Permit ELECTRICAL PERMIT
PERMIT #: ELC1999 -00192
DATE ISSUED: 4/5/99
PARCEL: 1 S134CA -00512
SITE ADDRESS: 11180 SW 119TH
SUBDIVISION: PANORAMA NO.2 ZONING: R - 4.5
BLOCK: LOT : 023 JURISDICTION: TIG
Project Description: Branch circuit
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: 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:
Bi Owner: Contractor: /91.4 ZOX/)*
11180 SW 119TH AVE go. d er)C G Is ySl
TIGARD, OR 97223 0/G Gv-,9k lc/
�.� y
Phone: Phone: V — (0"/ 4 /
Reg #:
FEES Required Inspections
Type By Date Amount Receipt E lect'I Service
Elect'I Final
PRMT GEO 4/5/99 $35.00 99- 314261
5PCT GEO 4/5/99 $1.75 99- 314261
Total $36.75
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.
Permit Sign. re: _ _ _ / Issued By: //
/4"k el _
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: ?C DATE: y--- 5 G �J
LICENSE NO: / /Z $f9
Calll 639 -4175 by 7:00pm for an inspection the next business day
CITY OF TIGARD Electrical Permit Application Plan Check#
13125 SW HALL BLVD. Rec'd By
TIGARD OR 97223 Date Rec'd
Phone (503) 639 -4171, x304 Date to P.E. Print or Type Date to DST
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit #��C°I�/- 60 /�j�
Fax (503) 598 -1960 Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business)0 /Z Service included: Items Cost Sum
Address /& p a S , , /71 4 ' 4a. Residential - per unit
,� 1000 sq. ft. or less $110.00 4
City /State /Zip .0/14" I> r,./ � e `7 7ZZ 3 Each additional 500 sq. ft. or
portion thereof $25.00 1 - Commercial ❑ Residential 01 Limited Energy $25.00
Each Manufd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all cu - 'cen 4b. Services or Feeders
Electrical Ctor
• ..1‘... � � � , Installation, alteration, or relocation
200 amps or less $60.00 2 -
Address a< 4 3rAril .>y 201 amps to 400 amps - $80.00 2
City / //»` /e - State - Zip a'" Alr, 401 amps to 600 amps $120.00 2
-
Phone No. ,S 3 - 46/ 601 amps to 1000 amps - $180.00 2
Job No Over 1000 amps or volts $340.00 2
-
Reconnect only $50.00 2
Elec. Cont. Lice. No. , ? 9 Exp.Date /0 - - �1Y
OR State CCB Reg. No. '?O 3 Z Exp.Date j O _) - 0/ 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
201 amps to 400 amps $75.00 2 -
Signature of Supr. a7_1,./e/ 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. /7i- 7 f Exp.Date / - / -f7 see "b" above.
Phone No. _ 5 - .44// 4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit - $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee. ��
First branch circuit / $35.00 0 2
Each additional branch circuit - $5.00 2
The installation is being made on property I own which is not
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting - $40.00 2
3. Plan Review section (if required):'`
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 $35.00
-
System over 600 volts nominal Per hour $55.00
Classified area or structure containing special occupancy In Plant - $55.00
as described in N.E.C. Chapter 5
5. Fees: 3S
* Submit 2 sets of plans with application where any of the above apply. 5a. Enter total of above fees $
Not required for temporary construction services. 5% Surcharge (.05 X total fees) $
Subtotal $
NOTICE 5b. Enter 25% of line 5a for
Plan Review if required (Sec.3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Subtotal $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY ❑ Trust Account # $
7
TIME AFTER WORK IS COMMENCED. Total balance Due
I: \DST \ELEC98.DOC REV 4/98
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
M
Date Requested mai I AM PM BLD
Location ((I rJ HH7 Lz Suite MEC 0111.1 ill
Contact Person Ph PLM
Contractor dd Ph SWR
BUILDING Tenant/Owner 66-C, CL _ D 4le1`/ ELC 19 q ° / ?"'
Retaining Wall ELR
Footing
Foundation , � ®4/ -;� FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam 1 Z1 S / v P _ l r' Q
Ext Sheath /Shear /
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fire wall �A /999 - ,- /
Fire Sprinkler /v /C / �`� �
/ f�j /J _ j v 1'
Fire Alarm `, �y /`�l�
Susp'd Ceiling E- G / 9 9 '� /`r Z
Roof
Misc:
Final � t /
P ASS PART FAIL !"
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In 4 4c
Gas Line
Smoke Dampers
i
A PART FAIL
TRICAL
Service
Rough In ik , f✓' •
UG /Slab
Low Voltage
Fire Alarm
in - r.
o • o •ART 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
Other Date ,c / 9 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.