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Permit CITY O T I G A R D ELECTRICAL PERMIT PERMIT #: ELC2002 -00019 � �;� DEVELOPMENT SERVICES DATE ISSUED: 1/17/02 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S126C0 -01107 SITE ADDRESS: 09573 SW WASHINGTON SQUARE RD B -6 SUBDIVISION: WASHINGTON SQUARE ZONING: C -G BLOCK: LOT : JURISDICTION: TIG Project Description: Installation of 2 branch circuits. 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: 1 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: PPR WASHINGTON SQUARE LLC WEST PORT ELECTRICAL CORP P.O.BOX 21545 10594 SW SUNNYSIDE DR SEATTLE, WA 98111 WILSONVILLE, OR 97070 Phone: Phone: 503 - 582 -1777 Reg #: LIC 138789 ELE 3-482C SUP 4430S FEES Required Inspections Type By Date Amount Receipt Elect'l Final PRMT CTR 1/17/02 $53.50 2720020000( 5PCT CTR 1/17/02 $4.28 2720020000( Total $57.78 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 0= : 9: - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to Permit Signatu EI 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: I - . ; TO : NSTALLATION ONLY Y SIGNATURE OF SUPR. ELEC'N: 1 DATE: t(/ 77 LICENSE NO: 14 3 0 S Call 639 -4175 by 7:00pm for an inspection the next business day 4 r Electrical Permit Application Date received: I --1 - 1 -0'—" Permit no.: �L(i�Qa - �9 [A., � r • • / .f I City of Tigard Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date Issued: By: - Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: TYPE OF PERMIT ❑ I & 2 family dwelling or accessory Commercial/industrial 0 Multi- family ❑ Tenant improvement ❑ New construction ■r Addition/alteration /replacement ❑ Other: ❑ Partial . JOB • SITE INFORMATION • . Job address: S 1i) 454.. , .11 Idg. no.: Suite no.: Tax map /tax lot/account no.: Lot: I Block: Subdivision: . --4 5 Project name: 6,4 m / ,---,e _o 'Description and location of work on premises: -� D 1 #1- 1.. 6)sr5 E yt S )7V Estimated date of completion/inspection: [ E • i S E✓LS CONTRACTOR APPLICATION 4 . FEE SCHEDULE Job no: Fee Max Business name: (j ,S T POr € CE O-T]�I L Description Qty. (ea.) Total no. insp ( Jv - I c.,2 Ttl tQ TIN a New residential - single or multi-family per Address: `� dwelling mit. Includes attached garage. City: / I State: I ZIP: g7 Z Service included: Phone: 7Z - 1777 IFax: S1Z OA; (o 1E-mail: 1000 sq. ft. or less 4 CCB no.: 'j g I Elec. bus. tic. no: Each additional 500 sq. ft. or portion thereof L energy, residential 2 City /metro ,'n e l 4) I/5/ no.: . la - c( -7' t — . I _ Limited energy, non- residential 2 I t , Each manufactured home or modular dwelling Sign. re"" is : el , . uired) / t'' Dat Service and/or feeder 2 Sup. elect. name (print): License no: / / QS Se rvices or feeders - installation, alteration or relocation: PROPERT']' OWNER 200 amps or less 2 Name (print): 201 amps to 400 amps 2 401 amps to 600 amps 2 Mailing address: 601 amps to 1000 amps 2 City: 'State: 'ZIP: Over 1000 amps or volts 2 Phone: IFax: 1E-mail: Reconnect only 1 Owner installation: The installation is being made on property I own Temporary services or feeders - which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation: ORS 447, 455, 479, 670, 701. 200 amps or less 2 201 amps to 400 amps 2 Owner's signature: Date: 401 to 600 amps 2 - ENGINEER Branch circuits - new, alteration, or extension per panel: Name: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 2 City: 'State: !ZIP: B Fee for branch circuits without purchase ifS-^ of service or feeder fee, first branch circuit: / 2 Phone: Fax: E-mail: Each additional branch circuit: PLAN REV II:IV (Please check all that apply) Th. Misc. (Service or feeder not included): ❑ Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2 ❑ Service over 320 amps -rating of 1 &2 ❑ Hazardous location Each sign or outline lighting 2 family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, ❑ System over 600 volts nominal more residential units in one structure alteration, or extension* - - 2 ❑ Building over three stories ❑ Feeders, 400 amps or more *Description: ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above: ❑ Egress/lightingplan ❑ Other: Per inspection Submit _ sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ / 3 • ) ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card number: / / within 180 days after it has been State surcharge (8 %) $ Expires accepted as complete. TOTAL $ S � 7 r7 Name of cardholder as shown on credit