Permit CITY OF TIGARD ELECTRICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: ELC99 -0170
DATE ISSUED: 03/25/99
= 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S134DB -04700
SITE ADDRESS... :11100 SW 109TH AVE
SUBDIVISION :CARNAHANS ADDITION ZONING:R -4.5
BLOCK • LOT •009 JURISDICTION: TIG
Project Description : Installaton of 2 branch circuits.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD'L 500SF...: 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
----SER V ICE/FEEDER---- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 — 200 amp • 0 W /SERVICE OR FEEDER: 0 PER INSPECTION • 0
201 — 400 amp • 0 1st W/O SRVC OR FDR.: 1 PER HOUR • 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 1 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
MICHAEL FLORA type amount by date recpt
11100 SW 109TH PRMT $ 40.00 DEB 03/25/99 99- 313974
TIGARD OR 97223 5PCT $ 2.O0 DEB 03/25/99 99- 313974
Phone #:
Contractor:
WEST SIDE ELECTRIC CO INC $ 42.00 TOTAL
1834 SE 8TH AVE
REQUIRED INSPECTIONS
PORTLAND OR 97214 Rough —in Elect'1 Final
Phone #: 231 -1548 Elect'1 Service
Reg #..: 13306
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 188
days of issuance, or if work is suspended for more than 188 days. ATTENTION: Oregon law r- • ou to follow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in DAR 952- 801-0818 rough OAR ' 1 -1987. You may obtain a copy
of these rules or direct questions to DUNC by calling ( '. )246 -1987.
Permittee Signature: ,�/ , ./ i `/ Issued By: A / e.,/ //,I 4 ,1
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 INSTALL•TION ONLY
SIGNATURE OF SUPR. ELEC' N: t 4 DATE:
LICENSE NO: 55 5
+ +++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+ +++++++++++ i-++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + +1-+ + ++ + + + + + + + + + + + ++
MAR -24 -99 05:15 PM WEST SIDE ELECTRIC 503 736 0677 P.01
RECEIVED
: CITY,OF TIGARD MAR 2 5 19 ectrical Permit Application Planck
1312$ SW HALL BLVD. Recd By At ,
TIGARD OR 97223 COMMUNITY DEVELOPMENT Date Reed .1 -9 Y
Date to P.E.
Phone (503) 639 -4171, x304 Date to as �--
Ins edtitsn (503) 639-4175 Print or Type
p Inco lete or Ills ible will not be accs ted Permit "' GC Y9�0/7Q
Fax ( 684-7297 P 9 P caned
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development, Number of Inspections per permit allowed
;Name (or name of business) F/ R" Service included: Items Cost Sum
1
;Address / / / 06 5 4 / /o 7 r4' 4a. Residential • per unit
Ti 1000 aq. ft, or lees $110.00 4
'City/Stile/Zip l � 'r' °► d 7 2 3 Each additional 500 sq. ft. or
Commercial ❑ �/ Residential El portion thereof _ $25.00 . 1
Limited Energy
Each Manned Home or Modular
Dwelling Service or Feeder $88.00 2
' 2a. Contractor installation only:
(Attach copy of all cu rent ice es rr L , 4b. Services or Feeders
Electrical C. rector 4 . 4 / c v G / C/ /C Installation, aheratlon, or relocation
Addre ` ` t.A Wi 200 amps or less 160.00 2
City .1,TJJL- State /7i 2i 201 amps to 400 amps $80.00 2
P �C4- 401 amps to 800 amps $120.00 2
Phone; No 2 - /SV/ ' 601 amps to 1000 amps $180.00 2
Job Nq. 3 s 3 -- o o 3 Over 1000 amps or volts ss4o.00 2
550.00 2
t only Cont. Lice. No. 6 - / ?S C Exp.Date Reconne ---
OR State CCB Beg. No. 1 13 Dt'_+ Exp.Date 3-24/ -O?) 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation
200 amps or less 550.00 2
Signature of Supr. Eisen 201 amps to 400 amps $75.00 2
401 amps to $00 amps $100.00 2
Over 600 amps to 1000 volts,
LicensSa No f S,,�4 ,S Exp.Date see "b" above.
Phone Nc 23/ / - VV
• 1.�pp
4d. Branch Clrculta
20. For owner Installations: New, alteration or lop per panel
a) Tho tee for branch anch circuits with
purchase of service or
;Print Owner's Name _ feeder fee.
Address Each branch circuit 15.00 2
b) The lee for branch circuits
City State Zip Without purchase of
Phone No, service or feeder fee.
First branch circuit / $35.00 S 2
The Initallatlon is being made on property I own which is not Each additional branch circuit / $5.00 . 5 2
intended for sale, lease or rent. 4e. Miscellaneous
• Owner's Signature (Service or feeder not Included) 5 40.00
g . . . Each pump or Irrigation circle 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):* Signal circuits) ore limited energy 540 2
panel, alteration or extension 5400 04
Minor labels (10) _�
Please check appropriate item and enter fee In section 59.
4 or more residential units in one structure 41. Each additional Inspection over
a Service and feeder 225 amps or more the allowable In any of the above
System over 600 volts nominal Per inspection _ _ _ $35.00
; Classified area or structure containing special occupancy Per hour S55.00
as described in N.E.C. Chapter 5 In Plant 555.04 N.
Submit 2 sets of plans with application where any of the above apply. 5. Fees: i/
Not required for temporary construction services. 54. Enter total of above fees S z NN
5% Surcharge (.05 X total fees) $
NOTICq Subtotal S \� d
6b. Enter 2M . of line Be for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED 13 Plan Review ' r uir $
(See.3) $
NLfT �D1JWlE W1ZFi1N 1SD DAYS, OR IF CONSTRUCTION OR WORK Subtotal
IS SU PETIDEO OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY Trust Account 4 ( 33 C) s 9 Z
TIME , FfER WORK IS COMMENCED. ` �`■
Total balance Due
•
leg
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested q--111 AM PM BLD
Location 1 I 100 1 (Y I v. Atie. Suite MEC
Contact Person -� ( Ph C S1 'l //l PLM
Contractor Ph SWR
/
BUILDING Tenant 41,t(,1�,LQ fl DYE ELC Q9 -0) 70
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab I 4 1 IJ 0 f, - d
Post & Beam
Ext Sheath /Shear � p A j Al- p
Int Sheath /Shear
Framing
Insulation
Drywall Nailing • _ / 0 _ _ L e
Fire wall
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 f&I1/4Post & Beam �
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
r°AL')
Rough In
UG /Slab
Low Voltage
Fire Alarm
irpp
'ART FAIL
r "
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 rein pection RE: [ ] Unable to inspect - no access
ADA
Other oach /Sidewalk Date Inspector r2Ze Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
6/19/00 Activities for Case #: ELC99 -00170
1:47:40 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 Application received 3/25/99 DEB FAX DRA 3/25/99
ELCA003 Permit created 3/25/99 DEB DONE DRA 3/25/99
ELCA700 Rough -in DRA 3/25/99
ELCA730 Elect'I Service DRA 3/25/99
ELCA799 Elect'! Final 4/7/99 CD PASS CD 4/7/99 gas furnace reconnection &
wiring of a/c unit
ELCA500 (F) Issue permit 3/25/99 DEB DONE DRA 3/25/99
ELCA800 Case finaled 4/7/99 AKJ DONE No Hold AKJ 4/7/99
Page 1 of 1,