Permit CITY F T I G A R D ELECTRICAL PERMIT
;
PERMIT #: ELC1999 -00687
(l DEVELOPMENT SERVICES DATE ISSUED: 11/15/1999
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S126C0 -01107
SITE ADDRESS: 09700 SW WASHINGTON SQUARE RD
SUBDIVISION: NORDS ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: First branch circuit
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: 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:
WASHINGTON SQUARE INC NEW TECH ELECTRIC
P O BOX 21545 1400 NE 48TH AVE
SEATTLE, WA 98111 HILLSBORO, OR 97124
Phone: Phone: 503 - 648 -1900
Reg #: LIC 41868
SUP 2113s
ELE 26 -418c
FEES Required Inspections
Type By Date Amount Receipt
Elect'I Service
PRMT BON 11/15/1995 $37.50 99- 319781 Elect'l Final
5PCT BON 11/15/1995 $3.00 99- 319781
Total $40.50 ORIGINAL
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 ISSUED BY:
� pl, ,
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: 71A _ DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
CITY, F TIGARD Electrical Permit Application Plan Check t
•13125 SW HALL BLVD. Rec'd By 0
TIGARD OR 97223 RECEIVED Date Rec'd 1l'15 - '11
Date to P.E.
Phone (503) 639 -4171, x304 NOV 151999 Date to DST
Inspection (503) 639 -4175 Print of Type Permit# EiLI Pr�o`67
Fax (503) 598 - 1960 COMMUNITY DEVEUIfplete or illegible will not be accepted Called
1. Job Address:
'� // 4. Complete Fee Schedule Below:
Name of Development�UO ,!/72# t %awe Number of Inspections per permit allowed
Name (or name of business) , h''.' v .4 .i 2 t� Service included: Items Cost Sum
Address 9 90� 4G& oQ/l.�j/% ierj .GLQ �£ 4a. Residential - per unit
n Each additional 500 sq. ft. or
(� 1000 sq. ft. or less $ 117 75 4
City/State /Zip /
,/ portion thereof $ 26'25 1
Commercial 1r 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 data v - � =). qy- / 4 / Installation, alteration, or relocation
Electrical Contractor /./ t/ / 200 amps or less $ 64.25 2
Address /// ■ -- !2� /�
201 amps to 400 amps $ 85.50 2
Cityf i T/ 4 ' • State /fr Zip - g 401 amps to 600 amps $ 128.50 2
601 amps to 1000 amps $ 192.50 2
Phone No. 0(V Over 1000 amps or volts $ 363.75 2
,.
Job No. ),33 Reconnect only $ 53.50 2
Elec. Cont. Lice. No. g, c:PC Exp.Date 4c. Temporary Services or Feeders
OR State CCB Reg. No. 4/ld6rf' Exp.Date 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
/0/44K-4/Af 6� ,.� 401 amps to 600 amps $ 107.00 2
Signature of Supr. Elec Over 600 amps to 1000 volts,
.� ` see "b" above.
License No. L/ /� S Exp.Date iirO/ O/ 4d. Branch Circuits
Phone No. -/ 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.
Phone No. First branch circuit / $ 37.50 37c/'')
�! (,J
Each additional branch circuit $ 5.35
The installation is being made on property I own which is not 4e. Miscellaneous
intended for sale, lease or rent. (Service or feeder not included)
Each pump or imgation circle $ 42.75
Owner's Signature Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy
3. Plan Review section (if required):*
panel, alteration or extension $ 60.00
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: �] C
5a. Enter total of above fees $ / 50
* Submit 2 sets of plans with application where any of the above apply. .444.40. Surcharge (.05 X total fees) $ (�)
7
Not required for temporary construction services. 7 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 ❑ Trust Account #
AT ANY TIME AFTER WORK IS COMMENCED Total balance Due $/O 6O
is \dsts \forms \electric doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
/ BUP
Date Requested /d , 1 1 J AM PM BLD
Location q7 s4) £L -$ J riv -LQ e€1 L —Suite MEC
Contact Person a (.P SCa-. J Akis ec' - Ph b`r`a 1 (57) PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC ! C g9serb(P f
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 ,�( 1 / �[
Drywall Nailing C IO C-- t DvYI — cJ / �
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final 1 44 /—
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
P AS FAIL
Rough In
UG /Slab !I
Low Voltage
Fire Alarm
�'i
- ART FAIL
BackfilUGrading
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 �S
Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.