Permit „
CITY OFTIGARD
,,,, ,, DEVELOPMENT SERVICES ELECTRICAL PERMIT #: ELC97-310
--. 13125SW Hall Blvd., Tigard, OR97223 (503)639.4171 DATE I ISSUED: 05 /27/97
PARCEL: 1S126DA -03522
SITE ADDRESS...:O9O85 SW WASHINGTON DR
SUBDIVISION ZONING:R -5
BLOCK • LOT JURISDICTION: WAC
Project Description: INSTL 2 BRANCH CIRCUITS // JOB # 97-616
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD'L 5O0SF...: 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/0 SRVC OR FDR.: 1 PER HOUR • 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 1 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
JANIS ROBERTS type amount by date recpt
9085 SW WASHINGTON DR PRMT $ 40.00 TAT 05/15/97 97- 294649
TIGARD OR 97223 5PCT $ 2.00 TAT 05/15/97 97- 294649
Phone #: .
Contractor:
THE ELECTRIC GROUP $ 42.00 TOTAL
4726 SE MILWAUKIE AVE
REQUIRED INSPECTIONS
PORTLAND OR 97202 Ceiling Cover Underground Cove
Phone #: 232 -2499 Wall Cover Elect' 1 Service
Reg #..: 000438
This permit is issued subject to the regulations contained in the v 4/itel,,,,t iL
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permit e Signat e
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started A
within 180 days of issuance, or if work is suspended for more .lip :(/�
than 1: days. 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 : (/ f'1. ./ ,iyjgi DATE: A7/,,
LICENSE NO: a0g 1S
Call for inspection — 639 -4175
r ` Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Permit # L C lq
1- 0'64)
-r)
, �,�, d , I , <� Date Issued °5/7-11/7
Iml" i Phone (503) 639 -4171
c "" FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
/
Address 0 8' S S l.J V./ 4-s 4-s h,INTIDA-) - 1)12, Service included: Items Cost(ea) Sum
City /State /Zip --- / - 7 � R9i2.G( / Of? '? 7 22- 3 4a. Residential - per unit
( 1000 sq. ft. or less $110.00 4
Name (or name of business)J4Ni5 �C� k( b�`5 Each additional 500 sq. ft or $zs 00
portion thereof 1
Commercial ❑ Residential Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
Electrical Contractor 771E ELEcrre c 60 2ou p I alteration, or relocation 2
200 amps or less $60 00
Address '"726 5 //9/G w.ON /c /E .aVe- 201 amps to 400 amps $80 00 2
401 am to 600 amps $120 00 2
City i L.a ND State0r2 Zip 97 $180.00 2
Phone No. ,..51:r3 - Z'� Z -2 c/ Over amps to amps amps
99 Over 1000 amps or volts $340.00 2
Job NO. 97- 6 5 /3- 9 Reconnect only $50.00 2
contractor's license NO. 26 yySC 4c. Temporary Services or Feeders
Contractor's Board Reg. No 6'3 S 5 Installation, alteration, or relocation
Signature of Sur. Elec'n ,- 200 amps or less 2
2
License No. des-------
Phone No. 201 amps to 400 amps $so 00 2
- 401 amps to 600 amps $75.00
Over 600 amps to 1000 volts $100.00
2b. For owner installations: see "b" above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee for branch circuits with
purchase of service or feeder fee. 2
City State Zip Each branch circuit $5.00
Phone No. b) The fee for branch circuits withou
The installation is being made on property I own which is purchase of service or feeder fee. 2
not intended for sale, lease or rent. Eat ddch na bit t $$5.00 3
Ea
a additional l branch circuit ( $5 00 $-^
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle $40 00 2
Each sign or outline lighting $40.00
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40.00
4 or more residential units in one structure Minor Labels (10) $100 00
Service and feeder 225 amps or more
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupanc the allowable in any of the above
Chapter 5 Per inspection $35.00
as described in N.E.C. Cha
p Per hour $55.00
In Plant $55 00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees:
5a. Enter total of above fees 4' '
NOTICE 5% Surcharge (.05 X total fees) $ 2.
Subtotal
PERMITS BECOME VOID IF WORK OR CONSTRUCTION $ 4 4Z
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. wordlcomdeNdeo- ❑ Trust Account #
pm .14
Balance Due $ /j/Z--
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested AM PM BLD
Location 9 b• � (na.Sin . DA . Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner • ELC 9?-0;10
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
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof •
Misc:
Final is 1 / _ Q ,,.
PASS PART FAIL ` ' 4
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
SASS -APART FAIL
ELECTRIC
Rough In
UG /Slab
Low Voltage
F' Al
mal
S 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 �J
Approach /Sidewalk Date 7 f -? G Inspector Ext
Other p
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.