Permit A CITY OF TIGARD
m:7%01;
DEVELOPMENT SERVI PERMIT Hall Blvd., Tigard, DATE ISSUED: 10/28/96
PARCEL: 1S135DD -05000
SITE ADDRESS...: 11981 SW PACIFIC HWY
SUBDIVISION • ZONING:C —G
BLOCK • LOT •
Project Description: ADD BRANCH CIRCUITS
- -- 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: 0 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
RAINBOW PLAY SYSTEMS type amount by date recpt
11981 SW PACIFIC HWY PRMT $ 35.00 TAT 10/28/96 96- 285786
5PCT $ 1.75 TAT 10/28/96 96- 285786
TIGARD OR 97223
Phone #: 503 - 620 -2653
Contractor:
OMNI ELECTRIC OF OREGON $ 36.75 TOTAL
PO BOX 1788
REQUIRED INSPECTIONS
LAKE OSWEGO OR 97035 Elect' 1 Service
Phone #: 503 - 635 -4306 Elect'1 Final
Reg #.. : 41789
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permittee ignature
applicable laws. All work will be done in accordance with
7 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. Issue By
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 : DATE:
LICENSE NO:
Call for inspection — 639 -4175
FROM : OMNI ELECTRIC PHONE NO. : 503 635 1391 Oct. 28 1996 04:18PM P1
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
Permit # eL0 -% -D q3
,,,,,,„.
_r Phone 503) 639 -4171
i'�" !-� FAx (503) 684 -7297 Date Issued /0 -,-,-- GICP
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by �/ L
Inspection (503) 639 -4175
1. Job Address: JOB No .
68279 8 2 7 9 4. Complete Fee Schedule Below:
RAINBOW PLAY SYSTEMS
Name of Development PACIFIC NW Number of Inspections per permit allowed
Add 11981 SW Pacific Hwy . - Service included: Items Cost(ea) Sum
City/State/Zip Tigard , OR 97223 4a Residential - per unit 4
1000 ea. ft. or Mel 5110.00
Name (or name of business) same Each additional 500 ea. n. or
pentien thereof 526.00 1
Commercial 121 Residential ❑ Limited Envier $25.00
Each Manure' Home or MadutN 2
D.eaYng Semi® or Feeder $66.00
2a. Contractor installation only: 4b. Services or Feeders
Irstahaiion, alteration. or relocation 2
Electrical Contractor Omni Electric of Oregon 200 amps or less 560.00 2
Address PO Box 1788 201 an CO amps *moo 2
Ci Lake OS o State OR Zip 97035 401 arnpsto600amps 5120•00 2
ry P sot amps to ,coo rungs 5180.00 2
Phone No. 635 -4306 Over l000 amps er volts $54000 2
Contractor's License No. 2695C neaanned only $50.00
Contractor's Board Reg. No. 203 4c. Temporary Services or Feeders
'retaliation. alteration. or relocation 2
Signature of Supr. Elec'n1 200 amps or rase 550m 2
License No. 2345S Phone o.635 -4'306 201 amps te 400amps 575.00 2
401 amps to 600 amps 5100.00
Over 600 amps to 1000 volts
2b. For owner installations: see le abate.
4d, Branch Circuits
Print Owner's Name New, alteration or extension par panel
Address a) The fee for branch awaits with
City • State Zip pt"`heae of service of feidir km 2
Ead, branch circuit 55.00
Phone No. b) The fee for branch circuits without
The installation is being made on property I own which is porches. of service oe roods` w. 2
not intended for sale, lease or rent. Fist branch circuit t 5$5.00 35 .00 , 2
Each addition's' brands anent 55.00
Owners Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle 540.00 - 2
Each sign or outliire lighting 340.00
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $4000
4 or more residential units in one structure Minor Labels (10) 5100.00
-- Service and feeder 225 amps or more
System over 600 volts nominal 4t. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.E.C, Chapter 5 Per ire Iron 1155.°°
Per hour 355.00
-
In Plant 555.00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees:
$a. Enter total of above fees $ 35.00
NOTICE 5% Surcharge (.05 X total fees) $ 1.
