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CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspectic.rl Line: 639-4175 Business Line: 63E-4171
BUP
^Date Requested
�AM PM BLD +-
Location / � j 3 ... .
_ Suite MEC ---
Contact Person Ph J /- y��3 �L PLM
Contractor !`_^ �� Q � / <', _ Ph _ _ SWR —_.-__---- _--
i3UILnING Tenant/Owner _?D dv r-6-l-y- It �_ ELC YU
Retainiirg Wall ELR
Fooling Access-. �--�—_--
Fo:indation FPS
Cta Drain
Crawl Drain Inspection Dotes — SGN _^
Slab - —-- — _ --- — _- -- --- SIT
Post& Beam —'— - -M--
Exl Sheath/Shear
Int Sheath/Shear — -
Framing
Insulation
Drywall Nailing
Firewall ----------------_..._-------
Fire Sprinkler
Fire Alarm --- ------_----------_----`�
Susp'd Ceiling --___-_�_-- -- _-- ---------- .._----- --..`T_
Roof
Misr __ — _ ------- ____._----------
rnal
PASS PART FAIL_
PLUMBING
Post& BFam -V-
Under Slab
Top Out ------_.----
Water Service _
Sanitary Sewer -- —--- _
Rain Drains
Final I'T r,,,,
PASS PART FAIL
MECHANICALPost& Hearn ---- — -- --—
Rough In
Gas Line --- --- -- --
Smoke Dampers
Final
p T FAIL
Service _
Rough In
UG/Slab _
Low Voltage
Fire Alarm -- -- ._ —_--.. - ---
S ART FAIL ----_---_..___.__._..-------_-_---
Backfill/Grading —
Sanitary Sewer
Storm Dram [ )Reinspection fee of$ _ required before next inspection P,*y at City Hal! 13125 SW Hall Blvd
Catch Basin
Circ Supply Line ( )Please call for reinspection RE — _ _ — /7 ( J Unable to inspect- no access
ADA
Approach/Sidewalk
Other Date ` i _.. Inspect)r is k - '-Ext
Final
PASS PART FAIL DO NOT REMOVE this. Impection record from the jots site.
CITY Y O F T I G A R D ELECTRICAL PERMIT —
PERMIT M ELC2.001-00140
DEVELOPMENT SERVICES DATE ISSUED: 3/9!01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 18135DC-00500
SITE ADDRESS: 11765 SW GREENBURG AVE
SUBDIVISION: TIGARDVILLE PARK ZONING: C-P
BLOCK: LOT : 008 JURISDICTION: TIG
Protect Description: Sign lighting.
_ RESIDENTIAL UNITTEMP SRVC/FEED_ERS_ _ MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMPIIR.RIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG. 1
LIMITF' 'NERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HMI SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS
_ � ADD'I. INSPECTIONS
0 - 200 amp. W/SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: Ist 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/FOR >=225 AMPS: _ CLASS.AREA/SPEC OCC:_
Owner: Contractor:
SCOTT BODYFELT DMD E S + A INC
11765 SW GREENBERG RD 19380 SW MOHAVE C1
TIGARD, OR 97223 TUALATIN, OR 97062
Phone: Phone: 503-691-8474
Reg #: LIC 145755
SUP 445SIG
EI_E 20-255CL
_ FEES Required Inspections
Type By Date Amount Recoipt
y — Underground Cover
PRMT CTR 319/01 $53.40 2720010000( Elect'/ Final
SPCT CTR 3/9/01 $4.27 2720010000(
Total $57.67
This Perm is issued subject to the regulations contained in the Tigard Municipal Code. State of OR Specialty Codes and all other applicable laws
All work v ill be done in acmrdance 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 WR 952-001-0010 through OAR 952.-001.0080 You may obtain copies of these rules ordirect questions to OUNC at(503)
246-1987
PERMITTEE'S SIGNATURE 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: t2 Al _ '/1% C9-
9 T/O� ___ DATE:_____
LICENSE NO: _-- -- -. _ --- -- —
Call 639.4175 by 7:0(tpm for an Inspection the next business day
Electrical Permit Application
Date received: ;; 9 p Permit noy�(('���1/-�n�.�
City Of Tigard Project/appl.no.: Expiredate:
00,ofTigard Address: 13125 SIN ILill Itivd,•rigard,OR 97223 Date issued: BY: eceipl;-o.:
Phone: (503) 639-4171 - -
Fax: (503) 598-1960 Case rile no.: Payment type:
Land use approval:
U I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
U New construction U Addition/alteration/replacement U(,)[her: U Partial
1
Job address: It 105 SW IeJE&JP-,.Q2G R C--) , toile. no.: i.tiuur nu. Tax map/tax lot/account no.:
['of: Hinck: subdivision:
Project name: Descriptijn and location of work on premises:CI I�I PJSI AL(..
