Permit TIGARD
ELECTRICAL PERMIT -
A CITY O F TI GA RESTRICTED ENERGY
I,, DEVELOPMENT I r SO RV 2CES 639 -4171 DATE ISSUED: E �R200000 -00258
SITE ADDRESS: 07140 SW FIR LP PARCEL: 2S101 DA -01600
SUBDIVISION: 72ND BUSINESS CTR -VARNS PARK ZONING: C -P
BLOCK: LOT: 006 JURISDICTION: TIG
Project Description: Installation of (1) signal circuit or limited energy panel.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: • HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: : X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
HOLDEN, DONNA M PHOENIX ELECTRIC CO
5458 SW MURRAY BLVD 7379 SW TECH CENTER DR.
BEAVERTON, OR 97008 TIGARD, OR 97223
Phone: Phone: 684 - 3600
Reg #: LAC 00052288
SUP 4140S
ELE 34 -247C
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 11/3/00 $75.00 2720000000 Elect'l Final
5PCT CTR 11/3/00 $6.00 2720000000
Total $81.00
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 -0 i ugh OAR 952 - 001 -0080. You may obtain copies of these rules or direct questi.ns to OUNC at (503)
246 -19 .
Issued y ;,/ 4.., /yi Permittee Signature ,_, // 14
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale. lease, or rent.
OWNER'S SIGNATURE: f DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
OCT -31 -00 TUE 12:18 PM PHOENIX ELECTRIC CO FAX NO, 15036843611 P. 02/02
"CITY OF TIGARD Plan Check #
13125 SW HALL BLVD. RECEIR trical Permit Application Redd By i 4 1- j(
%, TIGARD OR 97223 OCT 31 2000 Data Recd_ /o /-00
Phone (503) 639 -4171, x304 Print of Type Date to P,E.
Inspection (503) 639 4175 illegible P Date to DST
Ins
p ( ) COMMUNITY OI'fVi:M E e or ille ible will not be accepted Permit # e..C. IXX* -o025-
l=ax (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) ► Sc Service included: Items Cost Total 4
Address :7140. "S,..3 cl-1 a �� 4a. Residential - per unit
1000 sq, ft, or less _ $147.15 4
City /State/Zip - [k5ra..• a I ca- t1 �c) _ Each additional 500 sq. ft. or
portion thereof $33,40 1
Commercial K Residential El Limited Energy $75.00
Each Manned Home or Modular
Dwelling Service or Feeder $90.90 2
2a. Contractor installation only:
(Prior to permit Issuance, applicants must provide contractor license 4b• Services or Feeders
information for COT data ase). I alteration, or relocation
Electrical Contractor eY11 �P�#Y1 co f�a 200 amps or less 180.30 2
201 amps to 400 amps $106.85 2
Address -131.1 „_ 401 amps to 600 amps $160.60 2
City --11,)tleCCI State a e, Zip Q l'7.7.3 601 amps to 1000 amps $240.60 2
Phone No. .- 4 -3tfl o Over 1000 amps or volts 5454.65 _ • 2
Job No. I®10a6 Reconnect only $66.85 2
Elec. Cont. Lice. No. 3 -041C-, Exp.Date o 4c. Temporary Services or Feeders
OR State CCF3 Reg. No. Exp.Date 2. p
Installation, alteration, les n, or relocation
200 amps or less $66.85 2
COT Business Tax or Metro No_ Exp.Date 201 amps to 400 amps -"___ $100,30 2
L D `' 401 amps to 600 amps $133,75 2
Signature of Supr. Elec n �`-r �, /'�a''�, Over 600 amps to 1000 volts,
see "b" above.
License No. 3 S{; -3 S Exp.Date 10 4d. Branch Circuits
Phone No. _ ,,,,c,„1-,.,(N '3 - 6 n 4 '3 0 Q New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name Each branch circuit $6.65 2
b ) the fee for branch circuits
Address �_,_ without purchase of service
City State _ Zip or feeder fee.
First branch circuit $46.85
Phone No. Each additional branch circuit $6.65
The installation is being made on property I own which is not de. Miscellaneous
intended for silo, lease or tent. (Service or feeder not included)
Each pump or Irrigation circle $53.40
Owners Signature Each sign or outline lighting $53.40
5 Signal circult(s) or a limited energy
panel, alteration or extension / $75.00
3, Plan Review section (if required):* Minor Labels (10) $125,00
Please check appropriate item and enter fee in section SD. the allowable bl e in In an an Inspection y of the above
_,,,,,, or more residential units in one structure Per inspection $62.50
"__ Service and feeder 225 amps or more Per hour $62.50
System over 600 volts nominal In Plant 573,75
Classified area or structure containing special occupancy as 5. Fees:
described in N.E.C. Chapter 5 5a. Enter total of above fees $ f0 . r
* Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $
Subtotal $
Not required for temporary construction services.
5b. Enter 25% of line Sa for
NOTICE Plan Review if required (Sec. 3) $
Subtotal $ g /,' 011a-
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTI IORIZED ,,,���``' �QQ��
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR ust Account # 5 - a t-h
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS
AT ANY TIME AFTER WORK IS COMMENCED. T to balance Due $ f /. ° - -e2-
i:\dsts\forms \electric rsv.doc - 8/00
•
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 -
Date Requested / — 7' AM PM BLD
Location 7/ 0 5i/ ✓ C,Pol uite i � ME6
Contact Person ,i7/14( Ph 5v3 Gee./..?e, G PLM
Contractor Pi o ✓ t S' (.ems, Ph SWR
BUILDING _, Tenant/Owner ELC
Retaining Wall ELR ,e4" C. 6-
Footing Access:
Foundation FPS
Ftg Drain •
SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Drywall on
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
• PLUMBING,:. a
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
•
Final
PASS PART FAIL
Post & Beam
Rough In
• Gas Line
Smoke Dampers
• Final
PASS PART FAIL LRICAL:
Service
Rough In 4 1/4/7 /
UG /Slab
Low Voltage
Fire Alarm
Fina
PART FAIL
$7,
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 L - d / Inspector - _ — Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.