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Permit CITY OF T I G A R D ELECTRICAL PERMIT PERMIT #: ELC1999 -00759 Afk DEVELOPMENT SERVICES DATE ISSUED: 12/27/1999 rI 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 PARCEL: 2 S 113AB -01201 SITE ADDRESS: 16505 SW 72ND AVE BLDG F 16505 -16035 SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -L BLOCK: LOT : JURISDICTION: TIG Project Description: Electrical TI 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: SIGNAUPANEL: MANF HM/ SVCI 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: 23 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: PACIFIC REALTY ASSOCIATES STONER ELECTRIC 15350 SW SEQUOIA PKWY #300 -WMI 2701 SE 14TH PORTLAND, OR 97224 PORTLAND, OR 97202 Phone: Phone: 233 -3631 Reg #: LIC 00044823 SUP 4025S ELE 26 -122C FEES Required Inspections Type By Date Amount Receipt Elect'l Service PRMT BON 12/27/1990 $160.55 99- 320664 Elect'I Final 5PCT BON 12/27/1990 $12.84 99- 320664 Total $173.39 ORIGINAL 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 co (am _wlwLkC(�I 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 SIGNATURE OF SUPR. ELEC'N: (9V G (L"�' ` \ DATE: LICENSE NO: Call 639 -4175 by 7:OOpm for an inspection the next business day • CITY OF TIGARD Electrical Permit Application Plan CheckQQ#,,I --,�� 13.125 SW HALL BLVD. Rec'd By eD • TIGARD OR 97223 RECEIVERECEIVED Date Rec'd ( - 2-1 - /1 Phone (503) 639 -4171, x304 Date to P.E. Inspection (503) 639 -4175 DEC t 2� 7 • • • Yf jft 0 Date to DST • e Permit # g.4.4011 to 757 Fax (503) 598 - 1960 Cu4ncomPitifalitkigikitenjMot 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) ��L/ R. Service included: Items Cost Sum 4 ' Address ) LSO 6 S V I J 720 D 4a. Residential - per unit City /State /Zip P•, - 1Zrlkt4ll b� 97224 1000 sq. ft. or less $ 117.75 4 / Each additional 500 sq. ft. or (� portion thereof $ 26.25 1 Commercial ID 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 -S 2 c_._ 200 amps or Tess $ 64.25 2 Address 7Z.e4sKD ss 2.7o t S ---/e-i±‹- 201 amps to 400 amps $ 85.50 2 f- 8� State - - Zip 9 7 2d - 401 amps to 600 amps $ 128.50 2 City P 601 amps to 1000 amps $ 192.50 2 Phone No. 3 - 233 -3e.3/ Over 1000 amps or volts $ 363.75 2 Job No. -370 Z•Its Reconnect only $ 53.50 2 Elec. Cont. Lice. No. 24;,-/ 22- Exp.Date /o /'A ' 4c. Temporary Services or Feeders OR State CCB Reg. No. 448323 Exp.Date 3 /2a /e. 0 Installation, alteration, or relocation COT Business Tax or Metro No. 44 /4 Exp.D -te , i o 200 amps or less $ 53.50 2 201 amps to 400 amps $ 80.25 2 Signature of Supr. Elec'n /i . ; , lj /,. 401 amps to 600 amps $ 107.00 2 r r Over 600 amps to 1000 volts, License No. �' �a ' Exp.Date /d i see "b" above. a Phone No. ...12 / 4d. Branch Circuits New, alteration or extension 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 circuit $ 5.35 2 Address b) The fee for branch circuits without purchase of service City State Zip or feeder fee. Phone No. First branch circuit / $ 37.50 375 Each additional branch circuit 23 $ 5.35 /23. 4.5 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 alteration 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 $ /IGQ5:5 * Submit 2 sets of plans with application where any of the above apply. ei/o Surcharge (.l ( total fees) $ 12'84 Not required for temporary construction services. Subtotal $ /73 5b. Enter 25% of line 5a for NOTICE Plan Review if required (Sec. 3) $ - e3*- PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $ `9 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 $ is \dsts \forms \electric.doc CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP 4 1/ 2 1/00 Date Requested AM P M BLD Location ) LO S — MEC Contact Person ' � Ph - 70(p k PLM l Contractor £.e_L Ph SWR aG BUILDING Tenant/Owner 1r 7 ELC�Ig7 7 _ OD S 9 Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Slab Crawl Drain Inspection Notes: �� { �) I _ e' D U L L.t�'e— SIT Post & Beam /_ /4/ 5 Ext Sheath /Shear ° 'CU � 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 Final PAS s_ PART FAIL ECTRICA Service Rough In UG /Slab Low Voltage FirAAl y 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 1/71? Other Date D 0 Inspector ` - _ Ext Final • PASS PART FAIL DO NOT REMOVE this inspection record from the job site.