Estinuaecl date of completion/inspection: N I _G ce- F e
Job no: I cc nice
HUSIne55 tlaltie: A S(C-,I�J ( Descriplion Qt). (Co.) IbtAt nae insp
i c,.' mou� CT.
_-- - Nen rrguoil Ii-iingludt, n mullcheitgara a per
Address: �lA/ rT dncliin�unlr Includc•,allarfnelgarsrge.
City: MA�_ I State: ZIP:9'IQ(OZ Sen Ice hrluded:
Phone:5( LigI-841 Fax:503691$5 mail: 1000,q it nrlcss
CCHach additional MAI sq 't.or portion thereof
H no.: f .bus. tic.no: -
Clec
.,� Limited energy,residential 2
City/metro lic.no.: ;�42X�) Ir z. Liviiledenergy,non-residential 2
J5' /1_�-T �1 - - - I:acltmanufacwredhomeormodulardwcllit!p
Signature of supervising_electrician(requiredt Dine Service omUnrfeeder 2
Sup elect.name Iprint Licenscno Services or feeders-Installation,
alteration or relocation:
200 amps of less _ 2
Nance(print): 201 amps to 4(xI amps - _ 2
— - 401 amps to 60x1 amps 2
Mailing address_ 60)amps to IIxx1 amps V 2
City: TS(alc.: !.I I' Over 10(1(1 amps or volts 2
Phone: I E-mail- Reconnect only I
Owner installation:The installation is being made on properly I own Temporary.ervices or feeders-
which is not intended for sale,lease,ren[,or exchange according to Installation,allerstion,orrelocation:
ORS 447,455,479,670,701. 2tx1 i ogrs nr less 2
201 amps to 4(x)amps 2
Owner's sl nature: _ Date: 401 to 601 ams '_
Branch circuits-nen,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: LIP: Il. Fee for branch circuits without purchase
Phone a� P, mail:
of service or feeder fee,first branch circuit: 2
f
Each additional branch circuit:
Mlsc.(Servlce or feeder not Included):
U Service over 225 amps-cornmercial J Ilealth-care racil;n Each pump or irrigation cirrie 2
U Service over 320 amps-rating of I&2 U Hazardous location Fach sign or outline lighting 2
familydwellings U Building over 10,0M square-feet four or Signal circuit(s)or a limited energy panel,
U System over 6(1(1 volts nominal more residential units in one structure alteration,or extension* '-
U Building over three stories U Feeders,AIM amps or mote •[kscri nior;—_--
•Occupant load over 99 persons U Manufactured strucwrm or RV park fych additional Inspection over the allowable to any of the above:
U Egress/lighting plan U Othct Perins ection
Submit sets of plans with am of the aMrve. Investigation fee
I he above are not applicable to temporary construction.ervitz Other
- --- ----- — -
Net all Jurisi:ictions accept cre&cards.please call jurisdiction far mare infrxmatim Notice:This permit application Permit fee................. ...$ -5-
IQ_
U Visa U MasterCard expires if a permit is not obtained Plan review(at _ "f l $ _
cedh care numt»•r -. _ - _�L within 180 days eller it has been State surcharge(8%)....$ 44
Expires accepted as complete. TOTAL . . $ -5 7,t✓7
Name of:a o r as shown on credir card
S
Cardholder tirnatuir Arntwm 441.).4615(M OM
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED=RESIDENIA O
NLY
F? Restricted Energy Fee......................................... $75.00
Number of Inspections per permit allowad (FOR ALL SYSTEMS)
Service included: Items Cost 'Total d Check Typr+of Work Involved:
Residential-per unit
1000 sq.It or less $145 15 _. 4 ❑ Audio and Stereo Systems
Lath additional 500 sq ft or
portion thereof $3340 _^___ 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular C] 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 $8030 2 ❑ Vacuum Systems'
201 amps 10 400 amps - $10685 2
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $24060 ether _
Over 1000 amps or volts $454.65 2
only o
Peconnerl _ $66.85 � 2
Temporary sorFeeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Fee for each system................................_............... .... . $75.00
Installation,alteration,or relocation
200 amps or less $6685 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 ❑ Boiler Controls
New,alteration of extension per panel
a)The fee for branch circuits
with purchase of service or Clock Systems
feeder lee.
Each branch circuit $i 65 2 E] Data Telecommunication Installation
b)The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder loo.