card $ Cardholder signature Amount 440 - 4615 (6/00 /COM) i ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: I •`, Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY p Restricted Energy Fee $75.00 Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total y Check Type of Work Involved: Residential - per unit 1000 sq. ft. or less $145 15 4 ❑ Audio and Stereo Systems Each additional 500 sq. ft. or portion thereof $33 40 1 ❑ Burglar Alarm Limited Energy $75.00 Each Manufd Home or Modular ❑ Dwelling Service or Feeder $90 90 2 Garage Door Opener Services or Feeders ❑ Heating, Ventilation and Air Conditioning System* Installation, alteration, or relocation 200 amps or less $80 30 2 201 amps to 400 amps $106.85 2 ❑ Vacuum Systems* :: 401 amps to 600 amps $160.60 2 601 amps to 1000 amps $240.60 2 n Other Over 1000 amps or volts $454.65 2 - • Reconnect only $66.85 2 Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY Installation, alteration, or relocation Fee for each system $75.00 200 amps or less $66.85 2 (SEE OAR 918- 260 -260) 201 amps to 400 amps $100.30 2 401 amps to 600 amps $133.75 2 Check Type of Work Involved: Over 600 amps to 1000 volts, see "b" above. ❑ Audio and Stereo Systems Branch Circuits New, alteration or extension per panel n Boiler Controls a) The fee for branch circuits with purchase of service or IT Clock Systems feeder fee. Each branch circuit $6.65 2 n Data Telecommunication Installation b) The fee for branch circuits without purchase of service n Fire Alarm Installation or feeder fee. First branch circuit _$46.85 T) Each additional branch circuit $6765 n HVAC Miscellaneous - ❑ Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems Signal circuit(s) or a limited energy panel, alteration or extension $75.00 ❑ Landscape Irrigation Control Minor Labels (10) $125.00 Each additional inspection over ❑ Medical the allowable in any of the above Per inspection $62.50 ❑ Nurse Calls Per hour $62.50 In Plant $73.75 ❑ Outdoor Landscape Lighting Fees: ❑ Protective Signaling Enter total of above fees $ n Other 8% State Surcharge $ Number of Systems 25% Plan Review Fee See "Plan Review" section on $ * No licenses are required Licenses are required for all other installations front of application. Fees: Total Balance Due $ Enter total of above fees $ ❑ Trust Account # 8% State Surcharge $ Total Balance Due $ All New Commercial Buildings require 2 sets of plans. i:\dsts \forms \elc- fees.doc 08/30/01 • CIV OF tIGARD 24 -Hour . BUILDING Inspection Line: (503) 639 -4175 MST INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested Z- .122-- — AM PM BUP Location - S �1I ` r Suite 8° iJ MEC - Contact Person C r5 7 - 3 Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC a 0 0 I Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors /)d'E) (� t % i/ Ext Sheath/Shear 1 �� c l Int Sheath/Shear Framing Insulation ® TO C- 0' \ n , 4®` S 1 In tE c-40) Drywall Nailing `r `o o` Firewall Fire Sprinkler Fire Alarm 40 tT1 o I 1 r6 Susp'd Ceiling , 1 Roof ) 'T o C I ()A) Other: - - I ` 1 1 �1\ m Final � O (� IF 1.v\ ��� ) —L V��� 0 J I.) / v 1 PASS PART FAIL © �� C.O \ �� n � PLUMBING ^ lC ry� `1 "�, � ul Under Slab u ` Y' u Yv ' `� �� 1 ��"'a . T�, V15 Rough -In ®[� �' � �E 1 ��-✓ & . L ' 6 b � V Water Service Sanitary Sewer rn t \ L 1 YY\ Rain Drains V " Catch Basin / Manhole Storm Drain • Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service ou h -In G /Slab Low o age Fire Alarm • PART FAIL El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SI ❑ Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date 2 r 2 Inspectors Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 • ' `i= INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received D. e Requested ` - AM PM BUP Location O 4 41) 1' /9s D ,• > uite MEC - Contact Person 1'573 u M- - 561 Ph ( R-D r PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC • C_ 1‹.-12-d a � - O Do '7 Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall e �`� l�'J Fire Sprinkler �1 Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL - Post. & Beam Rough -In Gas Line Smoke Dampers Final _F RR P RT FAIL CT L Rough -In UG /Slab Low Voltage Varm Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. S PART FAIL SITE ❑ Please call for reinspection RE: ❑ Unable to inspect - no access Fire Supply Line ADA Date Inspector ( �Q - � - 1 Ext Approach/Sidewalk P `� Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL