Permit .- CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC2000 -00526
11t, DEVELOPMENT SERVICES DATE ISSUED: 9/1/00
- I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S134BC-00900
SITE ADDRESS: 12394 SW SCHOLLS FERRY RD
SUBDIVISION: PP1993 -058 ZONING: C -G .
BLOCK: LOT : 003 JURISDICTION: TIG
Project Description: Installation of temporary service of 200 amps or less for new construction.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: 0 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: 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:
DENNIS THOMPSON VIKING ELECTRIC INC
12475 SW MAIN 4326 SE WOODSTOCK
TIGARD, OR 97223 STE 518
PORTLAND, OR 97206
Phone: 503 - 781 -0124 Phone: 775 -3479
Reg #: LIC 00056527
SUP 3088S
ELE 26 -569C
FEES Required Inspections
Type By Date Amount Receipt
Elect'l Service
PRMT CTR 9/1/00 $53.50 2720000000( Elect'I Final
5PCT CTR 9/1/00 $4.28 2720000000(
Total $57,78
This Permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Spedalty 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 -_ •p - • • • - Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain •, lies of these rulesordirect questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE ISS D BY: / ���� , /
OWNER INSTALLATION ONLY
The installation is being ma• on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTO' LATION ONLY
SIGNATURE OF SAM. ELEC'N: %. ):� ( DATE:
LICENSE NO:o�V",
Call 639 -4175 by 7:00pm for an inspection the next business day
CITY OF TIGARD Plan Ch: do #
ri
f3125tW HALL BLVD. Electrical Permit Application Recd B _
TIGARD OR 97223 Date Recd - ��
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print of Type Permit # E'GL'a '05,0
Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below: -
Name of Development Number of Inspections per permit allowed
Name (or name of business a Few 4UT0 iP�PA'ff Service included: Items Cost Sum 4'
Address 123 9 f S w ,SC/-IcLL s FFlt4r RD 4a. Residential - per unit
City /State/Zip - 1 - /64 - 10 0 Cj -7 2 L 3 1000 sq. ft. or less $ 117.75 4
/ / Each additional 500 sq. ft. or
portion thereof $ 2615 1
Commercial X 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). K-111) G A I alteration, or relocation
Electrical Contractor I E L rC7 /b ` 200 amps or less $ 64.25 2
Address *3.2 6 S cucoDsmctr ►v) S/ g 201 amps to 400 amps $ 85.50 2
City 0 _ W0 State Zip 9 72. Ob 401 amps to 600 amps $ 128.50 2
Phone No. 0 77 3 ' 7q 601 amps to 1000 amps $ 192.50 2
Over 1000 amps or volts $ 363.75 2
Job No. Reconnect only $ 53.50 2
Elec. Cont. Lice. No. 2 6 - 5'41 C. Exp.Date /0 -/ - et .4c. Temporary Services or Feeders
OR State CCB Reg. No. 5 7 Exp.Date 5--/Z _0 Z Installation, alteration, or relocation
COT Business Tax or Metro No. l-O 75' Exp Date -/ - Q 200 amps or less / $ 53.50 , 3, 327 2
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n 401 amps to 600 amps $ 107.00 2
Over 600 amps to 1000 volts,
see "b" above.
License No. 30gcs Exp.Date /0-1-0/ 4d. Branch Circuits
Phone No. 775' 3 71 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
3. Plan Review section (if required):*
panel, alteration or extension $ 60.00
Minor Labels bels (10) $ 4$446
Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over eU
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 $ 5 foe * Submit 2 sets of plans with application where any of the above apply. r7 % Surcharge (. tal fees) $
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 $ Iibj;
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 $ S7, 70'
i:\dsts\forms\electric.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 7Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 7 , AM PM BLD
Location / 2 ..3 5 — w -5ci /43- ^ / 7 A Suite MEC
Contact Person i Ph , 319 6 4 PLM
Contractor V i lC r ni G E 7� e_.A..L, Ph SWR
BUILDING Tenant/Owner ELC ZCvv- aU 52
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
ic::
Fire Sprinkler -ef
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final � o
PASS PART FAIL �L ez—
PLUMBING i
Post & Beam
Under Slab
6-
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
P SS _ E RT FAIL
_XLECTRICJ.>
Service .4,„,,
Rough In
UG /Slab
Low Voltage
Fire Alarm
F '
AS PART FAIL
S E
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 reinsp ction RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date / Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.