Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2002 -00243
-- 13125 SW 1 1 Jh� DEVEL PMENT rd OR ERV ACES 639 -4171 DATE ISSUED: 5/31/02 (503) PARCEL: 2S 110CD -00105
SITE ADDRESS: 15900 SW 116TH AVE
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT : JURISDICTION: KIN
Proiect Description: Tenant Improvement
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: 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: 10 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:
UNITED STATES NATIONAL BANK PEGASUS ELECTRIC INC
REAL ESTATE MGMT DIV -T3 17057 SW 123RD AVE
PO BOX 8837 TIGARD, OR 97224
PORTLAND, OR 97208
Phone: Phone: 503 - 502 -0340
Reg #: LIC 148906
ELE 34 -574C
SUP 4754S
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 5/31/02 $113.50 2720020000( Elea! Final
5PCT CTR 5/31/02 $9.18 2720020000(
Total $122.68
This Permit is issued subject to the regNlations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable
laws. All work will be done in accordOce 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 18d days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification
Center. Those rules are set forth i OAR 95 - -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to
Permit Signature: 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: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
Date received: C - 2 )j /6a_ Permit n9(,, )_ - s, L/
` :4 -e(.. '■yh City of Tigard Pro ect/a 1 no.: Expire 1
: _� y g J PP • redate: P�
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi - family &Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: / ›',00 $'W //(o 1H Ati/� Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: 'Block: ISubdivision:
Project name: , $, /'T» ji,e>'#"/ I Description and location of work on premises: 1 ,4%E' ?..er e-..7"
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: 30— d Fee Max
Description Qty. (ea.) Total no. insp
Business name: ��S G6e�lX./GG, New residential - single or multi- family per
Address: /7037 $ i z34 Are- dwelling unit. Includes attached garage.
City: 774,42,60 I State:p,. I ZIP: 9 7eZ' • Service included
Phone: -oz, 0310 I Fax:(o70 9137 I E -mail:
1000 sq. ft. or less 4
� /t W6C, I 3 4/ - s- 7 � Each additional 500 sq. ft. or portion thereof
CCB no.: Y Elec. bus. lic. no: e
CCCC�, Limited energy, residential 2
(3it�j /m no.: — 7/ Z 6 Limited energy, non- residential 2
Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): ) J / 9 2/57,4, License no: `s'7.3 / s Services or feeders — installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration,orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail:
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc .(Serviceorfeedernotincluded):
❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps -rating of I &2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lighting plan ❑ Other. Per inspection I I I I
Submit _ sets of plans with any of the above. Investigation fee m
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card number: / I within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -46l5 (6/00 /COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY _
/� Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 1, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 n Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders n Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2 I I Vacuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 n Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 - 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. n Audio and Stereo Systems
Branch Circuits
New, alteration or extension per panel n Boiler Controls
a) The fee for branch circuits
with purchase of service or n Clock Systems
feeder fee.
Each branch circuit $6.65 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service n Fire Alarm Installation
or feeder fee.
First branch circuit I $46.85 4(.. es"
n
Each additional branch circuit ` o $6.65 ( . (r a' HVAC
Miscellaneous D Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 n Landscape Irrigation Control
Minor Labels (10) $125.00 _
Each additional inspection over n Medical
the allowable in any of the above n
Per inspection $62.50 Nurse Calls
Per hour $62.50
In Plant $73.75 n Outdoor Landscape Lighting
Fees: n Protective Signaling
Enter total of above fees $ // 3 >4' n
Other
8% State Surcharge $ 9. / 6 Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due s/ ii 2, g
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
All New Commercial Buildings require 2 sets of plans.
i:\dsts \forms \elc- fees.doc 08/30/01
KING CITY
15300 S.W. 116th Avenue, King City, Oregon 97 -2693
Phone: (503) 639-4082 • FAX (503) 639 -3771
Notice To Contractors Working In King City
Due to an intergovernmental agreement with the City of Tigard, many building related permits
for projects in King City are issued and inspected by the City of Tigard.
