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Permit CITY OF T ELECTRICAL PERMIT r Ai PERMIT #: ELC2000 -00165 ; DEVELOPMENT SERVICES DATE ISSUED: 04/10/2000 ' I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 • PARCEL: 25101 AD -02400 SITE ADDRESS: 12753 SW 68TH AVE. 200 SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE BLOCK: LOT : 032 JURISDICTION: TIG Proiect Description: 10 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: 9 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: GEORGE FOX ERSITY 1A)u -- eA V\, £'tf'ez•v1 • ,jQ/YVI., ST NE N ME AN 71 Po 1 . Z3 31 �'j NEWS G, RD 97132 X Phone: 503 - 538 -8383 Phone: 9 ?A Reg #: FEES Required Inspections Type By Date Amount Receipt Elect'l Service PRMT BON 04/10/200C $85.65 MANUAL Elect'l Final 5PCT BON 04/10/200C $6.85 MANUAL Total $92.50 ORI G I N A L .._ c /p.0 2 h�n I -I 3 Tl /640 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 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -1987. ___ , PERMITTEE'S SIGNATURE / ISSUED BY: 6. 11/ L ____, OWNER INSTALLATION ONLY The installation is being made on ,.." I own which i n • i, "ded for sale, lease, or rent. OWNER i I ■ l DATE: SSIGNATURE: / CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N• DATE: LICENSE NO: Call 639 -4175 by 7:OOpm for an inspection the next business day ;CI'TIt TIGARD Electrical Permit Application Plan Check 13125 SW HALL BLVD. Recd By Date Rec'd 1/9-700 TIGARD OR 97223 Date to P.E. Phone (503) 639 -4171, x304 Date to DST i Inspection (503) 639 -4175 Print of Type permit # 5/Z-2143 -00(4 Fax (503) 598 -1960 Incomplete or illegible will not be accepted Called 1. Job Address: I n 4. Complete Fee Schedule Below: Name of Development P 4 1�.( £�K�.04/ Number of Inspections per permit allowed Name (or name of business) 12_7S3 ' / S ✓ 69i& 54 Service included: Items Cost Sum 4 ' Address v 4a. Residential - per unit 1000 sq. ft. or less $ 117.75 4 City /State /Zip eg 97 2;7.3 Each additional 500 sq. ft. or 77 portion thereof $ 26.5 1 Commercial ❑ Residential ❑ Limited Energy $ 60.00 Each Manufd Home or Modular 2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2 (Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders information for COT data base). l Installation, alteration, or relocation ' Electrical Contractor &Coe 4 Uhr id*)., 7 200 amps or less $ 64.25 2 �/ t!7 Address 201 amps to 400 amps $ 85.50 2 p. tier, / e r 401 amps to 600 amps $ 128.50 2 City Pav 0 State O t Zip 41-7/32._ 601 amps to 1000 amps $ 192.50 2 Phone No. ,5'b3 .539 OZOI Over 1000 amps or volts $ 363.75 2 Job No. Reconnect only $ 53.50 2 Elec. Cont. Lice. No. '3 6- 7S Exp.Date 4c. Temporary Services or Feeders OR State CCB Reg. No. Exp.Date Installation, alteration, or relocation COT Business Tax or Metro No. Exp.Date 200 amps or less $ 53.50 2 201 amps to 400 amps $ 80.25 2 Signature of Supr. Elec'n 401 amps to 600 amps $ 107.00 2 Over 600 amps to 1000 volts, License No. 3e_ 7 SL Exp.Date See "b" above. Phone No. 4d. Branch Circuits New, alteration or extension per panel a) The fee for branch circuits 2b. For owner installations: with purchase of service or t feeder fee. C Print Owner's Name eAr5/ C ()bib/. Each branch circuit $ 5.35 2 " b) The fee for branch circuits Address �I l�l 14 - �t -C/' A � A� S t' without purchase of service City 'dew klePo State O2 Zip co 13 Z or feeder fee. ,�/ Phone No. Sa3 S38 9.56.3 First branch circuit 1 $ 37.50 3 ( - Each additional branch circuit p $ 5.35 L (S - The installation is being made on prope I own ich is not 4e. Miscellaneous -T- intended for sale, lease (Service or feeder not included) // /J Each pump or irrigation circle $ 42.75 Owner's Signature l" / Each sign or outline lighting $ 42.75 fi'ap / e 6, c •er- Signal circuit(s) or a limited energy panel, alteration or extension $ 60.00 3. Plan Review section (if required):* Minor Labels (10) $ 4.Tee • 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 $ 59.00 Classified area or structure containing special occupancy as described in N.E.C. Chapter 5 5. Fees: YYII % � 5a. Enter total of above fees $ ' * Submit 2 sets of plans with application where any of the above apply. ,dAo Surcharge( total fees) $ , Not required for temporary construction services. Subtotal $ 5b. Enter 25% of line 5a 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 ❑ Trust Account # AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ 92_,C0 i:\dsts\forms\electric.doc CITY OF TIGARD BUILDING INSPECTION DIVISION 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST BUP Date Requested (0/ 12/ D AM � P , M . BLD Location 1 2:7 S (J • 'l/`L Suite c -7 cxJ MEC Contact Person Pan Ph, 9 / PLM Contractor Ph SWR BUILDING Tenant/Owner ELC 2DO0 - o D/ S 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 v? 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 Final PASS PART FAIL ELECTRIGAt) Service Rough In UG /Slab Low Voltage Fire Alarm AS • PART FAIL SITE 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 Date 6 H Ins Ext Other Z7 Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site . CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 / BUP Date Requested � S/ S 1 OD AM PM BLD Location 1 2) c 3 Cog ` 11 44(_. Suite 2.60 MEC Contact Person Oa,) Ph S ; ' 1 0/ PLM Contractor Ph S50 '2-0 / SWR BUILDING Tenant/Owner ELC WO Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: / /0 _ e ` � y Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation /1 i 1 ` t Drywall Nailing /. �L �;�i _ ��� _�� Iw Firewall / f 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 Final PASS PART FAIL ECTR Service T UG/Slab Low Voltage Fire • • 'ART 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 EA S Date Inspector / Ext Other ff Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested 5/2 AM PM BLD Location 1 2,-1S5 Cogc sdtk Suite MEC ` Contact Person OQ.i Ph SS 'Z/ < PLM Contractor Ph SWR BUILDING Tenant/Owner ELC — 0 0 / (v S Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain Crawl Drain Inspection Notes: SGN �� a !2 Slab r SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing / Firewall f D 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 Final PASS PART FAIL tCTRICI'ti Service ough t. lab Low Voltage Fire Alarm PASS 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 1 ADA Approach /Sidewalk Other Date - s ` Z. OD Inspector .t Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.