PERMITS BECOME VOID IF WORK OR CONSTRUCTION subtotal S 36.75
5b. Enter 2596 of line A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS. OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec'3) E
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal ;
COMMENCED. El Trust Account 0 $ (36.75)
Balance Due $ -0-
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
,� ;� Mf ,,� Permit # EL�c/6
109
.� �i Phone (503) 639 -4171 Date Issued )0/2-7/0
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by �/ 1
Inspection (503) 639 -4175
1. Job Address:
JOB No . 6 8 2 7 9 4. Complete Fee Schedule Below:
RAINBOW PLAY SYSTEMS
Name of Development PACIFIC NW Number of Inspections per permit allowed
Address 11981 SW Pacific Hwy. Service included: Items Cost(ea) Sum
City /State/Zip T i g a r d, OR 9 7 2 2 3 4a. Residential - per unit 4
1000 sq. ft. or less $110.00
Name (or name of business) same Each additional 500 sq. ft. or
portion thereof $25.00 1
Commercial [3 Residential ❑ Limited Energy $25.00
Each Manul'd Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only: 4b. Services or Feeders
Installation, alteration, or relocation 2
Electrical Contractor Omni Electric of Oregon 200 amps or less $60.00 2
Address PO Box 17 8 8 201 amps to 400 amps $80.00 2
CityLake Oswego State OR Zip 97035 6601 amps 600
amps $120.00 2
Phone No. 635 -4306 Over t000 amps orvolts $340.00 2
Contractor's License No. 2695C Reconned only $50.00
Contractor's Board Reg. No. 203 4c. Temporary Services or Feeders
{ Installation, alteration, or relocation 2
!
, Signature of Supr. Elec'n 200 amps or less $50.00 2
License No. 23455 Phone No.635 -4306 201 ampsto400amps $75.00 2
- 401 amps to 600 amps $100.00
Over 600 amps to 1000 volts
2b. For owner installations: see •b• above.
Print 4d. Branch Circuits
rint Owner's Name
New, alteration or extension per panel
Address a) The fee for branch circuits with
City State Zip purchase of service or feeder fee. 2
Each branch circuit $5.00
1 . • Phone No. b) The lee for branch circuits without
The installation is being made on prope y i a� purchase of service or feeder fee. 2
not intended for sale, lease or rent. Fi E ach rst branch additional circuit branch circuit $3 I . 3 5.0 0 2
$5.00
Owner's Signature OCT 9` 4e. Miscellaneous
• (Service or feeder not included) 2
3. Plan Review section (if re ' '' 00- - Each pump or irrigation circle $40.00 2 - Each sign or outline lighting $40.00
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. ' panel, alteration or extension $40.00
1 4 or more residential units in one structure Minor Labels (10) $100.00
-
Service and feeder 225 amps or more
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.E.C. Chapter 5 Per inspection $35.00 - Per hour $55.00
-
In Plant $55.00
Submit 2 sets of plans with application where any of the above
I apply. Not required for temporary construction services. 5. Fees:
•
NOTICE • 5a. Enter total of above fees $ 35.00
5% Surcharge (.05 X total fees) $ 1 . 7 5
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ 36.75
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. El Trust Account #
$(36.75)
Balance Due $ -0 -
rovdeomdMN.rpm.app
"' I' k� DEPARTMENT OF LAND USE & TRANSPORTATION
WASHINGTON 155 NORTH FIRST, HILLSBORO, OR 97124
COUNTY, INSPECTION REQUESTS: 503 /640- 3561/693 -4415
OREGON XXXXXXXXX - -> 640 -3470
Page : 1 of 1
Date : 12/28/94
Time : 16:39
Permit Type : Residential Electrical Permit Permit # : 05062191
Permit Status : APPROVED Applied : 12/23/94
Situs Address : 11981 SW PACIFIC HW TI Issued : 12/23/94
Permit Title : SFR - ELEC /BURGLAR ALARM Completed :
Permit Descr. : HOMEOWNER 620 -2653 To Expire : 06/21/95
Project Title : SFR - ELEC /BURGLAR ALARM Project # : P0046431
Project Descr. : * EROSION *
•
Parcel Number : 2S1TI - Land Use District :
Valuation • 0
•
Legal Descr. •
Owner : INSPECTION - TIGARD Construction : OTH
Applicant Name : ADT Classification : 900
Applicant Addr.: 703 NE HANCOCK Occupancy : R3
PORTLAND, OR 97212 Validated by : KF
Applicant Phone: 284 -3265 Inspector Area :
Fee description Units Fee /Unit Ext fee Data
Limited Energy /Alter. /Extension 1 40.00 40.00
Subtotal Electrical Fees: 40.00
State Surcharge of 5% 2.00
Total Electrical Fees: 42.00
* ** Fees Required * ** * ** Fees Collected & Credits * **
Method Check # Receipt No. Date Payment
'DEP' 12/23/94 42.00
Fees: 42.00
Adjustments: .00 Total Credits: .00
Total Fees: 42.00 Total Payments: 42.00
Balance Due: .00
NOTICE: This permit becomes null and void if the work or construction for which It Is Issued Is not commenced within 180 days. Once construction has started,
the permit becomes null and void if construction is interrupted for a period of 180 days. I certify that the information presented by the applicant and
his agent or agents In support of this permit is true and correct to the best of our knowledge. I acknowledge that the Building Department's reliance
upon false and misleading Information may invalidate this permit. All provisions of applicable laws and ordinances governing the construction and use
of this building or structure will be complied with whether or not specified on the plans or noted on the plans correction sheets. I acknowledge that
the granting of a permit does not grant authority to access private property or to use easements. I further acknowledge that the use or occupancy of
the structure or building permitted depends upon my calling for Inspections at various times during the process of construction and the building
Inspection staff verifying compliance with the various codes. Use or occupancy of the building or structure permitted prior to approval by the
Building Department Is solely at the risk of the applicant and such use or occupancy is revocable until all Inspection requirements are satisfied and
approval Is given by the Building Official. I further acknowledge that a lien may be placed on the title of the property upon which the permit Is Issued
specifying that the use or occupancy of the building or structure Is provisional and revocable until the satisfaction of all Inspection requirements.