If your permit application DOES NOT REQUIRE PLAN REVIEW, simply complete the
appropriate application legibly and submit it to the King City staff. The King City staff will
collect all fees and fax the application to the City of Tigard. City of Tigard staff will then create
the permit, issue the permit, and perform inspections. Please indicate on the permit application
whether you would like the Tigard staff to call you when the permit is ready for issuance or
whether you prefer it to be mailed without any notification. Any incomplete or illegible
application will be returned to King City staff for correction and no processing will occur until a
complete, legible application is received.
If your permit application DOES REQUIRE PLAN REVIEW, this form must be signed by a
King City staff person. King City staff will simply sign this form indicating land use approval.
Take this signed form to the City of Tigard Development Services Counter located at 13125 SW
Hall Blvd, Tigard, to submit applications and plans. Development Services Technicians are
available at 639 -4171 Ext. 304 should you have any questions concerning submittal
requirements. All permit fees will be assessed and collected at the City of Tigard.
The City of King City hereby authorizes applicant to pursue permits a1t�� the �City of Tr
Building Department for the following project: ��Qc� Q �-- 0111.1. Tigard
_ "24:9-6 P,Pfa a-uaJ
located at: /5 60 ..5. ) /I/ Q Cl
King City Representa -e 4—F D?/
1 DSTS FCINST DOC
CITY -OF TIGARD 24- Hour
BUILDING Inspection Line: (503) 639 -4175
0./
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
EC
Z.owe - ao //
Received Date Requested 7'5-6 v AM •lll / / PM BUP ,
Location /370 .56,) // 4v-e 1/ Suite MEC
Contact Persor� Ph 70.5 S 2 PLM
Contractor � Ph (( ) 1 SWR
BUILD Tenant/Owner , Y �n/ ' � s c) A 1 Q_-I ' (0. 1 vL ■ ooting
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear Ai k -
Int Sheath/Shear a 1/ J' , , , , ! o
Framing I'`
Insulation n � 1 ° 7 b 2 - Cd i Co Z / , to I
x_. Drywall Nailing / u 1."-'3e)
Firewall C —'j• i fs_ _ ( 6 03 6 1 erl e) d k
Fire Sprinkler `/ / --
Fire Alarm ,, (� M e'Z i U V Z - 00 / / ( f' A T .- )
Susp'd Ceiling lN'/ X ` /�
Roof c...--, / ' s -dr &/ `l /u z (re--e, - d e-...---
Other: ' I _
Fir(31) ? 1"l 24 0 2 - 60 /43 1. TL >
PASS PART �� •/
PLUMBING
Post & Beam - 1
Under Slab ilk �� --2 6z1 - 7-- v �
Rough -In , - p -7 /:/d 'Z ((C) d
Water Service
Sanitary Sewer )(g V lQ 2 U -2._- 0 O / Z 5.-- / /\fin 4$)
Rain Drains i ( i
Catch Basin / Manhole 6 — . /243,( ‘e/f3/d _- 6 7 — dit..--
Storm Drain
Shower Pan 1r?■tai 7� Se � � C .40 _
Other: /, `� i
Final
PASS PART FAIL �/
MECHANICAL Lf f L 4- C S
Post & Beam /3 i / h1 S 1_ e
Rough -In �]�1 --7"-444- -li-x_60 17
Gas Line A 1 c 6 64 4
Smoke Dampers / / I - --
Final b.) di-a‘- c
PASS PART FAIL �� " � � (2.7 1:::( : ; ...... ......-- -
' ELECTRICAL C.) h i ,,;, --cv �SU L7- - ¢ 0
Service
Rough -In a , �c' C
Low Voltage Q r p ( ��
Low Voltage 1 // �
Fire Alarm � -) (A/ < 4- � / /4 G'�?�yJ S I. �A
Final 111 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: 111 Unable to inspect - no access
Fire Supply Line
ADA V� Approach/Sidewalk Date S a _ Inspector ' Ext 2 ' Z(-/
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL / ^
CITY OF TIGARD 24 -Hour
A BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear 3.� J, ,Q -
Framing •J w
Insulation /.. /G •
Drywall Nailing J �LJ _ , / / -
Firewall k.) / FS Le- - - : r ' e e
Fire Sprinkler
Fire Alarm h Le_ .r 4 Lt6 --rt yZ /.
Susp'd Ceiling ,, �
Roof �� C Ltd " -�G D
- ∎-k s -Q .
Other:
Final
PASS PART FAIL // n- `n
PLUMBING /LJ - ■
Post & Beam j ,
Under Slab p (C�
�,�
Rough -In ) d 1 YI 4 /� . /
Water Service C� [ /
Sanitary Sewer C
Rain Drains / v "—
Catch Basin / Manhole _
Storm Drain D "
Shower Pan �
Other:
Final
ECH ANICAL PART FAIL �l
M l � CArt—)Ar)
MECHANICAL
Post h & Beam
- In
Ro C6:
Rough-In �./
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
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 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line ✓ �/� `
ADA
Approach/Sidewalk Date /</c `Z� Inspector Est - 2 - 1/4° -
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour 6 b 'i p
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 ' MST
BUP
Received Date Requested 7 -0 3' 0 AM PM BUP
Location I .5 G s w /7 IC Suite MEC
Contact Person Dq Ph ( ) OZ— D 3 ¥ d PLM
Contractor k (5 as , k Gu , U t 4, Ph ( ) SWR
BUILDING Tenant/Owner ELC 2p0 2 - 0 0 Z '/3
Footing
Foundation Access: ELC
Ftg Drain K _ / _ ELR
�
Crawl Drain '� / U CL�'
Slab Inspection N es: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler _
�/�c
Fire Alarm
Susp'd Ceiling — » - -
Roof ljir -X' / L A
Other:
Final i e L, K' (2 J
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains ' 6
Catch Basin / Manhole ')C 1
Storm Drain
Shower Pan
Other:
Final -/�
PASS PART FAIL, O `
MECHANICAL � �
Post & Beam S'' g
Rough -In Gas Line � -
Smoke Dampers / (�'�
Final f.
PASS PART FAIL I� CI
E�edt � /��'fl
Rough -In
UG/Slab
Low Voltage
Fir Alarm
Finns 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
- PASS PART cI
SITE ❑ Please call for reinspection RE: 111 Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date — 3 -o Inspector •� I 4 . Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 - 4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
' Received Date Requested 7 l ., AM PM BUP
Location /5 00 / /<o `4L- Suite MEC
Contact Person Lct 4J - e— Ph ( ) , a sue-- 03 PLM
Contractor + •'�'.o. Ph ( �c�',) 5'e- /123
Contractor
BUILDING Tenant/Owner '2'i iJ T --e'er- - ELC o Z ' q3
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
1./
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fire wall
Fire Sprinkler
Fire Alarm +
Susp'd Ceiling C � � P L�� l 1 /� fE cv1
Roof
Other:
Final
/% a heMWM
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
( CC)
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fi - Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
E ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA D ate 7 In actor • L _ Ext
Approach/Sidewalk P
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION-DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested - AM PM BUP
Location / 5 76 v // Co '. Suite MEC
Contact Person Ph ( ) 3 - 0 3 4 16 PLM
Contractor PO L l P C C Ph ) SWR
BUILDING Tenant/Owner ELC V- a7
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Note - . , SIT
Post & Beam 1
Shear Anchors,
Ext Sheath/Shear e' ., iiitalleux .. 1 , �'a 4 . ," I !el f
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler Lie64,00
Fire Alarm �CiX Alin n, xN om q
Susp'd Ceiling v / � `) �
Roof Q3 ‘)0_ - cqd 7
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam YO - t.
