Permit CITY OF TI GARD ELECTRICAL PERMIT
PERMIT #: ELC1999 -00735
14 DEVELOPMENT SERVICES D ISSUED: 12/9/99
A. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 ('1` PARCEL: 1S136DA -00100
SITE ADDRESS: 11308 SW 68TH PKWY � `
SUBDIVISION: �� ZONING: MUE
BLOCK: LOT . JURISDICTION: TIG
Project Description: Installation of (2) services of 200 amps or less and 5 branch circuits. Job No. 83760.
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: 2 W /SERVICE OR FEEDER: 5 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+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
BENENSON 68TH PARKWAY OREGON ELECTRIC CONST /GROUP
KEY LLC, THE 1010 SE 11TH AVE
BY FIRST AMERICAN TAX VALUATIO PORTLAND, OR 97214
WORCESTER, MA 01615
Phone: Phone: 234 -9900
Reg #: LIC 203
SUP 1302S
ELE 26 -95C
FEES Required Inspections
Type By Date Amount Receipt Elect'l Service
PRMT DEB 12/9/99 $155.25 99- 320313 Elect'I Final
5PCT DEB 12/9/99 $12.42 99- 320313
Total $167.67
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 copie = - - ules or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE 1 41. ISSUE o 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: DATE:
CONTRACTOR INSTALLATION ONLY
• SIGNATURE OF SUPR. ELEC'N: . )\ Yt Cam-/ (� DATE:
LICENSE NO: gococi
Call 639 -4175 by 7:OOpm for an inspection the next business day
CITY OF TIGARD Electrical Permit Application PIanC -cit#
1 ;125 SW HALL BLVD. Rec'd :, 2 4 .
- TIGARD OR 97223 Date Rec'd IA -3 -9 '
Date to P.E. -------
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print of Type Permit # FLe1999- 0C 735 -
Fax (503) 598 -1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) Ti ga ra Da t a rPnt r Service included: Items Cost Sum `I'
Address 11 308 SW 68th Parkway 4a. Residential - per unit
City/State /Zip Tigard OR 9 7 2 2 3 1000 sq. ft. or less $ 117.75 4
Each additional 500 sq. ft. or
portion thereof $ 26.25 1
Commercial II 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). Installation, alteration, or relocation
Electrical Contractor Oregon Electric Group 200 amps or less 2 $ 64.25 128.50 2
Address 1 01 0 .CF. 1 1 th A V P 201 amps to 400 amps $ 85.50 . • 2
City Portland State OR Zip 9721 4 401 amps to 600 amps $ 128.50 '2
601 amps to 1000 amps $ 192.50 2
Phone No. 2 3 4- 9 9 0 0 Over 1000 amps or volts $ 363.75 2
Job No. - 8 3 7 6 0 Reconnect only $ 53.50 2
Elec. Cont. Lice. No. 2 6- 9 5C Exp.Date 4c. Temporary Services or Feeders
OR State CCB Reg. No. 2 0 3 Exp.Date Installation, alteration, or relocation
ire �
COT Business Tax or Metro ..D. 1IS 200 amps or less $ 53.50 2
+� '' M; 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,
2 see "b" above.
License No. 06 Exp.Date 4d. Branch Circuits
Phone No. 2-34--9-900 New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase ofservlce or
feeder fee.
Print Owner's Name Each branch circuit 5 $ 5.35 26.75 2
Address • b The fee for branch circuits
without purchase of service
City State • Zip or feeder fee.
Phone No. First branch circuit $ 37.50
Each additional branch circuit $ 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 included)
Each pump or irrigation circle $ 42.75
Owner's Signature Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy
if required):* panL el s (10 or extension $ 60.00
3. Plan Review section
(. Minor Labels (10) $ 107.00
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:
5a. Enter total of above fees $ 1 5 5.2 5
* Submit 2 sets of plans with application where any of the abo , a 8% 1% Surcharge (.05 X total fees) $ 1 2 _ 4 2
Not required for temporary construction services. Subtotal $
Sb. 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 $ 1 6 7.6 7
i:\dsts\forms\electric.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
y BUP
Date Requested (� AM PM BLD
Location I 1 ' 0 (o P Suite MEC
Contact Person ' DI1) ii Ph g ! 9 - Z 7 7 7 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC t7
q 9 -00 7 3 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
Fire Alarm
Roof 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
PAS PC4RT FAIL
LECTRICAI:
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
l;ft 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 /
Approach /Sidewalk Date / - . / ' t� Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.