Permit "CITY OF TI G A R D ELECTRICAL PERMIT
PERMIT #: ELC1999 -00381
bEVELOPMENT SERVICES DATE ISSUED: 6/25/99
AIL' 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 1S126C0-01403
SITE ADDRESS: 09300 SW WASHINGTON SQUARE RD
SUBDIVISION: ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Electrical TI work. Job No. 12036.
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: 69 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:
MAY DEPT STORES COMPANY ROSE CITY ELECTRIC CO INC
ATTN: PROPERTY TAX DEPT 4012 NE CULLY BLVD
611 OLIVE STREET PORTLAND, OR 97213
ST LOUIS, MO 63101
Phone: Phone:
287 -6164
Reg #: SUP 2127S
LIC 00003567
ELE 26 -113C
FEES
Type By Date Amount Receipt Required Inspections
PRMT DEB 6/25/99 $406.65 99- 316413 Ceiling Cover
Wall Cover "
5PCT DEB 6/25/99 $20.33 99- 316413 Elect'l Service
Total $426.98 Elect'l Final O R I GI A
"-
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 t ules or direct questions to OUNC at (503)
246 -1987
Permit Signature: , � � -
Issued By �0. a�
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: P — /! ' Pext- DATE: � 0 751 - 9
LICENSE NO: ot/ 5
Call 639 -4175 by 7:00pm for an inspection the next business day
RECEIVED
CITY OF TIGARD Electrical Permit Application Plan Ch
13125 S'WN HALL BLVD. JUN 2 1 1999 Recd l�+�
TIGARD OR 97223 Date Recd. to -At -99
1�VIMUNITY DEVELOPMENT Date to P.E. '�'
Phone (503) 639 -4171, x --
Inspection (503) 639 -4175 Print or Type g?uPr999-4b ° Permit # Eat999 -QO321
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: / � 4. Complete Fee Schedule Below:
Name of Development `il/5 l/797 n Number of Inspections per permit allowed
&../e... Name (or name of business) /1E �- J,P�K Service included: Items Cost Sum
Address ? ') 0 � u )C SAL,1/L0 k) 1 /2 4a. Residential - per unit .
1000 sq. ft. or less $110.00 4
City /State /Zip el a Each additional 500 sq. ft. or
Commerc Residential ❑ portion 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,- rrent licen - -s) , 4b. Services or Feeders
Electrical Co itractor -CliJ 0 ( Installation, alteration, or relocation - Addre s \F�n , �iA.�M 201 amps to 400 amps $60.00 2
City' St. ITT r 401 amps to 600 amps $120.00 2
Phone No. 411 1 I t. 601 amps to 1000 amps $180.00 2
Job No. _._ (2l>?, ? Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. 2-(_0( PI C--Exp.Date RV , /6-4 Reconnect onl $50.00 2
OR State CCB Reg. No. 4 7 Exp.Date t V c7 U 4c. Temporary Services or Feeders
COT Business Tax or Metro No. 6U -fa Exp.Da Installation, alteration, or relocation
J w, 200 amps or less $50.00 2
Signature of Supr. Elec'n (i 201 amps to 400 a mps $75.00 2
amps to 600 amps $100.00 2
2- L Z� 3 Ex p .Date I / /O I Over " amps to 1000 volts,
License No < l b see "b" above.
Phone No -2 6 (. f( 4, ` 7
4d. Branch Circuits
New, alteration or extension per panel /
2b. For owner installations: a) The fee for branch circuits with q
purchase of service or �/
Print Owner's Name feeder fee. //
Address Each branch circuit 447 .$613 .$C 2
b) The fee for branch circuits
City State Zip without purchase of 9 .S
Phone No. service or feeder fee. 3
First branch circuit / $ /
a 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: `I��
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) au.' 3?J$
NO 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 9g
TIME AFTER WORK IS COMMENCED. ❑ Trust Account #
Total balance Due _[g $
(Di. 4 .27 .1e 0 s ?- 3
I \OSTS \ELC96 APP Rev 9/96
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
(� BUP
Q Date Requested 9 �� 3- 9 ( AM PM BLD
Location -! � )O '061S1/1 Suite MEC
Contact Person Ph 2 9' ai (/ k ) 0 PLM
Contractor I (,t Ph SWR
BUILDING Tenant/Owner
ELC ► 5 ; 1
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: l Q ----
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 PART FAIL
LECloC
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
4•
• 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 [ ] Pleassecall for reinspection RE: [ ] Unable to inspect - no access
A • h
Approach/Sidewalk 9- ( V - ?9
Other roach /Sidewalk Date G Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
1;