Under Slab L , -
Rough-In
Water Service
Sanitary Sewer
Rain Drains - i II ca ' -''∎ #L. r _ -
Catch Basin / Manhole /4- �� f� �-� -1
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam n
Rough -In 4 L „ i VL
Gas Line I
Smoke Dampers ' de Pood'iLs,s+-)
Final
PASS PART FAIL
ELECTRICAL
Se
ough -ln Ca151;
a
Low Voltage 0 or
0 J 0 ` . ft •. _.*
Fire Alarm �� I F.
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
∎ (tio,t` FAIL
S 0 Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA _ Z o G
Approach/Sidewalk Date 4..11 Q C., 3i l7� Inspector Ext
Other:
Fjnal DO NOT REMOVE this inspection record from the job site.
a PASS PART FAIL
BUP - Building Permit ELC - Electrical Permit
Inspection Description Date Passed By \I Inspection Description Date Passed By
Footing /Setback Underground cover
Foundation walls Wall cover
Footing drain Ceiling cover
Waterproof bsmt walls Electrical rough -in
Slab Electrical service
Crawl drain Electrical final
Underfloor insulation
Post/beam structural
Shear walls /anchors ELR - Restricted Energy Permit
Roof nailing 4 Inspection Description Date Passed By
Firewall Low voltage
Tilt -up panel Electrical final
Masonry /Reinforcement
Framing
MFG- Structure set -up MEC - Mechanical Permit
Insulation _
Drywall nailing 4 Inspection Description Date Passed By
Post /beam mechanical
Suspended ceiling
Gas line
Engineered soils
Welding Lab Final Mechanical rough -in
Concrete Lab Final Fire damper _
Bolting Lab Final Duct work
Structural observation — Smoke detector
Mechanical final
Fireproofing Lab Final
Final inspection
PLM - Plumbing Permit
BUP — Fire Protection System Permit _ Inspection Description Date Passed By
Plumbing underslab
11 Inspection Description Date Passed By Crawl drain
Sprinkler underfloor /slab Post/beam plumbing
Sprinkler rough -in Plumbing top -out
Sprinkler final RP /backflow preventer
Fire alarm final Rain drain
Storm drain
Water service
SIT - Site Permit Sanitary sewer
I Inspection Description Date Passed By Culvert/catch basin
Footings Pump /fill septic tank
Foundation walls Plumbing final
Sprinkler supply lines
Sprinkler underfloor /slab
Catch basin/Manhole SWR - Sewer Permit
Engineered soils 4 Inspection Description Date Passed By _
Engineering acceptance Sanitary sewer
Final inspection Final inspection
Inspection Record - BUP, PLM, SWR, ELC, ELR, MEC, SIT Permits
is \dsts \form \InspRecordBUP.doc 04 /17/01
•
CITY OF T I GA R D ELECTRICAL PERMIT
PERMIT #: ELC2002 -00243
I/� DEV WLOPMENT o
- 13125 SERVICES (503) 639 -4171 DATE ISSUED: 5/31/02 Hall Blvd..
PARCEL: 2S110CD -00105
SITE ADDRESS: 15900 SW 116TH AVE
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT : JURISDICTION: KIN
Project Description: Tenant Improvement
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: 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: 10 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:
UNITED STATES NATIONAL BANK PEGASUS ELECTRIC INC
REAL ESTATE MGMT DIV -T3 17057 SW 123RD AVE
PO BOX 8837 TIGARD, OR 97224
PORTLAND, OR 97208
PIN Phone: Phone: 503 - 502 -0340
Reg #: EL 3
ELE 34 -574C
SUP 4754S
N FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 5/31/02 $113.50 2720020000( Elect'I Final
SPOT CTR 5/31/02 $9.18 2720020000(
Total $122.68
N
This Permit is issued subject to the regJlations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable
O laws. All work will be done in accord ce 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 18 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification
%Center. Those rules are set forth irVOAR 9 - -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to
( ermjt Signature: ✓ Issued By:
Q OWNER INSTALLATION ONLY
he installation is being made on property I own which is not intended for sale, lease, or rent.
WNER'S SIGNATURE: DATE:
tt i CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO: -
Call 639 -4175 by 7:00pm for an inspection the next business day •