Permit CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC1999 -00200
i1 DEVELOPMENT SERVICES DATE ISSUED: 4/7/99
l
'� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S101 BC -02501
SITE ADDRESS: 08200 SW HUNZIKER ST
SUBDIVISION: ZONING: I -
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of temporary service, 200 amps or less. Job No. 60 04003.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 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: 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:
Owner: • Contractor: Ct{ R4 E A J u n/1/4 ) crLE_e_fT✓L4 a _ " 1/4) C,
PALMER G LEWIS COMPANY 711 6 uxr.A1 qqo
PO BOX 1041 Po0.-Tt t- 02 972, _ 5 ' •
CHESTERFIELD, MO 63006
Phone: Phone:
Reg #: 4StS
FEES Required Inspections
Type By Date Amount Receipt Elect'l Service
Elect'I Final
PRMT DRA 4/7/99 $50.00 99- 314312
5PCT DRA 4/7/99 $2.50 99- 314312
Total $52.50
•
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 Signature: Issue. By:
441../4 L 4 4,!_
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 IINSTA LLATION ONLY
SIGNATURE OF SUPR. ELEC'N: -DLO Q ` p. t _ DATE:
LICENSE NO: $M.S
CaIII 639 -4175 by 7:00pm for an inspection the next business day
CITY OF TIGARD Ej trical Permit Application Plan Ch
13125 SW HALL BLVD. RECE� Rec'd
Date Rec'd 11-7 -11
TIGARD OR 97223 APR 0 7
1999 Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639-4175 t OPMENl Print or Typ Permit # f 4 a44Q - 00940
Fax (503) 684 -7297 COPrinCO plete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) RH MECHANICAL Service included: Items Cost Sum
I
Address 8200 SW HUNZIKER RD 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City /State /Zip TIGARD OR 97223 Each additional 500 sq. ft. or
Commercial Residential ❑ portion thereof $25.00 1
Limited Energy $25.00
QUESTIONS? CONTACT PATRICK ANDERSON 970 -2268 Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current licenses) 4b. Services or Feeders
Electrical Contractor CHRISTENSON ELECTRIC, INC. Installation, alteration, or relocation
or
Address 111 SW COLUMBIA, SUITE' 480 200 amps to less $60.00 2
201 amps to 400 amps $80.00 2 -
City PORTLAND State OR Zip97201 -5886 401 amps to 600 amps $120.00 2
Phone No. 503 241 -4812 601 amps to 1000 amps $180.00 2
Job No. 60 -04003 Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. 26 -34C Exp.Date 10 /99 10'1111 Reconnect only $50.00 2
OR State CCB Reg. No. 00458 Exp.Date 5 / 99 4c. Temporary Services or Feeders
COT Business Tax or Metro No.5246 Exp.Date 12/99 Installation, alteration, or relocation 1 50.
- 200 amps or less $50.00 2
Signature of Supr. el c'n v % 401 amps to 600 amps $75.00
100.00 2
Over 600 amps to 1000 volts,
License No. 873S Exp.Date 10/01 see "b" above.
Phone No. 503 241 - 4812
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 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 2
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 58.
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. 5. Fees:
50.
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ 7 - 50
NOTICE Subtotal $ 52.50
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $ 57 - 5
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account #
Total balance Due $ /
52.50 ✓
I: \DSTS \ELC96.APP Rev 9/96
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 7� 9F AM v PM BLD
Location . 7 2.420 /7 A/ 7 /�G/L Suite MEC
Contact Person Ph PLM
Contractor (/tJ?n'sS Ph SWR
BOLDaNG a, �. ,: v � _ m� Tenant/Owner ELC / — 0020 O
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: / � _X - r!OI':5
Slab f� SIT
Post & Beam /
Ext Sheath /Shear c...40 off ,QQ �/�j'T �� I/(k�S 74 /ml-
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
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
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Fin
PART 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
Other oach /Sidewalk Date '1z��� Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.