Permit A- CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC1999 00684
DEVELOPMENT Tigard. OR (503) 39 -4171 RVICES DATE ISSUED: 11/15/1999
- 13125 SW Hall
PARCEL: 2S113AB-01201
SITE ADDRESS: 16280 SW UPPER BOONES FERRYRD
SUBDIVISION: BANfE0 CREEK ACRE TRACTS ZONING: I -L
BLOCK: LOT : JURISDICTION: TIG
Project Description: Electrical TI
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: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 19 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 RC COSTELLO
15350 SW SEQUOIA PKWY #300 -WMI 1439 SE 12TH LOOP
PORTLAND, OR 97224 CANBY, OR 97013
Phone: Phone: 266 -8483
Reg #: LIC 87402
ELE 3 -344C
SUP 3934S
•
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT BON 11/15/199E $139.15 99- 319768 Elect'I Final
5PCT BON 11/15/199E $11.13 99- 319768
Total $150.28 ORIGINA L
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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 lc — ISSUED BY: ( W
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: (7 . _ DATE / / /
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
CITY OF TIGARD Electrical Permit Application
PlanChec;f
A
1,31256SW HALL BLVD. Recd By I! iA
Date Rec'd - I _ -4' TIGARD OR 97223
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print of Type Permit # flLMg- ODIp V`l
Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called
1. Job Address: � 4. Complete Fee Schedule Below:
Name of Development L' r /u511 El /� / ,IP,Se e±..' Number of Inspections per permit allowed
Name (or name of business) FLT,g Sys 1E-pis p Service included: Items Cost Sum
Address /62E30 S W UPPF/e p 3 )&J Fra (4a• Residential - per unit
City /State /Zip /i`Gj(]i r � o � 9 7 22 4 Each ad t o less $ 117.75 4
7 Each additional 500 sq. ft. or
portion thereof $ 26.15 1
Commercial la^ 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 datae� Lim �� Installation, alteration, or relocation
Electrical Contractor a tor �i E GG f 2 (' 200 amps or less $ 64.25 2
Address 143 / l2 =)-/ ,..44. 201 amps to 400 amps $ 85.50 2
City an State /')2 Zip G7 601 amps to 1 p 13 401 amps to 1000 amp $ 128.50 2
000 am s $ 192.50 2
Phone No. / 2 6,6 - e ll2'S Over 1000 amps or volts $ 363.75 2
Job No. Reconnect only $ 53.50 2
Elec. Cont. Lice. No. • LAIC Exp.Date 0 1 46 4c. Temporary Services or Feeders
OR State CCB Reg. No. 1 02 Exp.Date Ill 13� o 2 - Installation, alteration, or relocation
COT Business Tax or Metro No. Exp.Date 200 amps or less $ 53.50 2
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n 401 amps to 600 amps $ 1 07.00 2
Over 600 amps to 1000 volts,
l� see "b" above.
License No. c, 3 C /3"1 S Exp.Date � 0 /
Phone No. o I g 3 4d. Branch Circuits 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. 7
Phone No. First branch circuit / $ 37.50 3 - 1,So
Each additional branch circuit rI $ 5.35 - '
The installation is being made on property I own which is not 4e. Miscellaneous IO(,4 $'
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
• panel, a alteration or extension $ 60.00
3. Plan Review section (if required):*
Minor Labels (10) $ 107.00
Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over
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: . q /
5a. Enter total of above fees $ 1 ! , IS
* Submit 2 sets of plans with application where any of the above apply. r % Surcharge (.05 X total fees) $ I , ii")
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 $
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD,OF 180 DAYS El Trust Account # w /
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ 1 5b • Z`6
is \dsts \forms \electric.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
UP
/ ,r_
/ Date Regquested t l )2� rip AM PM B LD
Location• I l0 uite #'i MEC Contact Person P-eit l 14 XL Ph 1(.4 3 3 33 P
Contractor Ph SWR
BUILDING Tenant/Owner , `'l.rt c. , ELC l 41 9 C - 1 - 06 (ogzt-
Retaining Wall EL 7
Footing \ Access:
Foundation FPS
Ftg Drain _ S
Crawl Drain Inspection Notes:
Slab _. SIT
Post & Beam
Ext Sheath /Shear
Int Framing ��� ct6
Framing ��ll`"'11
Insulation
Drywall Nailing . 20 C1 Q o U U 0 Q e( \ c )-A) S °`� C M
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final ]' // 5-
\/ � cS C � _ l S
PASS PART FAIL [ ( U/ °
PLUMBING (1),%
Post & Beam • (ir)
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
LCECTRICAt
Service
Rough In
UG /Slab
Low Voltage
Fire farm
li 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
Approach /Sidewalk Date l -/ / Oo Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.