12510 SW GLACIER LILY CIRCLE-1 N
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S']02�I0 xlyi dSI0tl70 MS OTSZT
Y CITY OF TIGARD BUILDING INSPECTION DIVISION MST
o4\ 24-Hour Inspection Line: 639-4175 Business Line: 339-071 BUP
---- —
Date Requested 1 Z 1 `1 AM-- —PM _ BLD
Location 2 �uite —� MEC
Ph ��__�0� PLM
Contact Person, _ --------
Cortractor �� ��� l l.. Y� �i ,k�_ L Ph ---- _ SWR
LC ��--
BUILDING Tenant/OwnerE
� �j— ��:-��o -- —
Retaining Wall 14 ELR
Footing Access: <tJ c.,"/ �,. Ca 'r`+ S�\ 1 FPS
Foundation QI dk� --
Ftg Drain -- SGN
Crawl Drain Inspection Note. - - —
Slab --_-- -- -- - - SIT -- ---...- -- ---
Post&Beam
Fxt Sheath/Shear -- - ----
Int Sheath/Shear
Framing -- - — ------
Insulation -�
Drynall Nailing --
---------- --
Firewall !-
Fire Sprinkler ��1�-t �--- - ------- - - -
Fire Alarm
Susp'd Ceiling -- -- - --- _... - - -
Roof
Misc: - -- -- --- -
Final - -
PASS PART FAIL ----- - -- --
PLUMBING
Post& Beam
Under Slab -
Top 00
Water Service
Sanitary Sewer
(lain Drains -- -- -
Final
PASS PART FAIL_
MECHANICAL
Post& Beam ---
Rough In
Gis Line --- -------- --- - -
Smoke Dampers
11-mal - __-- --- ----- ----- ..---- -
PASS PART FAIL _
ECTR
orvice
Low Voltage d
larm
TIP!ASS
IART FAIL ----_-_ ._--.--- --- - ---- ____- ___-�
SIT � ---------_---.---- - \
Backfill/Grading --- -_ --- -
Sanitary Sewer
Storm Drain i ]Reinspection fee of$ rf,.,uired before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Bat.in I ) Please call for rei,ispection RF �__--_-- - ---- _-� I 1 Unable to inspect-no arcs.s
Fire Supp,y Line
ADA
Approach/Sidewalk Date - _Inspector �_. Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the jijw site.
CITY OF TIGAR DELECTRICAL PERMIT
\ PERMIT#: ELC1999-00699
DEVELOPMENT SERVICES DATE ISSUED: 11/18/1999
r 131?5 SW Hall Blvd., Tictard, OR 97223 (503) 639-4171 PARCEL: 1S 13317A-03800
SITE ADDRESS: 12:,10 "'%N (;r r,CIER LILY CIR
SUBDIVISION: AMART SUMMFRLAKE ZONING: R-7
BLOCK: LOT : 060 JURISDICTION: TIG
Proiec# Description: Add two (2)branch circuits.
RESIDENTIAL UNITTEMP SRVC/FEEDERS M'SCELLANEOUS
1000 SF OR LESS: 0 200 amp: PUMPi IRRIGATION:
EACH ADD'L 500SF: 201 400 amp: SIGNIOI lT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SI(,NAL/PANEL:
MANF HM/SVC/FDR: 601+amps - 1000 volts: MINOF LABEL (10):
_SERVICE/FEEDER ...... BRANCH_CIRCUITS AC r,'L INSPECTIONS _
0 200 amp: W/SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st WO SRVC OR FDR: 1 PER HOUR:
401 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION_
1000+ amplvolt: >=4 RES UNITS: > 600 VOL r NOMINAL:
Reconnect only: SVC/FDR >= 225 AMPS: __ _ CLASS AREA/SPEC OCC:_
Owner: Contractor:
DE GUZMAN, GREGORIO B JR AND Y RO:;E CITY ELECTRIC CO INC
12510 SW GLACIER LILLY CIRCLE 4012 NE CULLY BLVD
TIGARU OR 97223 POR rLAND, OR 97213
Phone: Phone:
287-61r-4
Reg#: SUP 2127S
LIC 00003567
ELE 26-113C
`FEES l Required Inspections
Type BDate Amount Receipt y ae pT 1
_ f..lect'I Service _
PRM1 GEO 11/18/199 $42.85 99-319864 I Elect'I F nal
5PCT GEO 11/l8/199� $3.42 99-319864 ORIGINAL
—-- - Total $46.27 ^--_
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 stated within 180 days of issuance,or d work is
suspended for more than 180 days ATTENTION Oregon law requires you to follow rules adoptf d by the Oregon Utility Notirication Center Those
rulas are set forth in OAR 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 Bi', `�✓ �u
_ OWNER INS)ALLATION ONLY
rhe installation is being made on property I own wh,ch is not intended for sale, lease, o rent.
