Permit � CITY OF TIGARD ELECTRICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: ELC97 -0677
��'� " � 1 .4 i DATE ISSUED: 10/ 17/97
J-' " I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171
PARCEL: 2S115BA -00101
SITE ADDRESS... :16200 SW PACIFIC HWY ill
S
?(
UBDIVISION • ZONING:C —G
BLOCK • LOT • JURISDI TION: TIG / j
Project Description : Electrical permit for new spec space in the old Ernst store. i —
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- -- -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD'L 500SF...: 0 201 — 400 amp • 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY • 0 401 — 600 amp • 0 SIGNAL /PANEL • 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 — 200 amp • 2 W /SERVICE OR FEEDER: 24 PER INSPECTION • 0
201 — 400 amp • 1 1st W/0 SRVC OR FDR.: 0 PER HOUR • 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 0 IN PLANT • 0
601 — 1000 amp • 0 PLAN REVIEW SECTION
1000+ amp /volt • 0 > =4 RES UNITS • > 600 VOLT NOMINAL..:
Reconnect only • 0 SVC /FDR >= 225 AMPS..: CLASS AREA /SPEC OCC.:
Owner: FEES
TIGARD TOWN SQUARE type amount by date recpt
16200 SW PACIFIC HWY PRMT $ 320.00 JD 10/10/97 97- 299953
TIGARD OR 97224 PLCK $ 80.00 JD 10/10/97 97- 299953
SPCT $ 16.00 JD 10/10/97 97- 299953
Phone #:
Contractor:
ROSE CITY ELECTRIC CO INC $ 416.00 TOTAL
4012 NE CULLY BLVD
REQUIRED INSPECTIONS
PORTLAND OR 97213 Ceiling Cover Underground Cove
Phone #: 287 -6164 Wall Cover Elect' 1 Service
Reg #.. : 000035
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001- %10 through OAR 952- %1 -1987. You may obtain a copy
of these rules or direct questions to OUNC by culling (503)246 -1987.
Permittee Signature: _ Issued By: L
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for
sale, lease, or rent.
OWNER'S SIGNATURE: Crn litiA44 DATE:
CONTRACTOR INSTALLATION ONLY - - - - ---
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + ++ + + ++ ++ + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
PE to-At- /7 /0 - -Fc� o
/-'( - 9?
Gj\ Community Development ELECTRICAL PER APPLICATION
13125 SW Hall Blvd. -�I
Tigard, OR 97223 Permit # 1✓Lcq' 7 0 &T7
, ��,al , � rol L Date Issued (o '�1 )
I Phone (503) 639 -4171
V FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of D evelopmer �M % 1v ZQc. it ,/ Number of Inspections per permit allowed
Address /(, gi Z.Zeo SW 11 1 L iE= l Service included: Items Cost(ea) Sum
City /State /ZirrG p-v-CA O2 . 9 7 Z Z 4a. Residential - per unit
/ 1000 sq. ft. or less $110.00 4
Name (or name of business) Each additional 500 sq. ft. or
portion thereof $25.00
Commercial Residential El Limited Energy $25.00 1
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
/� / / ' �. ( Installation, alteration, or relocation
Electrical Contracto yC- C6 v 200 amps or less 2- $60.00 2
Addre _ .i t� 1� flifl • 201 amps to 400 amps 7 $80.00 g o 2
City / /L / I � Zip 'jL 401 amps to 600 amps $120.00 2
L 601 amps to 1000 amps $ 80.00 2
Phone No. , ` . Over 1000 amps or volts $340.00 2
Job NO. �� " /� Reconnect only
$50.00 2
contractor's license NO. 1&J /1 3e, 4c. Temporary Services or Feeders
Contractor's Board Reg. No. a Installation, alteration, or relocation
Signature of Sur. Elec'n I�'/l, u� 1 200 amps or less 2
License No. L-D.-1S Phone No. 201 amps to 400 amps $50.00 2
401 amps to 600 amps $75.00
Over 600 amps to 1000 volts $100.00
. 2b. For owner installations: see "b" above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee for branch circuits with
purchase of service or feeder fee. 2
City State Zip Each branch circuit 2 � $5.00 i 20
Phone No. b) The fee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder fee. 2
not intended for sale, lease or rent. First branch circuit $35.00
Each additional branch circuit $5.00
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40.00
4 or more residential units in one structure Minor Labels (10) $100.00
J( Service and feeder 225 amps or more
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.E.C. Chapter 5 Per inspection $35.00
Per hour $55.00
In Plant $55.00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees:
5a. Enter total of above fees $ 3Zo r'
NOTICE 5% Surcharge (.05 X total fees) $ [ f,� ...-•
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ �`(�
5b. Enter 25% of line A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. vwdkomdeNeko- ❑ Trust Account # $
prm.app
Balance Due $ /6
6/30/99 • Activities for Case #: ELC97 -00677
4:42:34 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 10/14/97 10/10/97 JD RECD BON 10/14/97
ELCC003 Permit created 10/14/97 10/14/97 B MEMO BON 10/14/97 sent to PE 10/14/97:
ELCC700 Ceiling Cover 10/14/97 . BON 10/14/97
ELCC720 Wall Cover . 10/14/97 BON 10/14/97
ELCC725 Underground Cover 10/14/97 BON 10/14/97
ELCC730 Electl Service 10/14/97 11/25/97 BRP COND MJR 11/25/97 if water bonded to service
ELCC799 Elects Final 4/28/99 JMT 180+ JT 4/28/99 inspection request/research
sent to Chuck D.
ELCC110 Plans checked /approved by P.E. 10/16/97 MJR PASS MJR 10/16/97
ELCC115 Approved plans routed to DSTs 10/16/97 . MJR SENT MJR 10/16/97
ELCC117 DST Post - Review complete 10/17/97 B DONE BON 10/17/97
ELCC400 (F)Ready to issue 10/17/97 B PASS ' BON 10/17/97
ELCC500 (F)Issue permit 10/17/97 B PASS BON 10/17/97 .
ELCC799 Elects Final 5/5/99 5/5/99 5/5/99 BRP PASS No Hold AKJ 5/5/99
ELCC800 Case Finaled 5/5/99 AKJ DONE No Hold AKJ 5/5/99
•
Page 1 of 1 •
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Reque ed AM PM BLD
Location Suite MEC
Contact Person Ph PLM
Contractor , �S G Ca,/ P h - 6/6 SWR
ELC — 77 er a wner 7
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final � �_ PC PASS PART FAIL J ( l
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
FAIL
ELECTRICA
Rough In
UG /Slab
Low Voltage
R►-� rm
PART FAIL
SI
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
Approach /Sidewalk Inspector D 6 ( It
Other Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.