Permit J CITY OF TIGARD
DEVELOPMENT SERVICES ELECTRICAL PERMIT
rlli'� PERMIT #: ELC9E -0816
:_.. 13125 SW Hall Blvd., Tigard, OR97223 (503)639.4171 DATE ISSUED: 12/30/96
PARCEL: 2S112AD -00900
SITE ADDRESS...: 14800 SW SEQUOIA PKWY
SUBDIVISION • ZONING:I —P
•
BLOCK • LOT
Project Description: instl signal circuit /limited energy panel
- -- 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.. • 1
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.: 0 PER HOUR • 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 0 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
WON PARK type amount by date recpt
13056 SW TEAROSE WY PRMT $ 40.00 TAT 12/30/96 96- 288232
5PCT $ 2.00 TAA 12/30/96 96- 288232
TIGARD OR 97223
Phone #: 590 -7308
Contractor: --
ACTION TECHNOLOGY SYSTEMS $ 42.00 TOTAL
(TELEPHONE R- ALARM SUPPLY)
835 SE 17TH AVE REQUIRED INSPECTIONS
PORTLAND OR 97214 Ceiling Cover Underground Cove
Phone #: 503 -231 -1992 Wal]. Cover Elect'l Service
Reg #..: 007913
This persit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permtlle Signature
applicable laws. All work will be done in accordance with
approved plans. This perm; will expire if work is not started
within 180 days of issuance, or if work is suspended for yore
than 180 days. 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 : DATE:
LICENSE NO:
Call for inspection — 639 -4175
art O TIGARD Electrical Permit Application Plan Check It
13125 SW HALL BLVD. Rec'd By
TIGARD OR 97223 Date Recd
Date to P.E.
Phone (503) 639 -4171, x304
Print or Type Date to DST
Inspection (503) 639 - 4175 Permit it 64--( Ois 1 l
Fax (503) 684 Incomplete or illegible will not be acce Called
1. Job Address: 14800 SW Sequoia Pkwy 4. Complete Fee Schedule Below:
Name of Development `.'.J ;.-.■ Number of Inspections per permit allowed
Name (or name of business) CUPS -ABOVE Service included: Items Cost Sum
Address 14800 SW Sequoia Pkwy 4a. Residential - per unit
City /State /Zip TIGARD , OR 1000 sq. ft. or less $110.00 4
Each additional 500 sq. It. or
portion thereof $25.00 1
Commercial El Residential ❑ Limited Energy $25.00
Each Maned Homo or Modular
Uwollinq Sorvice or Foodor . $68.00 2
2a. Contractor installation only:
(Attach copy of all current licenses) 4b. Services or Feeders
Electrical Contractor ACTION TECHNOLOGY SYSTEMS Installation, alteration, or relocation
Address 835 SE 17th Avenue 200 amps or less $60.00 2
201 amps to 400 amps $80.00 2
City PORTLAND State OR Zip 97214 401 amps to 600 amps $120.00 2
Phone No. 231 -1992 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. Zb- / / 5ULE Exp.Date i=15=98-- Reconnect only $50.00 2
OR State CCB Reg. No. 79136 Exp.Date 1 -15 -9 / 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Supr. Elec'n 201 amps to 400 amps $75.00 2
401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. 579JLE Exp.Date 1 -1 -98 see "b" above.
Phone No. 'L.i1 -1992
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 lee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 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 X $40.00 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:
Not required for temporary construction services. 5a. Enter total of above fees $ 40.00
5% Surcharge (.05 X total fees) $ 7
NOTICE Subtotal $
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 # 42.00
Total balance Due $
I:1DSTSVELC98.APP Rev 9/98
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 3 '2 "71 AM PM BLD
Location I l Agtib S u �) l C� ICitrl� " �( Suite MEC
Contact Person U Ph PLM
Contractor Ph SWR
BUILDING '4111rOwner 132 Shf emsletz, d ' ELC q i)
Retaining Wall ¢•1CW - 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
PASS PART FAIL
(ELECTRICAL)
She vtce - -�`
Rough In /
UG /Slab
Low Voltage
Fire Alarm
- ART 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 ate 3 Ext
~ J Inspector E
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.