Permit • CITY OF T ELECTRICAL PERMIT
PERMIT #: ELC2000 -00638
' , v(4 , DEVELOPMENT SERVICES DATE ISSUED: 11/16/2000
"' �! 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 2 S 113AD -01900
SITE ADDRESS: 16600 SW 72ND AVE B -10
SUBDIVISION: ROSEWOOD ACRE TRACTS ZONING: I -L
BLOCK: LOT : 009 JURISDICTION: TIG
Project Description: Signal circuit or limited energy panel alteration or extension.
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: 1
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: 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:
PACIFIC REALTY ASSOCIATES HONEYWELL INC
15350 SW SEQUOIA PKWY #300 -WMI 15495 SW SEQUOIA
PORTLAND, OR 97224 STE 100
PORTLAND, OR 97224
Phone: Phone: 968 -3300
Reg #: SUP 941 -JLE
LIC 00057824
ELE 26- 207CLE
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT CTR 11/16/200C $75.00 2720000000( : Elect'I Final
5PCT CTR 11/16/2000 $6.00 2720000000(
Total $81.00
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 07 v ISSUED BY:Z
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: DATE:
LICENSE NO:
Call 639 -4175 by 7:OOpm for an inspection the next business day
OCT -04 -2000 17 13 HONEYWELL • 503 968 3398 P.02/02
CITY TIGARD Electrical Permit Application Ret , "� Z°nV �°�
- -1'i"25 SW HALL BLVD.
TIGARD OR 97223 Date Recd
Date to P.E.
.Phone (503) 639 -4171, x304 Print of Type Date to DST
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permits E1.Cao of - Q)6 , 3e
Fax (503) 598 -1960 Caned
1. Job Address: { 1 10 /,I( , /2 4. Complete Fee Schedule Below:
1 5 i
Name of Development N allowed Number of Inspections per permit
Name (or name of business) FI i h I- D na -cs
• � , � Cr 6 w.t /0 Service included: Items Cost Sum 1
dress
� O � �� as. Residential - per unit
City /State /Zip . 7 - 1_5 1 a...,-4 1000 sq. n. or less $ 117.75 4
/ 6,c, crp S'cJ 72, i . Each additional 500 sq. ft. or
Commercial Residential ❑ L N - So Z V? Limited f Energy $ 80.00 1
So 3 "
2a. Contractor installation only: Each Man S Home or c ede
Dwelling Service or Feeder
$ 72.75 2
(Prior to permit issuance. applicants must provide contractor -
license information for COT data base). / db. Services or Feeders
Electrical Contractor TI V l7 14.,1-ill Inatallatlon, alteration, or relocation
Address 1 5 1 , 200 amps or lase 3 84.25
2
�� [�7� ,� 201 amps to aoo amps $ 85.50 2
City Pte'+ a-A.4 State O R Zip q� �a-'� 401 amps to 600 ampa $ 128.50 2
Phone No. 503 -- 94 - 3 5 5 a 601 amps to 1000 amps $ 192.50 - 2
Job No. 7 a.44 -0/ - al/ 9 8O- 0 5 over 1 000 amps or volts 5 363.75 2
Elec. Cont. Lice. No.24 - 2- 0 7CL€Exp.Date /o / /01 Reconnect only $ 53.50 2
OR State CCB Reg. No. 5182. Exp. Date I 'a--7 /0A 4c. Temporary Services or Feeders
COT Business Tax or Metro No. 46 r ei Exp.Date 11 / //a Installation, alteration, or relocation
200 amps or less $ 53.50 2
Signature of Supr. Elec'n ,�....- 201 ampa to aoo amps $ was 2
401 amps to 600 amps $ 100.00 2
L/ / TI-., Ex p. Date /0l / O /o a.. Over 800 amps to 1000 volts,
License No. p see °b" above.
Phone No. -503- 967 8- 3"3 /
't, ad. Branch Circuits
2b. For owner installations: 5-1-Q/") . New, aiteration or extanalon per panel
a The fee for branch circuits with
purchase of service or leader
Print Owner's Name fee.
Address Each branch circuit $ 5.35 2
City State Zip e) The fee for branch dreuits
without purchase of service
Phone No. or leader fee.
First branch circuit $ 37.50
The installation is being made on property I own which is not Each additional branch circuit $ 5.35
intended for sale, lease or rent
de. Miscellaneous
(Service or feeder not included)
Owners Signature Each pump or Irrigation circle $ 42.75
Each sign or outline Ilghdng 5 42.75
3. Plan Review section (if required) Signal clrcult(s) or a limned energy 1 #7.,00 7� t7`
penal, alteration or extension $ SOren
Please check appropriate Item and enter fee in section 5B. Minor Labels (10) 5 100.00
4 or more residential units in one structure
4f. Each additional Inspection over
Service and feeder 225 amps or more rho allowable In any of the above
System over 600 volts nominal Per inspection $ 50.00
Classified area or structure containing special occupancy as Per hour $ 50.00
described in N.EC. Chapter 5 In Plant $ 59.00
5, Fees:
* Submit 2 sets of plans with application where any of the ea. Enter total of above fees 75, cD $ 470
above apply. 8% Surcharge (.08 X total fees) V , o z) $ Q
Not required for temporary construction services. Subtotal $ ... k-9.40 --
Sb. Enter 25% of line 6a for / f tr
NOTICE Plan Review IL.figmba (Sec. 3) $
Subtotal S bir fa
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS Trust Account # 14 2-01
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME Total balance Due j2/ o1 $ , r ii0
AFTER WORK IS COMMENCED.
TOTAL P.02
CITY OF TIGARD = ' 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received / Date Requested -I 02 AM PM BUP
Location /6 l� d /
U �� 6 AV� /DSuite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ,�/!� 2/76
Foundation Access: et) ' �/, _ ,� 7
Ftg Drain �,/�/dP/L � � r ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
•
PLUMBINGRT FAIL m) mesas
Post & Beam \( \..
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
P FAIL
ELECTRI L
`g ernc e —
Rough-In
UG/Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: ❑ Unable to inspect – no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL