Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC1999 -00526
Rio, DEVELOPMENT Tigard, SERVICES (503) 39 -4171 CES DATE ISSUED: 8/25/99
"7 1 I 13125 SW Hall Blvd..
PARCEL: 2S103AA -00101
SITE ADDRESS: 10865 SW WALNUT ST
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT : JURISDICTION: TIG
Project Description: Signal circuit or limited energy.
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: 1
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:
SCHOOL DISTRICT NO 23 J ADAMS ELECTRIC CO INC
13137 SW PACIFIC HWY 7980 SE 17TH AVE
TIGARD, OR 97223 PORTLAND, OR 97202
Phone: Phone: 234 -9651
Reg #: LIC 00000596
SUP 2056s
ELE 26 -5C
FEES Required Inspections
Type By Date Amount Receipt
Elect'l Final
PRMT GEO 8/25/99 $60.00 99- 317942
5PCT GEO 8/25/99 $4.20 99- 317942
Total $64.20 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: 4 ")
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: e''" DATE: S'as
LICENSE NO: oZOSG- S
Call 639 -4175 by 7:00pm for an inspection the next business day
08/23/99 MON 10:46 FAX 503 598 1960 CITY OF TIGARD IJ002
CI iY OF TIGARD Electrical Permit Application Plan Check#
13125 SW HALL BLVD. RECEIVED Redd By
TIGARD OR 97223 Data Redd
Data to P.E.
Phone (503) 639 -4171, x304 AUG 2 51999 Date to DST
Inspection (503) 639 -4175 Print of Type Penult #iLG /? GoG
COMMUNITY DEVELOPR)
Fax (503) 596 -1960
Incompi or illegible will not be accepted caned
1. Job Address: r- u� 1 4. Complete Fee Schedu Below:
t
Name of Development e L£ tQ y� t /11 e Cc.,1 AA.. Number of Inspections per permit allowed
Name (or name of business) Service included: Items Cost Sum •
Address I 0 S 5 " S. 4) WA i_ 4 i 1" 4a. Residential - per unit
City/State/ Tit AR. Dad 9 i va - at-3 1000 sq. ft. or less $ 117.76 4
Each additional 500 sq. ft. or
portion thereof $ 26.76 1
Commercial ti4 Residential ❑ Limited Energy $ 60.00
Each Manurd 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 a ). iusiailatiorr, elleralion, or ieivwiiuii
Electrical Contractor Awl. [14:e.;1 n. lr. ) =sae. 200 amps or less $ 64.25 2
Add 198r) S. E, . 1111. 201 amps to 400 amps $ 85.50 2
City a St a t e r 0 QC Zip 6 1 ° - j 2.OZ 401 amps to 00 amps $ 128.50 2
ry p 601 amps to 1000 amps $ 192.50 2
Phone No. , 2 3 957 Over 1000 amps or volts $ 363.75 2
Job No. „3.2 /ea, A Reconnect only $ 53.50 2
Elec. Cont. Lice. No. .,.."lo -SC-- Exp.Date / / - 99 lit. 4c. Temporary Services or Feeders
OR State CCB Reg. No. . -13 Exp.Date / 7 -O/ ix Installation, alteration, or relocation •
COT Business Tax or Metro No. /076 Exp.Date 7 O ® 200 amps or less $ 53.50 2
201 amps to 400 amps $ 80.26 2
Signature of Supr. EIec53.‘: - a 4 ve r a mps 600 to 800 to amps 1000 volts, $ 107.00 2
•
amps
License No. --. d , ..:6 - 6. - S Exp.Date / 9 / 014_ sae "b" above.
Phone No. 2 3 9 76 / 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 dreult $ 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
Each additional branch circuit ' $ 6.35
The installation is being made on property I own which is not 4e. Miscellaneous
intended for sale, lease or rent. (Service or feeder riot included)
Each pump or irrigation circle $ 42.75
Owner's Signature Each sign or outline lighting $ 42.75
Signal ctrcuit(s) or a limited energy
3. Plan Review section if 176 ulred :* panel. Labels (10) or extension $ 60.00 fp o,DO
q � 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
Por hour $ 60.00
,System over 800 volts nominal In Plant $ 59.00
Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 5. Fees:
5a. Enter total of above fees $ 6r0'
* Submit 2 sets of plans with application where any of the above apply. 7% Surcharge (.05 X total fees) $ -V 2.O
Not required for temporary construction services. Subtotal $
66. 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 FORA PERIOD OF 180 DAYS ❑ Trust Account# , �1
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ (07
is \dsts \ forms \electric.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
•24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
n / Date Requested ‘/2- (/6 O g PM BLD
Location \ Lc �
` Suite MEC
Contact Person `/e-U + Ph7, 1 ?Pc PLM •
Contractor Ph X 1 0 SWR
BUILDING Tenant/Owner SOT 1.ZYZ- -- t=1 : 11)Le 7 : -- '
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Slab
Crawl Drain Inspection Notes: . \ ., a ,� S ,Q, SGN
Post & Beam �i SIT
Ext Sheath /Shear
Int Sheath /Shear •
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler Y _ JAL
Fire Alarm
Susp'd Ceiling •
Roof A
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 P RT FAIL (6Th
ECTRIC /
Service
Rough In
UG /Slab
ow Volt ge
•ART 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
Other Date —2 (v //
—0 O Inspector 4,, eix, Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.