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Permit 1. ` CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: At DEVELOPMENT SERVICES DATE ISSUED: 5/9/00 r- - II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S126C0-01107 SITE ADDRESS: 09619 SW WASHINGTON SQUARE RD 1110 SUBDIVISION: ZONING: C -G BLOCK: LOT : JURISDICTION: TIG Project Description: Installation of one signal circuit or limited energy panel on mezzanine level. Job No. 083 - 12402 -01. 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: PPR WASHINGTON SQUARE LLC ADT SECURITY SERVICES, INC 9585 SW WASHINGTON SQ RD 2815 SW 153RD DR TIGARD, OR 97223 BEAVERTON, OR 97006 Phone: Phone: 503469 -7100 0\G\N P\_- Reg #: LIC 0059944 ELE 26209CLE FEES Required Inspections Type By Date Amount Receipt Elect'I Service PRMT DEB 5/9/00 $60.00 0002004 Elect'l Final 5PCT DEB 5/9/00 . $4.80 0002004 Total $64.80 This Permit is issued subject to the regulations contained in the Tigard Muniapal 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,4 ISSUED Y: / i • u / ` 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: DATE: LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day 503 599 1960 4 , 03'/17/00 FR I 12:15 FAX 503 598 1960 CITY OF TIGARD IJ003 CITY OF TIGARD 13125 SW HALL BLVD. Electrical Permit Apps Plan Ch �- FFtt Recd TIGARD OR 97223 1t0 Date Recd 3" -ov Phone (503) 639 -4171, x304 7 Date to P.E. inspection (503) 639 -4175 401)' W V $ QO� Date to DST Print of Typ �� e t��AA DejEEOPMEN} Permit # - Gba / Fax (503) 598 - 1960 Incomplete or illegible willvtui ue accepted Called 1 1. Job Address: 4. Complete Fee Schedule Below: y r( Name of Develo Number of Inspections Name (or name of business) , i PeC per permit allowed Wei? � ) �'� ' -- �1 ��o Service included: Items Cost Sum Address - � cS A A. , 4a. Residential - per unit City /State /Zip - id 1000 sq. ft. or less $ 117.75 4 Each additional 500 sq. ft. or Commercial © Residential ❑ portion thereof $ 26.75 1 / Limited Energy $ 60.00 q 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 base). Installation, alteration, or relocation u Electrical Contractor ADT Security Services, Inc. 200 amps or less $ 64.25 ddress 519 SW 15 rrl Dr. . 201 amps to 400 amps $ 85 2 2 City Raaxrari-nn State nit Zip 97006 401 amps to 600 amps $ 128.50 2 Phone No. , _ 601 amps to 1000 amps $ 192.50 2 Over 1000 amps or volts $ 363.75 Job No. /�;jl� / O 2 Elec. Cont. Lice. No. 76-209CT,F Exp.Date 10 / 2000 .Temp Temporary y $ 53.50 2 �, Installation, TemporaryServices to or Feeders OR State CCB Reg. No. 5g94 Exp.Date V7/01 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 Signature of Supr. Elec'n ./A4 401 amps to 600 amps $ 100.00 2 � Over 600 amps to 1000 volts, License No. ! Exp.Date /4/.30 ,2) See "b° above. �� C , Phone No. 4d. Branch Circuits New, alteration or extension per panel - 2b. For owner installations: a ) The fee for branch circuits with purchase of service or Each Print Owner's Name branch h circuit $ 5.35 2 Address b) The fee for branch circuits City State Zj without purchase of service Phone No. p or feeder fee. First branch circuit $ 37.50 Each additional branch circuit $ 5.35 The installation is being made on property I own which is not intended for sale, lease or rent. 4 e• Miscellaneous (Service or feeder d Each pump or imgation not inducte 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 1 $ 60.00 $60 . 00 Minor Labels (10) $ 100.00 • 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 • • System over 600 volts nominal Per hour $ 50.00 Classified area or structure containin g special occupancy as In Plant $ 59.00 described in N.E.C. Chapter 5 p 5. Fees: • * Submit 2 sets of plans with application where any of the above apply. 5a. Enter total of above fees $ PPIY• S urcharge (.08 X total fees) $ 4 Su Not required for temporary construction services. Subtotal NOTICE 6b. Enter 25% of nine 5a for Plan Review if required (Sec. 3) $ PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $ $64.80 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 $ $64. $ 0 \dsts\forms \e lectric.doc CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 /' / BUP Date Requested 1S " 1 l AM - PM BLD Location 't / ? sit czi 54 S, Suite MEC Contact Person Ph 35T -79 Y PL Contractor Ph '" v/e, pm 0;5-e/ BUILDING Tenant/Owner ELC Zi vv -c-a "y I Retaining Wall ELWie— 7000 -002-3 S Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear n Framing A O r ; Insulation v n � Drywall Nailing 4 C— ,V)061— O 2 3 ( 4 i / Firewall Fire Sprinkler Fire Alarm v Susp'd Ceiling Se_ O V / ! � A` Q T— l S Q ms " /► Roof fL L "e C Misc: Final n� PASS PART FAIL V PLUMBING Post & Beam Under Slab Top Out Water Service S • anitary Sewer / /4o Rain Drains C5 re vrf C"Y Dv) x ^ Q /,/�Q, ie r Final PASS PART FAIL MECHANICAL / , _ Post & Beam i ' , Rough In i p� Gas Line Smoke Dampers Rio ve_ E C 4 v // hzJs -s - �� Final S PASS PART FAIL v c'c' 4 c ,1pScJ re - Service Rough In UG /Slab Low4oltage Fire ' larm \\4 " li PA' AIL E 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 it Approach /Sidewalk Date F In spector Other Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.