Permit CITY OF T I GA R D ELECTRICAL PERMIT
PERMIT #:
16 DEVELOPMENT SERVICES DATEISSUED: 9/27/00 0 -00567
'� '�� 13125 SW Hall Blvd.. Tigard, OR 97223 (503)'639 -4171
PARCEL: 1S136CD-00100
SITE ADDRESS: 11705 SW PACIFIC HWY C
SUBDIVISION: ZONING: C -G
BLOCK: • LOT : JURISDICTION: TIG
Project Description: Installation of one branch circuit. Job No. 00 -478.
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:
Owner: Contractor:
PACIFIC CROSSROADS PROPERTIES, LEAR ELECTRIC
BY WYSE INVESTMENT SERVICES CO PO BOX 573
200 SW MARKET ST STE 345 GRESHAM, OR 97030
PORTLAND, OR 97201
Phone: Phone: 665 -9840
Reg #: LIC 00052278
SUP 3786S
ELE 26-411C
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT CTR 9/27/00 $46.85 2720000000( Elect'I Final
5PCT CTR 9/27/00 $3.75 2720000000(
Total $50.60
•
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.
•
PERMITTEE'S SIGNATURE I A , I � r 6 y , ISSUED Y: : `� _ `•
AA. OWNER INS ALLATION 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:
2
LICENSE NO: d 7 vaS
Call 639 -4175 by 7:00pm for an inspection the next business day
.
CITY OF TiOAR Electrical Perrifit A��p�i��a�t�0 Plan C ck is
13125 SW HALL BLVD. Read . =�� '
,
Date Recd `
TIOARD OR 97223 �Ep 2 2000 Date to P.E.
Phone (503) 639 -4171, x304 Print of Type Date to DST ----""-
Inspection (503) 639 -4175 Incomplete or illegibleceghlt ffI eDig N P Permit N .. ✓' 6 7
Fax (503) 598.1960 Called
1. Job Address: 4. Complete Fee Schedule Below:
Number of inspections per permit allowed
Name of Development • Service included: Items Cost Total
Name (or name of business) / � _ ���rJ
Address 05 ___ ...! _ 4a. Residential • per unit
1000 sq. ft, or less 5147.15 4
City /State/Zip i /_ i /� ��v i ' Each additional 500 sq. ft. or
� ' „ /� portion thereof $33.40 1
/ J Limited Energy $75.00 Commercial Residential ❑ Each Manuf'd Home or Modular
Dwelling Service or Feeder $90.90 2
2a. Contractor Installation only: 4b. Services or Feeders
(Prior to permit issuance, applicants must provide contractor license Installation, alteration, or relocation
Information for COT data base). fi chic. 200 amps or less $80.30 2
Electrical Contractor,�Z�rgt (4 201 amps to 400 amps $106.65 2
Address 5 /40 �&---Cerc-f-e 401 amps to 600 amps $160.60 2
C State Zip Y'7,43ro 601 amps to 1000 amps $240.60 2
Phone No ‘,„,....0 .7 t 4o Y4O Over 1000 amps or volts $ 65 2
78 Reconnect only $66.85 2
Jab No. Eb - o
Elec. Cont. Lice. No. 2-4._,- Exp.Date /O/ / 4c. Temporary Services or Feeders
Installation, alteration, or relocation
OR State CCB Reg. No. 52 Exp.Date / zolW 200 amps or less 566.85 2
COT Business Tax or Metro No. 4504LExp.Dale AA) 201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2
Signature r r supr. Elec'rin.� 7,h Over 600 amps to 1000 volts,
bee "IV above.
License No. 7e3f.5 Exp. to / / J / . 4d. Branch circuits
Phone No. ) C,:4=6"-`7E-4-c) New. alteration or extension per panel
a) The fee for branch circuits
with purchase of service or
2b. For owner installations: feeder fee.
Each branch circuit $6.05 2
Print Owner's Name b) The fee for branch circuits
Address without purchase of service •
or feeder fee. 11/67, Q
City State Zip First branch circuit / $46.85 C�
Phone No. , • Each additional branch circuit 56.65
The installation is being made on property I own which is not 4e. Miscellaneous •
(Service or feeder not included)
intended for sale, lease or rent. Each pump or Irrigation circle $53.40
Each sign or outline lighting $53.40
Owner's Signature Signal circuit(s) or a limited energy
panel, alteration or extension $75.00
3. Plan Review section (if required):* • Minor Labels (10) $125.00
• 4f. Ehch additional Inspection over
Please check appropriate item and enter fee in section 5B. the allowable in any of the above
4 or more residential units in one structure Per Inspection $62.50
• Service and feeder 225 amps or more Per hour $52.50
System over 000 vats nominal
In Plant 573.75
Classified area or structure containing spedal occupancy as 5. Fees: S
described In N.E.C. Chapter 5 Sc. Enter total of above fees $ ( AO.
8% Surcharge (.08 X total fees) $ 2,7s
* Submit 2 sets of plans with application where any of the above apply. Subtotal $ .J • CnO
Not required for temporary construction services. 5b. Enter 25% of line 5a for
. NOTICE Plan Review illeou red (Sec. 3) 5
Subtotal $ D • (Oh
PERMITS BECOME VOID iF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR ❑ Trust Account tt •
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS
Total balance Due $ 5 ,690 AT ANY TiME AFTER WORK IS COMMENCED. -
i :\dcts\forms \clectric rev.doc - 8 /00
7nnFAI r1 %IF'nT' an rr1 n..:•r op: r•nr ••v.r r. TNr.f ws.77/an
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
- our Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested /0 - AM PM BLD
Location 1/ 7 o 5 Ste✓ QGrC (c" Suite G MEC
Contact Person Ph 57r3 G . - 984/0 PLM
Contractor L ,4-(1_, gjec_ 71 c Ph SWR
BUILDING Tenant/Owner ) .. W -0514 ELC UU - Z
Retaining Wall Y ELR
Footing Access:
Foundation / FPS
Ftg Drain f fk' 14-wY SGN
Crawl Drain Inspection Notes:
Slab ��� [/N c� SIT
Post & Beam
Ext Sheath /Shear _ �¢ P/4 ,a- z L
Int Sheath /Shear /
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler -- _ • , - -
.-
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab t�
Top Out
Water Service
Sanitary Sewer •
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ECT C
ervice
Rough In
UG /Slab
Low Voltage
F' - larm
PART FAIL
SI E
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 - Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.