Permit A- CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC1999 -00685
4001 - 13125 SW DEVEL P ME N T r S O ERVICES 1639 -4171 DATE ISSUED: 11/15/1999
PARCEL: 2S1 15 BA -00101
SITE ADDRESS: 16200 SW PACIFIC HWY S
SUBDIVISION: PP1994 -028
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ZONING: C -G
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: Install (2) 200 amps or less Service /Feeder and (25) 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 (101:
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 2 W /SERVICE OR FEEDER: 25 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+ amplvolt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
BIT HOLDING LTD TICE ELECTRIC
BY FORUM PROPERTIES INC 2139 SE BELMONT ST
FIVE CENTERPOINTE DR PO BOX 15009
LAKE OSWEGO, OR 97035 PORTLAND, OR 97215
Phone: Phone: 233 -8801
Reg #: LIC 00000166 ORIGINAL
SUP 25865
PLM 2586s
ELE 26 -126C
FEES • Required Inspections
Type By Date Amount Receipt
Elect'l Service
PRMT KJP 11/15/1995 $262.25 99- 319770 Elect'I Final
5PCT KJP 11/15/1995 $20.98 99- 319770
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Total $283.23
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 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 -001 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987. -
PERMITTEE'S SIGNATURE _, J J 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
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SIGNATURE OF SUPR. ELEC'N: !h/` DATE: II / (�
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
CITY OF TIGARD RE CEIVED
Electrical Permit Application Plan Check #
13125 SW HALL BLVD
OV 1 1999 Rec'd By
TIGARD OR 97223 v o f 413 Date Rec'd
ak ' �� Tr � Date to P.E.
11T
Phone (503) 639- 417Y DEVELOPMENT Date to DST
Print or Type
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit # ��L I 9 y - 606/5
Fax (503) 684 -7297 Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Blockbuster Video
Name (or name of business) Service included: Items Cost Sum I
Address 16200 SW Pacific Hwy S 4a. Residential - per unit
Tigard OR 1000 sq. ft. or less $110.00 4
City /State /Zip Each additional 500 sq. ft. or
Commercial ® Residential El Limited thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current licenses) 4b. Services or Feeders 15 I ).
Electrical Contractor Tice P,1 pc..f - ri C. c.- Installation, alteration, or relocation 2 b�. �,
200 amps or less $6p:8p 2 -
Addre s pn 5nx 1C009 201 amps to 400 amps $80.00 2 -
City l'Ortl State OR Zip 9 /293 - 5009 401 amps to 600 amps $120.00 2
Phone No. 503 - 233 -8801 601 amps to 1000 amps $180.00 2
Job No. 5.370n Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. 76_126( Exp.Date whin /Am
OR State CCB Reg. No Exp.Date 6 it " 03 4c. Temporary Services or Feeders
COT Business Tax or Metro No. 2014 Exp.Date 01 /01 /00 Installation, alteration, or relocation
200 amps or less fin,, $50.00 2 -
Signature of Supr. Elec'n /� V `( �/ 401 amps to 600 amps $100.00 2
2 10/01 /00 Over 600 amps to 1000 volts,
License No Exp.Date see "b" above.
Phone Nc 503- 233 -8801 4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with 1 33.15
purchase of service or S
Print Owner's Name feeder fee. 25 • 3 I�'3 -98-
Address Each branch circ $5.90 2
b) The fee for branch circuits
City State , Zip without purchase of
Phone No. service or feeder tee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circui
$5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
i Each sign or outline lighting $40.00 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 2
$100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure Minor Labels (10)
4f. Each additional inspection over
Service and feeder 225 amps or more the allowable in any of the above
System 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 above apply. S. Fees: 245.00 111) 2 '
Not required for temporary construction services. 5a. Enter total of above fees $
g% Surcharge (.05 X total fees) $ 19 . bU �p9a
NOTICE Subtotal $ 7 /16.60
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $ ova.
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY Man
TIME AFTER WORK IS COMMENCED. ❑ Trust Account #
Total balance Due $ 264.76°-
072,3,- .
I: \DSTS \ELC96.APP Rev 9/96
I.
12/17/1999 Activities for Case #: ELC1999 -00685
3:04:42 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 11/12/1999 KJP RECD No Hold KJP 11/15/1999
ELCC003 Permit created 11/15/1999 KJP DONE No Hold KJP 11/15/1999
ELCC730 ElecYl Service 11/15/1999 11/15/1999 No Hold KJP 11/15/1999
ELCC799 Elect! Final 11/15/1999 11/15/1999 12/08/1999 BP PASS No Hold DGW 12/09/1999
ELCC500 (F)Issue permit 11/15/1999 KJP DONE No Hold KJP 11/15/1999
ELCA700 Rough -in 11/17/1999 11/17/1999 11/16/1999 BP PASS No Hold VT 11/17/1999 walls and slab - Pass
ELCC800 Case Finaled 12/09/1999 HAP PASS No Hold DGW 12/09/1999
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested / A PM BLD
Location / ,„1 1 Suite MEC
Contact Person Ph evy' - ?5 7 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC / r- 004 5
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
PASS PART FAIL
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
oSti Final
FAIL . (
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
PART FAIL
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 q C�
Approach /Sidewalk D //� � L9 ` / Inspector �/ _ �i� /J Ext
Other _
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
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