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Permit { CITY OF TIGARD ELECTRICAL PERMIT DEVELOPMENT SERVICES PERMIT #: ELC99 -0043 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 0 i i 19 / 99 PARCEL: 2S112DD -01300 SITE ADDRESS ° °. :15650 SW UPPER BOONES FERRY RD SUBDIVISION ZONING :C -G BLOCK LOT ° ° ° °. °. ° ° ° ° ° °: JURISDICTION: TIG Proj ect Description: Add twenty (20) branch circuits. - - -- 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 ° °.. ° ° °: 0 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 °: 1 PER HOUR ° 0 401 - 600 amp ° °.. ° °: 0 EA ADD'L BRNCH CIRC: 19 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 - BURGERVILLE USA type amount by date recpt 15650 SW UPPER BOONES FERRY RD PRMT $ 130 °00 GEO 01/19/99 99- 312255 TIGARD OR 97223 5PCT v 6.50 GEO 01/19/99 99- 312255 Phone #: Contractor: ------------------ DELSTAR ELECTRIC INC g 136.50 TOTAL PO BOX 1371 - -- REQUIRED INSPECTIONS - -• - -- TUALATIN OR 97062 Elect'l Service Phone #: 692 -3219 Elect'l Final Reg #..: 000636 This peroit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This peroit will expire if work is not started within 1821 days of issuance, or if work is suspended for Dore than 180 da - ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Centel. V rules ar se in OAR 952 -001 -0010 through OAR 952 - 021-1987. You Day obtain a copy of these rules or direct questions to 1 'C by n (51 187. Permittee Signature :,_11��y`_ � L , _ Issued By- .1114 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: 69-71J ��` DATE: / /7 LICENSE NO: j 3.15 +++++++++++4.++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ Call 639 -4175 by 7 :00 p °m° for an inspection needed the next business day ++++++++++++++++++++++++++++++ i•+++++++++++++++++ + +++ + ++ ++ + + + + + + ++ + + + + + + + + + + + + ++ i CITY OF TIGARD Electrical Permit Application Plan Check # 13125 SW HALL BLVD. Rec'd By TIGARD OR 97223 Date Rec'd Date to P.E. Phone (503) 639 -4171, x304 Date to DST Print or Type 4 c- 99- o �� Inspection (503) 639 -4175 Permit# Incomplete or illegible will not be accepted Fax (503) 684 -7297 Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development Number of Inspections per permit allowed Name (or name of business) B (2(mt= 2vt i ll- OSP\ Service included: Items Cost Sum I Address /.S Cot D SVI l 7PPe i�oo►-1-t_`S cE- 2`( -ate 4a. Residential - per unit sq. ft. City /State /Zip 11(. t Each ad I -i. , 0 2- or less $110.00 4 Each dit dional 500 sq. ft. or Commercial pi. Residential El Limited thereof $25.00 1 Limited Energy $25.00 Each Manuf'd Home or Modular Dwelling Service or Feeder $68.00 2 2a. Contractor installation only: (Attach copy of all current licenses 4b. Services or Feeders Electrical Contractor "Dt=i nTP R L LT1Z.t-C.. inlC_ . Installation, alteration, or relocation Address - P.0 . . bst l l 200 amps or less $60.00 2 �4i © 201 amps to 400 amps $80.00 2 y j.hf�.t Cit frJ iZ Zip p q ZO Q2. 401 amps to 600 amps $120.00 2 Phone No. lo 321.4 601 amps to 1000 amps $180.00 2 Job No. Over 1000 amps or volts $340.00 2 Reconnect only $50.00 2 Elec. Cont. Lice. No. 3 2 i 4 1 e- Exp.Date 379 9 OR State CCB Reg. No. - . . Exp.Da - . .-- • 4c. Temporary Services or Feeders COT Business Tax or Metro i ► - . •� - Installation, alteration, or relocation �;m: 200 amps or less $50.00 2 Signature of Supr. Elec'n 4 J ��� 201 amps to 400 amps $5.00 2 NM 401 amps to 600 amps $100.00 2 Over 600 amps to 1000 volts, License No. 32t�.S p.Date to /zDOv see "b "above. Phone No. C947- ,2.-/7 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 circ $5.00 2 b) The fee 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 $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 $ I 5% Surcharge (.05 X total fees) $ _____Lelp 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 # /(p. Total balance Due $ I \DSTS \ELC96 APP Rev 9/96 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP // 1p 57. Date Requested ��J AM PM BLD Location ./ _ /� , /� /� ���. Suite MEC Contact Person Ph /, - PLM Contractor Ph .3 7 Sc2f/Q'SWR pG� / / BUILDING Tenant/Owner /��,/1t�� ELC / /'607,3 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 4i 1Q0 j c i 1 /Pi C / (� — /9r FprPi),"nit e �q Firewall Fire Sprinkler S u s p la Ceiling ! � di ( Cf pia 8GY S KO CD 171/0 /j/ Sus 'd Ceilin // 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 PAS T FAIL LECTR Service Rough In UG /Slab Low Voltage Fire Alarm oral PASS 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: Adia [ ] Unable to inspect - no access ADA ill" Approach /Sidewalk p Other D a t e ' / l Inspe " E x t Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.