Permit 4 CITY OF TIGARD
DEVELOPMENT SERVICES ELECTRICAL PERMIT
Aar ' ' L I 13125 SW HaII Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT #: ELC96 -0722
DATE ISSUED: 11/12/96
PARCEL: 2811OAA -00300
SITE ADDRESS...: 14145 SW 105TH AVE
SUBDIVISION. ZONING:R -12
BLOCK • LOT •
Project Description: ADD FEEDER & BRANCH CIRCUITS
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 1 PUMP /IRRIGATION : 0
EACH ADD'L 5O0SF...: 0 201 — 400 amp • 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY • 0 401 — 600 amp . 0 SIGNAL /PANEL • 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 — 200 amp : 0 W /SERVICE OR FEEDER: 22 PER INSPECTION • 0
201 — 400 amp • 0 1st W/O SRVC OR FDR.: 0 PER HOUR • 0
401 — 600 amp : 0 EA ADD'L BRNCH CIRC: 0 IN PLANT : 0
601 — 1000 amp • 0 PLAN REVIEW SECTION
1000+ amp /volt . 0 > =4 RES UNITS > 600 VOLT NOMINAL..:
Reconnect only • 0 SVC /FDR >= 225 AMPS..: CLASS AREA /SPEC OCC.:
Owner: FEES
SUNRISE HEALTHCARE type amount by date recpt
14145 SW 105TH ST PRMT $ 170.00 TAT 11/12/96 96- 286346
SPCT $ 8.50 TAT 11/12/96 96- 286346
TIGARD OR 97224
Phone #:
Contractor:
ROSE CITY ELECTRIC CO INC $ 178.50 TOTAL
4012 NE CULLY BLVD
REQUIRED INSPECTIONS
PORTLAND OR 97213 Ceiling Cover Underground Cove
Phone #: 503 -287 -6164 Wall Cover Elect'1 Service
Reg #..: 000035
This permit is issued subject to the regulations contained in the a.I IV/
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permit Signatu
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started
within 188 days of issuance, or if work is suspended for more 441 , /,
than 188 days. I ued 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: DATE:
LICENSE NO:
Call for inspection — 639 -4175
• V Community Development ELECTRICAL PERMIT APPLICATION
. A 13125 SW Hall Blvd. (�
Tigard, OR 97223 Permit # �Lt✓7 P -072Z
�� �i�i�IIN� I � Date Issued /1/010 i Phone (503) 639 -41
-1 /
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175 S //0 ,q - Z)0366
1. Job Address: r ono , 4. Complete Fee Schedule Below:
Name of Development -- no . (1. ' 1 -_ �i. ,♦ Number of Inspections per permit allowed
/\ i►
Address \ A �. W 1 Service included: Items Cost(ea) Sum
City /State /Zip � 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
Name (or name of b ?I ss) Each additional 500 sq. ft. or
portion thereof $25.00 1
Commercial kr Residential El Limited Energy $25.00
Each Manufd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
IP ' i �-/ ( Installation, alteration, or relocation / _D
Electrical ontr- ctor 0 v 200 amps or less $60.00 C9 2
Ad • - - " A , L ;��!�rtill �l��n 201 amps to 400 amps $80.00 2
$120.00 2
�iT �7 401 amps to 600 amps 2
CRY (1����I� ►�t► IP 601 amps to 1000 amps $180.00
Phone No. ra • • Over 1000 amps or volts $340.00 2
Job NO. 'Mani. Reconnect only $50.00
contractor's license NO. �imium 4c. Temporary Services or Feeders
Contractor's Board Reg. No. /I A , 1 • ' Installation, alteration, or relocation
Signature of Supr. Elec'n `r.�� ragErM 200 amps or less 2
i - 201 amps to 400 amps $50.00 2
License No. 0 1 P one No. _� ■ t 401 amps to 600 amps $75.00 2
Over 600 amps to 1000 volts $100.00
2b. For owner installations: see „b„ above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee for branch circuits with
purchase of service or feeder fee. 2
City State Zip Each branch circuit 2 $5.00 I40
Phone No. b) The fee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder fee. 2
First additional circuit br $35.00
not intended for sale, lease or rent.
Each addltional branch circuit $5.00
Owrrer's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40.00
4 or more residential units in one structure Minor Labels (10) $100.00
Service and feeder 225 amps or more
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.E.C. Chapter 5 Per inspection $35.00
Per hour $55.00
In Plant $55.00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees:
5a. Enter total of above fees $ 17 0 S0
NOTICE 5% Surcharge (.05 X total fees) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
5b. Enter 25% of line A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. word \comdeNeiec- ❑ Trust Account # $
prm.app O
Balance Due $ I l e
I
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /Flr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
.. Other: + q
Date: 1 i I L i , l l 1 A.M. P. . Entry:
`'/
Address: �I / J 44.5 /0,5 ,St'
Tenant: ..S //LL (L o MST:
4 - BUP:
Con /Own: i._ .....;/ - - MEC:
111 PLM:
ELC: "L- O
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
?. C-fr; rce_ / -alb ...-
.%)e-e c ( •-i. -t-e...ex. 5 "re cre-ei
0 _ .,-- ... �� x-41
Inspector: // �� AI. Awl ai
Date:, — L� -y7
X APPROVEDiISAPPROVED /CALL FOR REINSP. CF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /Flr /Slab Plbg. Top Out Insulation 4412P.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other:
Date: 3 / 6 l A.M. P.M. �v E � ntry:
Address: / 1 i i / 0 T� ,31
Tenant: _ 4 ,4Z2 _ Ste: MST:
BUP:
Con /Own: 4A�11_2_ (a. £/ ' MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR: al-
�� c7-9e-c/ $;4/
Inspector: ?fr. C 4 c f 51 Date:, 0
APPROVED _DISAPPROVED /CALL FOR REINSP. CF CO
�1. 77-oa77
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other:
Date: i , G I LP I _l 7 A.M* P.M. Entry:
Address: / / LI S 6 e)
Tenant: -e. Ste: MST:
��''' II BUP:
Con /Own: v MEC:
PLM:
ELC: Z
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:77 /9 ,
1c il P (/ 7/2le
_a______40 I 5 1 ( ; c.--e-7 di
Inspector: 1 /. C * •-P / X u e Date: / "'",G -97
/APPROVED DISAPPROVED /CALL FOR REINSP. CF CO