Permit c. ,CITY OF T I G A R D ELECTRICAL PERMIT
2002 -00036
�& DEVELOPMENT SERVICES DATE ISSUED: 2/5/02
�Ij,.
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1 S126C0 -01107
SITE ADDRESS: 09619 SW WASHINGTON SQUARE RD L -4
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of 4 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: 3 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 TURC ELECTRIC
P.O.BOX 21545 995 SW HIGHLAND DR
SEATTLE, WA 98111 GRESHAM, OR 97080 -6352
Phone: Phone: 661 -8872
Reg #: LIC 00088541
SUP 3970S
ELE 26 -825C
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 2/5/02 $66.80 2720020000( Wall Cover
Elect'I Final
5PCT CTR 2/5/02 $5.34 2720020000(
Total $72.14
This Permit is issued subject to the r gulation contained in the Tigard . icipal Code, State of OR. Specialty Codes and all other applicable
laws. All work will be done in accor ance wit approved plans. This 4- rmit will expire if work is not started within 180 days of issuance, or if
work is suspended for more than 1 0 days. ' TTENTION: Oreg. • law requires you to follow rules adopted by the Oregon Utility Notification
Center. Those rules are set forth ' OAR 9:2-001-0010 thro s OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to
Permit Signature: , Issued By: A / ,
is N
OWN INSTALLATION ONLY
The installation is being made on property I own wh h is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONT OR INSTALL
4 SIGNATURE OF SUPR. ELEC'N: ` DATE:
LICENSE NO: 5 g 2 o S
Call 639 -4175 by 7:00pm for an inspection the next business day
s
Electrical Permit Application
__,_ , „A
Date received: . 5" --- Q , 9-- Permit no.: o -0/, 3C, 4 ,.•1 1 I City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: M Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
. ,TYPE OF PERMIT - : . -
❑ 1 & 2 family dwelling or accessory , Commercial/industrial ❑ Multi - family Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
. . JOB SITE INFORMATION •
Job address: `' ` q A.71gl 1 J pr4,i 5 eC Bldg. no.: Suite no.: � Lt Tax map /tax lot/account no.:
Lot: Block: I Subdivision:
Project name: r'o - iz-y ?nit AI I Description and location of work on premises: sfpeK /L c. vsi /9-8plr1Dui
Estimated date of completion/inspection: L - • 7 S / LAI ki 0w
.CONTRACTOR APPLICATION - " ' . FEE SCIIEDU.E . • ' .
Job no: Fee Max
Description Qty. (ea.) Total no. insp
Business name: 1 L ,2 C 6L4 -r - i= C O
p`� New residential - single or mold- family per
Address: 4 -6 0( cw /7 S/C- dwelling unit. Includes attached garage.
City: £ ap ll/9 .,. I Sta • : 0 I ZIP: V 7 o g 0 Service included:
Phone: bbl - g 7 2 Fax: 67Y- 1' / 8 E- ai l: m ,Sy' r" f//RC5Zt oo sq. ft. or less 4
CCB no.: ' ,' (f Elec. b �* 'no: 2 6 - 13 C iu 500 sq. ft. or portion thereof
� united energy, residential 2
City /metro lie. no.: VIMIIMP / Qy Limited energy, non residential 2
-- Each manufactured home or modular dwelling
Signature of supervising electrtci• (required) Date Service and/or feeder 2
Sup. elect. name (print): v s A-1 V (LL License no: . 3 7 O S Services orfeeders — installation,
alteration or relocation:
.. - - - PROPERTY - 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: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: . I E -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,orrelocation:
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: I State: I ZIP: B. Fee for branch circuits without purchase l
of service or feeder fee, first branch circuit / 2
Phone: Fax: E -mail: 3
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
❑ Service over 225 amps- commercial U Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps - rating of l &2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings U Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
U 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/lighting plan U 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 $ (9(O - b_(L
❑ Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ 5 34
Expires accepted as complete. TOTAL $ /../
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6/00 /COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT F
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: 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 n Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80 30 2 El 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. . n Audio and Stereo Systems
Branch Circuits
New, alteration or extension per panel ❑ Boiler Controls
a) The fee for branch circuits
with purchase of service or n Clock Systems
feeder fee.
Each branch circuit $6 65 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit / $46.85 - . /
Each additional branch circuit -' $6.65 ' . ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53 40 n
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 n Nurse Calls
Per hour $62 50
In Plant $73.75 n Outdoor Landscape Lighting
Fees: ` /- / ❑ Protective Signaling
Enter total of above fees $ (2 /0 . V 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 $ '7c2- , 71
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 ,
i
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Lo 2- Date Requested AM PM BUP
Location 94° /9 ) t - SCE . k_p Suite. MEC
Contact Person Ph ( )..C) 5 .D-,5W q PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 2- o4 Z CO 3(
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: J SIT
Post & Beam 7) �1
Shear Anchors � (�
Ext Sheath/Shear [ Lhd • � J
Int Sheath/Shear
Framing
Dry atl N ` � � S`� W ThA d '
Drywall Nailing v ` L
Firewall L -- r n
Fire Sprinkler t �� l ' \
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
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
/+"*. PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA Date _ C — 2
Approach/Sidewalk Ins - 1.7e/ - Ext
Other:
Final DO NOT REMOVE this inspection record from the • b site.
PASS PART FAIL
� a
2 4 -Hour
CITY OF TI AD
BUILDING — - Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
" 4// Received ` f D ate Requested ` Z AM PM BUP
Location c lv (9 (2b Suite MEC
Contact Person Ph ( ) G / Y PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC O Q °6)623
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT i� 4
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing 'AA
Firewall S b v ' 0)0\ , ' `f 1 � 1 �
Fire Sprinkler am
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
PASS PART FAIL
ELECTRICAL
Service
UG /Slab
Low Voltage
Fire Alarm
Final fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS FAIL
SITE El Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date — 0 In pector / Ext
Other:
Final DO NOT REMOVE this inspection record from th® ob site.
PASS PART FAIL
CITY ARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
•
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested -7-(e AM PM BUP •
Location 6/9 Log- - S2 - Rd Suite MEC
Contact Person Ph ( ) �- PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ��!1� I J/ .4.i ELC a t ' 6063
Footing 1
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT 1 �•
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall \1J )0� , A� \1S,1�G, l�J � � `1 V
Y�w�
Fire Sprinkler 1 ' 1
Fire Alarm
Susp'd Ceiling ^�
Roof WRIT 1d \�
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
PASS PART FAIL
CTRI
Rough -
UG /Slab
Low Voltage
Fire Alarm
Final 7 ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE. ❑ Unable to inspect — no access
•
Fire Supply Line
ADA
Approach/Sidewalk Date - Inspector / . __ yam— Est
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
4