Permit C ELECTRICAL PERMIT
CITY O F T I G A R D
PERMIT #: ELC2000 -00104
A lk_ ti DEVELOPMENT SERVICES DATE ISSUED: 03/15/2000
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 25101 DC -03800
SITE ArDRESS: 07180 SW SANDBURG ST 100 •
SUBDIVISION: ZONING: I -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of a signal circuit or limited energy panel.
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: 1
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: 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:
WILLIAM MCCORMACK AMERICAN TELECOM INC
7415 SW FAIRWAY LOOP 2410 SE 11TH AVE
WILSONVILLE, OR 97 PORTLAND, OR 97214
Phone: Phone: 236 - 8991
Reg #: LIC 0077238
ELE 26 -763CL
FEES Required Inspections
Type By Date Amount Receipt
Elect'I Service
PRMT GEO 03/15/200C $60.00 0000664 Elect'I Final
5PCT GEO 03/15/200C $4.80 0000664
Total $64.80 ORIGINAL
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 acoo . - . ith approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 181 days. A . NTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 95 - 001 -0010 thri OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNA - � � �� ISSUED BY: 4�_
OWNER INSTALLATION ONL
The installation is being made on probe I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: a DATE /
LICENSE NO: 19/a
Call 639 -4175 by 7:00pm for an inspection the next business day
Ts ' Plan Check#
�F TIGARD Electrical Permit Application
1,. 5 SW HALL BLVD. Rec'd By
TIGARD OR 97223 Date Rec'd
Date to P.E.
Phone (503) 639 -4171, x304
Date to DST
Inspection (503) 639 -4175 Print of Type Permit # d -60
Fax (503) 598 -1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development d g6 C) Number of Inspections per permit allowed
Name (or name of business) llMIII �i 1 I II\ Service included: Items Cost Sum 4'
Address to ��0 1I • 4a. Residential - per unit
City/State /Zip ` i► 'ii 1000 sq. ft. or less $ 117.75 4
Each additional 500 sq. ft. or
r
portion thereof $ 26.25 1
Commercial Residential ❑ Limited Energy $ 60.00
Each Manufd Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit issuan : applicants must provide con r ctor license 4b. Services or Feeders
information for COT da i ,. . e). �Th Installation, alteration, or relocation
Electrical C • tractor ` Vic. ■ ■ ? 0_ *a 200 amps or less $ 64.25 2
Ad. - s * • graMilltgr ■, 201 amps to 400 amps $ 85.50 2
Ci v4D _ State �/_ 'l • Zip swot, 401 amps to 600 amps
601 amps to 1000 amps $ 128.50
$ 192.50 2
� �I /� 2
Phone No. ' i ve Over 1000 amps or volts $ 363.75 2
Job No. Le • Reconnect only $ 53.50 2
Elec. Cont. Lice. No. 1MPU( Exp.Date IW 1 4c. Temporary Services or Feeders
OR State CCB Reg. No. IG��t . Exp.Date 11' awe Installation, alteration, or relocation
COT Business Tax or Me h o No. Exp.Date 200 amps or less $ 53.50 2
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n 1 V v 401 amps to 600 amps $ 107.00 2
Over 600 amps to 1000 volts,
I r1, 1 .7 9 92 see "b" above.
License No. ` E .Date 1 JJ �/v
3 1 6 4d. Branch Circuits
Phone No. J t,.i 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 Name Each branch circuit $ 5.35 2
Address b) The fee for branch circuits
without purchase of service
City State Zip or feeder fee.
Phone No. First branch circuit $ 37.50
Each additional branch circuit $ 5.35
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
Owner's Signature Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy .
* panel, alteration or extension $ 60.00
3. Plan Review section (if required): Minor Labels (10) 111 $
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:
5a. Enter total of above fees $
* Submit 2 sets of plans with application where any of the above apply. a r a yt Surcharge (.96 X total fees) $
Not required for temporary construction services. Subtotal r $
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 # ¢
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ . v
is \dsts \forms \electric.doc out aQ00 - Al
06/09/2000 Activities for Case #: ELC2000 -00104
10:29:04 AM
Assigned Hold Updated •
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 03/15/2000 GEO RECD No Hold GEO 03/15/2000
ELCC003 Permit created 03/15/2000 GEO DONE No Hold GEO 03/15/2000
ELCC730 Elect'l Service No Hold GEO 03/15/2000
ELCC799 Elect'I Final 03/29/2000 CD PASS No Hold AKJ 03/29/2000
ELCC500 (F)Issue permit 03/15/2000 GEO DONE No Hold GEO 03/15/2000
ELCC720 Wall Cover 03/17/2000 CD PASS No Hold AKJ 03/19/2000
ELCA800 Case finaled 03/29/2000 AKJ DONE No Hold AKJ 03/29/2000
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 2 - 6 ? 00 AM PM BLD
Location - I SCE S / / Suite/DO so MEC
Contact Person Si S /\ Ph 2, 3 3 PLM
Contractor g A-L4 Oi2 f 2 D Ph SWR
BUILDING Tenant/Owner ELC ZOC) CO)O(p
Retaining Wall Eta ze — s(''/Q
Footing Access: V
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall // Q
Fire Sprinkler / 444
Fire Alarm
Susp'd Ceiling `
Roof ()
Misc: `��
Final
PASS PART FAIL
PLUMBING C 2 7 /0 V — /
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
EEECTRIC
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
ft 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 7 Date 3 �l Inspector a Ext
Final
—
PASS PART FAIL 0 NOT REMOVE this inspection record from the job site.