Permit ELECTRICAL PERMIT
CITY OF T I G A R D PERMIT #: ELC1999-00348
111 DEVELOPMENT SERVICES DATE ISSUED: 6/14/99
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S101 DA -02100
SITE ADDRESS: 06960 SW VARNS ST
SUBDIVISION: VARNS ACRES ZONING: C -P
BLOCK: LOT : 003 JURISDICTION: TIG
Proiect Description: Installation of a 200 AMP serivce/feeder.
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:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 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:
OBIE MEDIA JARMER ELECTRIC INC
6960 SW VARNS STREET 5105 SW 45TH AVE
TIGARD, OR 97223 , PORTLAND, OR 97221
Phone: Phone: 246 -5381
Reg #: LIC 00006924
SUP 3488s
ELE 26 -144C
FEES Required Inspections
Type By Date Amount Receipt Elect'l Service
PRMT GEO 6/14/99 $64.25 99- 316106 Elea! Final
5PCT GEO 6/14/99 $3.21 99- 316106
Y t
Total $67.46 L ' ' ' y
This Permit is issued subject to the regulations contained in the Tigard Municipal 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 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. /
/ i
Permit Signature: 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:G
LICENSE NO: 3
Call 639 -4175 by 7:00pm for an inspection the next business day
2- ,
RECEIVED
CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. JUN 11 1999 Rec'd By
Date Rec'd
TIGARD OR 97223 Date to P.E.
Phone (503) 639 -4171, x3U� DEVELOPMEN �' Date to DST
Print or Type
Inspection (503) 639 -4175 Permit # ote m9 - 60 34g
Fax (503) 684 -7297 Incomplete or illegible will not be ac t ed Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) obit Aer.‘ in . Service included: Items Cost Sum
I
Address (O loo S uo f r/Arrn , 4a. Residential - per unit
� - r 1000 sq. ft. or less $110.00 4
City /State /Zip I 110.4 0 ci 7 Z2 3 Each additional 500 sq. ft. or
Commercial IJ 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 G 4_ '
/ Installation, alteration, or relocation (�¢ A ,�
G ,."_,,,,,, G ,."_,,,,,,,, \ Electrical Contractor G ,."_,,,,,,,, \ Q e, s _
• ) �f Jule 200 amps or less - $6e76e 2
Addtess • '1 4' 4 -6 , • 201 amps to 400 amps $80.00 2
Cit .A.-1-, J ' ■ �, -, _. State b (R Zip 9 7 a ( 401 amps to 600 amps $120.00 2
Phone No. a k4 b - S . 6 J 601 amps to 1000 amps $180.00 2
9 Over 1000 amps or volts $340.00 2
Job No. 1 Reconnect only $50.00 2
Elec. Cont. Lice. No. a (o ! 1-4 4 ( Exp.Date /
OR State CCB Reg. No. l.2 9 a L) Exp.Date 3 0 / of 4c. Temporary Services or Feeders
COT Business Tax or Metro N000c c 3 i aE_ x .D 3 ® Installation, alteration, or relocation
200 amps or less $50.00 2
-
Signature of Supr. Eisen - 201 amps to 400 amps $75.00 2
401 amps to 600 amps $100.00 2
-
Over 600 amps to 1000 volts,
License No. 39- T S S Ex Date 1 01 9' 9 see "b" above.
Phone No. .. 1}(o- �i.--), R I
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 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: -4. 0
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $
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 & l �lo
TIME AFTER WORK IS COMMENCED. ❑ Trust Account #
$
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
604-74 BUP
Date Requested AM PM BLD
Location 69%0 V an V) s Suite / MEC
Contact Person TAiv tvLe/t, Ph 2-. I PLM •
Contractor Ph SWR
BUILDING Tenant/Owner ELC [ 1 G
/ e l _-( )39g
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 . — d/ � 5
Drywall Nailing .�JS� — lac ,e . ■.��
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 it
Rain Drains
Final ►
PASS PART FAIL •
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
etre
SVige.)
Rough In
UG /Slab
Low Voltage
Fire Alarm
4141
,'A 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 /' •
- Other oach /Sidewalk Date 6 /7 9P Inspector Ext
Final
. PASS PART FAIL D NOT REMOVE this inspection record from the job site.