C WNER'S SIGNATURE: _ DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: C���J �u _ _—_ DATE:__
LICENSE NO:
Call 639.4175 by 7:00pm fo, an inspection the next business day
CITY OF TIGP,RD Electrical Permit Application Plan Check#i_
25 SW HALL BLVD. RECLI Recd By
Date Recd
I IGA.RD OR 97223
Date to P E.
Phone(50:x)639-4171, x304 NOV l 7 IT`S Date to DST-
Inspection (503)639-4175 Print Of Type Permt# C��/'9 �O41
Fax 503 598••1960 COMMUNITY Utvtt.ur�r�,:��i YP ---
( ) Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development AJV,q j . sA� Number of Inspections per permit allowed
Name(or n me of b siness) �' !' Service included: Items Cost Sum W j
Address � `�" `. �-�t.� L' `jl�_l L a. Residential-per unit -{
City/Stat@/Zi ( % 1 Z ' 2 `j 1000 sq.It or less $ 117.75
p Each additional 500 sq.ft.or
portion thereof $ 26.25
Commercial ❑ esidential47 Limited Energy i $ 60.00
Each Manufd Home or Modular i
2a. Contractor Installation only: Dwelling Service or Feeder $ 72.75
(Prior to permit Issuance,applicants must provide contractor license 4b.Services or Feeders
information for COT data b I. 1 _ i Installation,alteration,or relocation
Electrical Co tractor h 1 200 amps or less $ 64.25 2
Address �- 201 amps to 400 amps _ $ 85.50 2
401 amps to 600 amps $ 128.50 2
City If state-- 601 amps to 1000 amps $ 192.50 2
Phone No. -7 , - Over 1,000 amps or volts $ 363.75 _ 2
Job No. Reconnect only $ 53.50 2
Elec. Cont. Lice. No. (,�, ll• Exp.Date 4c.Temporary Servicas or Feeders
OR State CCB Reg. N0. 3.: ] Exp.Date L' Installation,alteration,or relocation
COT Business Tax or Metro No. Ex .Dat eco amps or less $ 53.50 _ 2
201 amps to 400 amps $ 80.25 2
401 amps to 600 amps $ 107.00 2
Signature of Supr. Elec'n t L'�� Over 600 amps to 1000 volts,
see"b"above.
License No _, QExp.Datp_�(r/
Phone No � _ 4d.Branch Circuits
_ New alteration or extensiol per panel
a)The fee for branch circuits
2b For owner installations: with purchase of service or
feeder fee.
Print Owner's Name _ Each branch,ircuil $ 531,
Address T b)The fee for branch circwls
without purchase of service
City_-__ State__Zip or feeder fee.
Phone. No. First branch circuit _ ( $ 37 50
-- Fach additional branch circ n __ $ 5.35
The installation is being made on property I own which is not 4e.Miscellaneous
intended for sale, lease or rent. (Service or feeder not'ncluded)
Each pump or irrigation circle - $ 42.75
Owner's Signature _ Each sign or outline lighting $ 4275
Signal circult(s)or a limited energy
(if required):*uPanel, elerallon or extension _ $ 07.n0
3. Plan Review section
(. Minor Labels(10) $ 1 .UU
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
_.� Per hour � $ 50.00
System over 600 volts nominal In Plant , $ 5900
_ Classified area or structure containing special occupancy as
described in N E C Chapter 5 5. Fees: L
5a. nter total of above fees $
` Submit 2 sets of plans with application where any of the above apply. (9%Surcharge(05 X total fees $ -'.
Not required for temporary construction services. Subtotal $
5b.Enter 25%of line 5s for
NOTICE Plan Review if required(Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Yru,. Account#
AT ANY TIME AFTEn WORK IS COMMENCED Total balance nue $
Odsts1orms\clectric,dre