First branch circuit $4685 _ ❑ HVAC
Each additional branch circuit _ $665
Miscellaneous E] instrumentation
(Service or feeder not Included)
Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems
Each sign or outline lighting $5340
Signal circuit(s)or a limited energy C� Landscape Irrigation Control'
panel,alteration or extension $75.00
Minor Labels(10) $125.00
--- C] Medical
Each additional Inspection over
the allowable In any of the above ❑ Nurse Calls
Per inspection $62.50_
Per hour $62.50
In Plant $7375—' _ ❑ Outdoor Landscape Lighting'
Fess: ❑ Protective Signaling
Enter total of above Pecs $ Other
8%State Surcharge $ K __Number of Systems
25%Plan Review Fee No licenses ar!regwred Licenses are required for all other installations
See"Plan Review"section on $
front of apl, catlon
Fees:
Total Balance Due $
r'� -------- Fnter total of above fees
LJ Trust Account# _ 6!'.State Surcharge s -
Total Balance Due S_ -
i.\dststiomisklc-fees.doc 10/09/W
CITY OF TIGARD Electrical Permit ,Application Plan Check 4
13125 SW HALL BLVD. Rec,'d By _
TIGARD OR 97223 Date Rec'd-
DatP to P.E.
Phone(503)639-4171, x304 Date to DST_ _
Inspection (503) 639-4175 Print or Type Permit N_ _
Fax (503)684-7297 Incomplete or illeg?ble will not be accepted called__.___ _
1. Job Address: _ 4. Complete Fee Schedule Below:
Name of Development_ _ Number of Inspections per permit allowed --�
Name(or nameofbusiness)S(0 5WY 6LT Service included: Items Cost Sum
Address 11-765 Svc 6QE;Wr-2:11Y-6 R"U 4a. Residential-per unit j
-r r�t� O 1000 sq.it.or less $t 10 no
City/State/Zip. F-v t �- �Z _ Each additional 500 sq.ft.or
Commercial Residential ❑ Limitedportion thereof $,5 00
Energy $25 00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68 00
2a. Contractor installation only: `-
(Attach copy of all cyrrent licenses) 4b.Services or Feeders
Electrical Contractor 511 f1 St 4 A W M I ISG installation,alteration,or relocation
200 amps or less $60.00 2
Address_115ft SW "()H*VE C-T• 201 amps to 400 amps $80.00 2
City State 6R-_Zip_'-A-1062- 401 amps to 600 amps $120.00 2
Phone No. Ib03-If11 'B4-14 601 amps to 1000 amps _ $180.00 2
.lob No. Over 1000 amps or volts $340.00 2
Elec.Cont. Lice. No.?-n-� G EI;p.Date I r I fJ► Reconnect only $50.00 2
OR State CCB Reg. No. 145155 Exp.Date 4c.Temporary Services or Feeders
COT Business Tax or Metro No. 2925 Exp.Date I I I 1 O_ Installation,alteration,or rolocation
200 amps or less $50.00 2
Signature of Supr. Elec'n 201 amps to 400 amps $75.00 2
401 amps to 600 amps $100.00 2
t Over 600 amps to 1000 volts,
License No.�j S L __Exp.Date L _ see"b"above.
Phone No. 503-181 '84 4d.Oranch Circuits
Now,alteration or extension per panel
2b. For owner installations: a)The fEe for branch circuits with
rv`iasv of service or
Print Owner's Name_ _ feeder fee.
Address Each branch circuit $5.00
- - b)The fee for branch circuits
City _ State Zip without purchase of
Phone No. service or feeder tee.
Fust branch circuit $3500 _ 2
The installation is being made on property I own which is not Each additional branch circuit, $5.00 A
intended for sale,lease or rent. 4e.Miscellaneous
(Service or feeder rr,1 it sed'
Owner's Signature Each pump or Irrigaticn circle $40.00
Each sign or outline lighting _ $40.00 _ _ 2
3. Plan Review section (if required):* Signal circult(s)or a limited energy
panel,alteration or extension $40.00 _
-`_
Please check appropriate item and enter fee in section 5B. Minor Labels(10) $100.00---
4 or more residential units In one structure 4f.Each additional inspection over
Service and leader 225 amps or more the allowable In any cf the above
Svstem 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 nbove apply. S. Fees:
Not required for temporrry construction services. So.Enter total of above lees $ �-
5%Surcharge(.05 X total fees) $ - --.
NMI CLE Subtotal $ - - -
5b. Enter 25%of line So for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review If rr uir (SE--3) $ --- -NOT COMMENC30 WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED-IR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTFRI WORK IS COMMENCED. Q Trust Account is
Total balance Due
nosts�eresr,qrr nes s se ----