC INC $ 52.50 TOTAL
PO BOX 222
REQUIRED INSPECTIONS
WOODBURNE OR 97071 Elect'1 Service
Phone #: 981 -4016 Elect'1 Final
Reg #..: 000883
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 180
days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952-.' -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling ( )246 -1987.
Permittee Signature: 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: _ 5 eo - DATE: -Fe
LICENSE NO: ?` 40 °C
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By
Date Recd
• TIGARD OR 97223
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Print or Type
Inspection (503) 639 -4175 Permit # /CC` ("GI
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: Al _P 4. Complete Fee Schedule Below:
A Name of Development \3CY afi 1 v ` Number of Inspections per permit allowed
Name (or name of business) Service included: Items Cost Sum
Address 1 'qa. . Iw\ J am y Pal (Q.( 4a. Residential - per unit
City /State/Zip Ti C,G.IA �. • c " I Eac ad or less $110.00 4
� aa Each addit tional 500 sq. ft. or
portion thereof $25.00 1
Commercial ❑ Residential"
Limited Energy $25.00
Sur S` `^ , ,�, . p n � � C . Each Manuf'd Home or Modular
N) f" Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of1a cur nt I ce ses) ,� �'" 4b. Services or Feeders
Electrical C • ntract• L O i `+' \ - e/i .; i (, a - Y ifte, , Installation, alteration, or relocation
200 amps or less $60.00 2
Addre S AP • tit o a 'a- _ 201 amps to 400 amps $80.00 2 -
City . X14• State 'If Zip Q 70--1 1 401 amps to 600 amps $120.00 2
Phone No. 5 03 - of 1 - 40 1 I e 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. a4,- ba L Exp.Date 0 D
OR State CCB Reg. No. ?-)o a.. Exp.Date 61 h in I 4c. Temporary Services or Feeders
COT Business Tax or Metro No.06054131 Exp.Date 0 1i 144 Installation, alteration, or relocation
200 amps or less $50.00 2 -
201 amps to 400 amps - $75.00 Signature of Supr. Elec' ' --- Z7 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No C� '.(0 - S Exp.Date Ito / 1 /D I see "b" above.
Phone No. 503 - G � 1 '- 40/Le 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 :3S-, 00 2
The installation is being made on property I own which is not Each additional branch circuit ;3 $5.00 / T. oO 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 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: -1_5_3()
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $
NOTICE Subtotal $ 5a-s-6
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 # $ S 0
Total balance Due
I: \DSTS \ELC96.APP Rev 9/96
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
J BUP
Date Requested (o / 0 AM PM BLD
,
Location � )2A Z e / ,9,,) Suite 0 MEC
Contact Person &1, �, p c� PLM
Contractor id rN -i U -. - ph / 8 � — � /�i SWR o C�
• rfe
BUILDING Tenant/Owr 04./4,44_6_ p Q / +�� g
Retaining Wall ELR
Footing
Foundation Access: o. FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: po y-6„
Slab " SIT
Post & Beam // Si) /�
Ext Sheath /Shear ` '' 7 J+&^ -' % ✓ / /'Cu, /S
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
< Et CTROAD
Service
Rough In
UG /Slab
Low Voltage
Fire larm
AS 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 Date Inspector .(.C./�1 Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
r.