Permit CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC2000 -00010
Vi DEVELOPMENT SERVICES DATE ISSUED: 1/7/00
� I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 25101 DD -00401
SITE ADDRESS: 06955 SW SANDBURG ST
SUBDIVISION: SALEM FREEWAY SUBDIVISION ZONING: I -P •
BLOCK: • LOT : 001 JURISDICTION: TIG
Project Description: Electrical 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: 1 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:
NORTHWEST MEDICAL TEAMS WEST SIDE ELECTRIC CO INC
INTERNATIONAL INC 1834 SE 8TH AVE
PO BOX 10 PORTLAND, OR 97214
PORTLAND, OR 97207 •
Phone: Phone:
231 -1548
Reg #: LIC 13306
SUP 1556s
ELE 26 - 135c
FEES Required Inspections
Type By , . Date Amount Receipt
Elect'1 Service
PRMT . BON, 1/7/00 $42.85 00- 320988 Elect'I Final
5PCT BON 1/7/00 $3.42 00- 320988
Total • $46.27 ORIGINAL
This Permit is issued subjed to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth in OAR 952- 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -1987.
PERMITTEE'S SIGNATURE (91A Pfl M� - ma(' ISSUED
• 1 OWNER INSTALLATION ONLY ' v"
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: 9V` Il (' DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
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JAN -06 -00 05:07 PM WEST SIDE ELECTRIC 503 736 0677 P.01
s�v • > � TIGARD Electrical Permit Application Re f Chock p
1312 SW HALL BLVD. p Reed By
Dale Recd / - G - CO
(IGA - D OR 97223 Date to P.E.
phone (503) 639-4171, x304 Date to DST
Inspe• ion (503) 839 -4175 Print of Type Permits E:LG2.09 /G
F ax ( 1 3) 598 -1960 Incomplete or Illegible will not be accepted Called _
•
1. J b Address: 4. Complete Fee Schedule Below: •
Name • Development Number of Inspections per permit allowed
Name (• name of business) kitr%) t>Wcv'e 'T Service Included: Items Cost Sum 1
Addre: = ( '11t.) SfNIJ6Ztia.C, 'S r • 4a. Re$ldenUsl - per unit
1000 tta fl or Tess $ 117.75 4
(;itylSta = p C n , fJr1. h'122'� Each additional 500 sq. fl or
rte potion thereof 5 20.25 1
Comma 'al Residential El Umned Energy $ 80.00
Each Manufd Home or Modular
2a. C ntractor Installation only: s Deetling Service or Feeder $ 72.75 2
(prior w milt Issuance, applicants must provide contractor license 4b. Services or Feeders
lt��l • for COT data base). l Installation, alteration, or relocation
Elettn , . Contractor - !� - , 7,-. C 200 amps or less - $ 61.25 2
gddres �1r� 7.0-e . 201 emps to 400 amps $ 85.50 2
City ��1� f , r Zip e. ?/ '' 401 amps to 600 amps $ 129.50 2
1501 amps to 1000 amps - $ 192.50 2
F!hone • . Over 1000 amps or volts $ 383.75 2
Job No. UOO 1"1"› Reconnect only - __• �_ $ 53.50 2
Elec. C t. Lice. No. 26-/3 G Exp. Date . 4e. Temporary Services er Feeders
OR Ste i • CCB Reg. No. / 3_3 Exp.bate Installation, alteration, or relocation
OOT B Mess Tax or Metro No.. Exp.Date 200 amps or less S 53.50 2
201 amps to 400 amps $ 80.25 2
SIgnatu.: of Supr. Elec'n 401 amps to 800 amps 3 107.00 2
Over 800 amps to 1000 volts,
I;icense : o. yrs _S Exp.Date , tl above.
Phone o. 3/-4S y.47 4d. Branch Circuits •
New, alteration or extension per panel
a) The fee for branch circuits
b, F„ r owner installations: with purchase of service or
• (Seder fee.
front • er's Name Each branch Circuit 5 5.35 2
Addres, b) The fee for branch Circuits
without purchase of service
46, State ZIp or feeder 1W.
F) 0. First branch dreult , $ 37,50
Each additional branch circuit ] S 5.35
•
the Ins : : Ilation Is being made on property I own which is not 4e. Miscellaneous
Intends . for sale, lease or rent. (Sendai or feeder not Included)
Each pump or irrigation circle S 42.75
Owner': Signature Each sign or outline lighting : $ 42.75
Signal dreull(s) or a limited energy
a. P : n Review section (if required):* panL alteration or extension s 60.00
Minor Labels (10) $ 107.00 •
•
Pleas check appropriate Item and enter fee in section 5B. 41. 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 800 volts nominal In Plant ,
$ 59.00
•
Classified area or structure containing special occupancy is
described In N.E.C. Chapter 5 5. Fees:
Se. Enter total of above fees S 1 12.e5 -
•; Subm ■ 2 seta of plans with application where any of the above apply, 5% Surcharge (.05 X total fees) S
Not re uired for temporary construction services, Subtotal $
sb. Enter 25% dike de for
NOTICE • Plan Review if retui e4 (Sec. 3) $
PERMIT • BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal S - -
IS NOT •OMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR , ,,
r
yNORK I • SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS Trust Account # t Z 20 cY
d T ANY IME AFTER WORK IS COMMENCED. Total balance Due 5 A L .271
i e\rlcrlric Mr
•
,CITE OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested / - 2 2_ — u / AM PM BLD
/
Location l ' _ D , Suite MEC
Contact Person Ph PLM
Contractor A e- j S i g-- Ph SWR
BUILDING Tenant/Owner ELC 0-007e2
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
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
FAIL
C'SLECTRIC
Service
Rough In
UG /Slab
Low Voltage
Fi larm
in
ASS PART FAIL
S
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 /A-0/ d/ InS ector Ext
Other Inspector
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.