Permit CITY OF TIGARD ELECTRICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: ELC97 -0363
'. - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 06 / 18 / 97
PARCEL: 1 S 135DC -02000
SITE ADDRESS... :11875 SW 91ST AVE #3
SUBDIVISION - ZONING :R -7
BLOCK • LOT . JURISDICTION: TIG
Project De scr i pt ion: Electrical permits for 11865 and 11875 SW 91st Ave.
- -- 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
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 •- 200 amp ° 0 W /SERVICE OR FEEDER: 0 PER INSPECTION ° 0
201 — 400 amp • 0 1st W/0 SRVC OR FDR.: 1 PER HOUR ° 0
401 — 600 amp - 0 EA ADD'L BRNCH CIRC: 95 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
VILLA LA PAZ type amount by date recpt
11865 SW 91ST AVE PRMT $ 510.00 JSD 06/18/97 97- 296107
TIGARD OR 97223 PLCK $ 127.50 JSD 06/18/97 97-296107
5F'C.T $ 25.50 JSD 06/18/97 97- 296107
Phone #:
Contractor:
TICE ELECTRIC $ 663.00 TOTAL
2139 SE BELMONT ST
REQUIRED INSPECTIONS
PORTLAND OR 97215 Ceiling Cover Underground Cove
Phone #: 233 -8801 Wall Cover Elect' 1 Service
Reg #..: 000001
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 180
days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001-0010 through OAR 952 - -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling ?246 -1987.
Permittee Signature: Issued • / /e/
- 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
SIGNATURE OF SUPR. ELEC'N: _�___C�t L- --✓`-' DATE:
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 6 :00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + ++ + + + + + + + + + + + + ++
•
CITY,OF.TIGARD Electrical Permit Application Plan Check # 5 I CS
13125 SW HALL BLVD. Reed By 6.1A '-.A-VL-
Date Rec'd `J - zc6 '17
TIGARD OR 97223 Date to P.E. to I2.-17
Phone (503) 639 -4171, x304 Date to DS " / 2 `r 7
Print or Type
Inspection (503) 639 -4175 Permit it ELG/17 3
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called h-i b -'fl
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development P D A, - A P Q t Number of Inspections per permit allowed
Name (or name of business) CO (--D‘ &-r3) Service included: Items Cost Sum
II 7s CS) �^
A
I
ddress II 56,E N, St-t/ /1 J # 4a. Residential - per unit
City /State /Zip ( ,Q [) Each additional it or less $110.00 4
t ' Each additional 500 sq. ft. or
Commercial Residential ❑ portion thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all curieqt licenses) 4b. Services or Feeders
Electrical Contractor "I Old &Z e.. Installation, alteration, or relocation
Address 2/ 39 F 4 200 amps or less $60.00 2
201 amps to 400 amps $80.00 2
City State Q to Zip ____9_7(_Y_ 401 amps to 600 amps $120.00 2
Phone No. - QC)/ 601 amps to 1000 amps $180.00 2
Job No. A- /3 Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. -- f'0/lJe---' Exp.Date /0197
OR State CCB Reg. No. /6 Exp.Date 6( /�` 4c. Temporary Services or Feeders
COT Business Tax or Metro No. r�U/ y Exp.Date //, f 1? Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Sur. Elec'n 201 amps to 400 amps $75.00 2
g p 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. " I I I 1 Exp.Date 10/ f / 13 see "b" above.
Phone No. g ? 1 - Fi.2 >h
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 s 2
The installation is being made on property I own which is not Each additional branch circuit q�+ $5.00 _�g2
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): * Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional inspection over
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 $55.00 ,
as described in N.E.C. Chapter 5 In Plant $55.00
* Submit 2 sets of plans with application where any of the above apply. Jr. Fees: .G' /.0
Not required for temporary construction services. 5a. Enter total of above fees $ 7 •J
5% Surcharge (.05 X total fees) $
NOTICE Subtotal $
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY O=
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # $ �j 3 ,� •
Total balance Due
I: \DSTS \ELC96.APP Rev 9/96
(1 fJ
V P � 4( I
1
CITY OF TIGARD BUILDING INSPECTION DIVISION
♦ - 24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: ,Cf 3---�� A.M. P.M. MST:
Location: " -
. BUP:
T
Tenant Suite: Bldg: , MEC:
Contractor: ( 1 (' I 1 Phone: PLM:
Owner: Phone: ELC:
ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL < T_ TRICAL SITE
Site Post/Beam 'Post/Beam Post/Beam Cove ervice Sewer /Storm
Footing Roof UndFl/Slab Rough -In C ei mg Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C • UG Slab
. Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved _ pproved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved o pproved Not Approved
FINAL FINAL FINAL FINAL FINAL
3 � .39 J 39 4 f O 77 E,..5 E° ,APT, ,9 -A6
A L L 0 k' Fo A. R 60 9 1 N 14'oA 4
‘/ 2, 6„ 3 6
/3_, / .
DO 0 a - F/54 o .5 A iN 7 °,» /v- Pa deZ Tick
O Call for reinspection Reinspection fee of $ r- • fired before next inspection O Unable to inspect
Inspector: 6 Date: L � 3 i/ ! Page of
i
/A
R' g
(� CITY OF TIGARD BUILDING INSPECTION DIVISION
)'' 24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: ° JAC 7- 1-q7 , P.M. MST: _
Location:. iJ O Cr(U J , ,5
S i 4 q 5 BUP:
Tenant: Ill GL LPG 1 Bldg: 3 MEC:
Contractor: / Phone: 0- 4 — z_c7 PLM:
Owner: Phone: ELC: c` y
7 -036 3
'? blGI:'r`-vn- cu.)t_er,a ELR:
TT:
BUILDING BLDG (con't) PLUMBING MECHANICAL • a • •4 SITE
Site Post/Beam Post/Beam Post/Beam Co ' - ' • . - Sewer /Stone
Footing Roof - UndFl/Slab. Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved ed Not Approved
FINAL FINAL FINAL FINAL FINAL
f7/1//9-- L — p k-
_._.12_6__'..5 . T /7/_ , jI/, : L SC) E7) t1 — S
C r \
. ___--- ., ,
_ _
O Call for reinspe• on / Reinspection fee of $ re sui / red .; fore next inspection O Unable to inspect •
/ Inspector: . J Date: 2 Page of
•
•
it
r ; CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: - 7 - .2...._z_ 1 -9 7 A.M. P.M. MST:
Location: 11 3 75 �' "`. C7(4it, , j BUP:
Tenant: Suite: Bldg: 3 Er' '- MEC:
���t.2, L.P. ' 7 /
Contractor: � P � PLM:
Owner: Phone: , 7- 0 a
Ciii `f I'i 7 0 1p0 5' c. . . ` i - - 77 -036
(J CS' di, SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam ov= II.ervice Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt.Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump w Vnl
Approved Approved Approved Approved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
Lt 1 a 6 d . .
66' 7 72-, fl-p 7 U Ni TS Ca ve 0
O Call for reinspection O Reinspection fee of $ required before next inspection O Unable to inspect
Inspector: reinspection
Date: 7 'N _f Page of