Permit CITY OF TI G A R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00038
I ;� DEVELOPMENT SERVICES DATE ISSUED: 1/19/01
,.� 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S1 12 DA -01400
SITE ADDRESS: 15350 SW SEQUOIA PKWY 100
SUBDIVISION: PP1996 -048 ZONING: I -P
BLOCK: LOT : 002 JURISDICTION: TIG
Project Description: Connect (4) signs
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: 4
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:
PACIFIC REALTY ASSOCIATES TUBE ART DISPLAYS
15350 SW SEQUOIA PKWY #300 -WMI 4243 -A SE INTERNATIONAL WAY
PORTLAND, OR 97224 MILWAUKIE, OR • 97222
Phone: Phone: 503 - 653 -1133
Reg #: LIC 00070956
SUP 366SIG
ELE 37- 554CLS
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 1/19/01 $213.60 2720010000( Elect'I Final
5PCT CTR 1/19/01 $18.00 2720010000(
Total $231.60
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 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
64 ISSUED BY:
,c
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 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
Datereceived: l 14 I o l Permit no. :, g 001
, i- ,,,.i. City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171 ..
Fax: (503). 598 -1960 Case file no.: _ Payment type: - -
Land use approval:
TYPE OF PERMIT '
0 1 & 2 family dwelling or accessory tommercial/industrial 0 Multi- family 0 Tenant improvement
O New construction 0 Addition/alteration /replacement 0 Other. _ 0 Partial
JOB SITE INFORMATION
Job address: / )3C3 60 ' QO014 Bldg. no.: 7 Suite no.: Tax map/tax lot/account no.:
Lot: ,Block: (Subdivision: /l�
Project name: fl4a6u, ascription an location of work on premises: — // , c t)
Estimated date of completion/inspection: n� P 0 alI!M�� l_ Y 07746.1e5'
CONTRACTOR APPLICATION FEE SCIIEDU.E
Job no: 2_1 "15Gl I , Fee Max
_ ea
Business name: t E , r f description Qty. (ea) Total no. trip
Address: ' 2• 'S- A � - ,Mpllgk• , . J d residential Includes -single attached per
City: ) t WA,i,( en State: Q ,e' ZIP: �y y .� Z Z Z/ Servtoeindad
Phone: 6p3S_(t I Fax q- e I C tI I E-mail: K iM[f+' 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: '7095 4, I Elec. bus. lic. noS'7_szICGS
� Limited energy, residential 2
City / t rO ic. no.: 5 23 / ) / Limited energy, non- residential 2
411111P • _ / .1...._.......4 / Each manufactured home or modular dwelling
Signature of su. ising el -.. cian (requi -. Date Service and/or feeder 2
Sup. elect name (print): fRk .i z... License no: , cp. Services or feeders — Installation,
alteration or relocation:
PROPERTY OWNER. 200 amps or less 2
Name (print): eL i d, / '0 A., ; 201 amps to 400 amps 2
g address:/ 5,35 401 amps to 600 amps 2
Mailin address J 0
?/ ( I (J ZI 9 7.Zr f Over amps to amps amps 2
City:
"' " � `7 Over 1000 amps or volts 2
Phone: b — 77$•71 Fax: (E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - •
which is not intended for sale, lease, rent, or exchange according to Installation, alteration, or relocation:
ORS 447, 455, 479, 670,.701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: . . Date: 401 to 600 am .s 2
ENGINEER Branch circuits - new, alteration,
Name: or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
Phone Fax E -mail: of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc .(Serrlce or feeder not included):
O Service over 225 amps-commercial 0 Health-care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of 18c2 0 Hazardous location Each sign or outline lighting 2
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel.
O System over 600 volts nominal more residential units in one structure alteration, or extension* _ 2
O Building over three stories . 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional Inspection over the allowable in any of the above:
O Egress/lighting plan O Other Per inspection
Submit _ sets of plans with any of the above. . Investigation fee
. The above are not applicable to temporary construction service. Other
Permit fee $
Na an jurisdietiom accept audit cards, please call Jurisdiction for more information. Notice: This permit application Plan review (at O Visa 0 MasterCard expires if a permit is not obtained ( — %) $
Cram card number: / / within 180 days after it has been State surcharge (8%) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 4404615 (6100OCOM)
Electrical. Permit Fees: Limited Energy Fees:
- - - lete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee - •
• - - Number of Inspections per permit allowed • (FOR ALL SYSTEMS) "
Service included: - 'i Items Cost Total y Check Type of Work Involved:
Residential - per unit
1000 sq. ft or less $145.15 M4 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or -
• portion thereof - = ?• . - , , , $33.40 • . 1 - . ❑ - Burglar Alarm .
Limited Energy k ''. $75.00 . '
Each Manufd Home or Modular . El Garage Door Opener'
Dwelling Service'or Feeder ' -' $90.90' • • 2
- Services or Feeders , , . E] , Heating, Ventilation and Air Conditioning System' •
Installation, alteration;'or relocation' y
' ''20gan or less "' -' "
' • $80.30 2
-.201 amps to 40000 .amps .. ■ $106.85 • 2 ❑ ---'. Vacuum Systems'
_
401 amps to 600 amps $160.60 2 ,
601 amps to 1000 amps - $240.60 ' - . 2 - ❑ : Other
• Over 1000 amps or volts - . - - $454.65 - 2 .. -. - - - - • -- -
Reconnect only $66.85 2 '
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system ' $75.00
200 amps or less ' $66.85 . 2 - • - (SEE OAR 918 -260 -260) - - • .
201' amps to 400 amps ' - .1 $100.30 2 •
401 amps to 600 amps -. 4133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, -
see "b" above. • Audio and Stereo Systems
Branch Circuits El Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or , • ❑ - Clock Systems
feeder fee. •
Each branch circuit - - $6.65 ' _ 2 ❑ _ Data Telecommunication Installation •
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee. _ -
• First branch circuit • $46.85
Each additional branch circuit $6.65 ❑ HVAC
- Miscellaneous - •❑ Instrumentation -
.(Service or feeder not included) - .
Each pump or irrigation circle $ ❑ Intercom and Paging Systems •
I./ Each sign or outline lighting -- . $53.40 -
Signal circuit(s) or a limited energy . . • * '
panel, alteration or extension $75.00 • ❑ Landscape Irrigation Control
Minor Labels (10) - -. $125.00 •
. Each additional inspection over ❑ Medical
the allowable In any of the above
Per inspection $62.50 • El Nurse Calls
Per hour $62.50 .
In Plant $73.75 ❑ Outdoor Landscape Lighting*
Fees: T ❑ Protective Signaling •
Enter total of above fees ' • $ 13' (d n • Other •
8% State Surcharge • $ Number of Systems
. 25% Plan Review Fee
See 'Plan Review" section on $ No licenses are required. Licenses are required for all other installations
front of application. _ •
. - = - - Fees:
Total Balance Due N3 / t 6, O •
•
Enter total of above fees -$
-
0 Trust Account #
• - 8% State Surcharge $
-
• Total Balance Due $
i :\dsts\fo fees.doc 10/09/00 • _
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 i r►inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested ,2 ` / y AM PM BLD
Location /5 5� $ `° I. Q w l rs Suite 1 MEC
Contact Person // /("i Ph «f 3 / /'} 3 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC u u 3?
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
PASS PART FAIL
CtLEQXRICAN
Service
Rough In cum/ we
UG /Slab
Low Voltage 5 /P1
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
Other Date ‘ O Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.