APPLICANT'S SIGNATURE
olMok WASHINGTON COUNTY RESTRICTED
Department of Land Use & Transportation
Electrical Inspection Section
155 North ELECTRICAL ENERGY
155 North First Avenue, #350 -12
Hillsboro, Oregon 97124 APPLICATION
Information: (503) 640-3470 Fax: (503) 693-4412
PLEASE PRINT 5-(p 77 I'll
Please complete all sections, 1 through 5. Project No. Permit No. (O °�
1. Locatip f i st "on Label No. Date L,2 -43-R t f
Address // 5 ll / � f f 1 444/7 Issued By Office
City mod' Zip Code 2-Z.� 4. Type of work:
ap
Tax M Map No.
/ RESIDENTIAL Restricted Energy Fee $40.00
Thomas Map Book: Page �/ 5 5 ' Section (for all systems)
�o �/ 0 fe Check type of work involved:
Direct �� • ns • L L. d.. s !• r ., . / ill
T i �. f I 1 —
Audio and Stereo Systems*
Commercial Residential w ' Burglar Alarm
Tenant Name /� / , - Telephone Systems*
(if commercial) I -I � et-. 4 - Garage Door Opener*
, i'
This permit becomes null and void If the work a by the — F ire Alarm
permit is not commenced within 180 days from • e •f issuance — *
of such permit or if the work authorized is suspended or abandoned — H eating, Ventilation a Air Conditioning Systems
at any time after work Is commenced for a period of 180 days. Vacuum Systems
Electrical Permits are non - refundable and non - transferable. Other
2. Contractor applicatio
COMMERCI Fee for each system $40.00
Electrical Contractor A (see OAR 918 -260 -260)
Address i "
Date /2- NZ" Job Number / C 2/2___ Check type of work involved:
Property owner
Contractor's License No. O N Boiler Controls
Contractor's Board Fag. No. . Clock Systems
Phone No. e qg '2J' XcR • Data Telecommunications Installations
. Fire Alarm Installation
3. Owner application: . HVAC
6 -2_0-.2(05 . Instrumentation
Print Owner's Name Phone No. • Intercom and Paging System
. Landscape Irrigation Control*
Address • Medical
• Nurse Calls
City State Zip II 0 • ..r Landscape Lighting*
This permit is Issued under OAR 918 - 320 -370. The applicant agrees g - rotective Signaling
to make only restricted energy installations (100 volt amps or less) • Other
under this permit and to do the following:
1. Only use electrical licensed persons to do installations where
required. (Certain residential and other transactions are exempt / Number of Systems
from licensing. These have asterisks ('). All others need licens-
ing.) * No licenses are required. Licenses are required for all other installations.
2. Call for an inspection when all the installations under this permit e9 �
are ready for Inspection.
3. Purchase separate permits for all Installations that are not ready 5. Fees / /11)
for inspection when the inspector is out to inspect under this Enter fees $ 't
permit.
4. Assume responsibility for assuming that all corrections required ' .-
by the inspector are done, and 5% Surchar •. • I t t. otal above) $
5. Assume responsibility for calling fb Ina! inspection when all of
the corrections are completed. V7
The person signing this • st the applicant ore person Total / $ ��
authorized to bind the ., • . .
Signature 110Zttt Space below reserved for validation.
Authority if other anapplicant
For inspections call
640 -3561 or 693 -4415
24 -hour recorder, one working day In advance of need 11/92
L
4/24/00 Activities for Case #: ELC96 -00693
4:54:17 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes •
ELCC001 Application received 10/28/96 TAT PASS TAT 10/28/96
ELCC003 Permit created • 10/28/96 TAT PASS TAT 10/28/96
ELCC500 (F)Issue permit 10/28/96 TAT PASS TAT 10/28/96
ELCC800 Case Finaled 11/5/96 MJR PASS MJR 11/6/96
•
•
•
•
•
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service VD,.
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation Ea
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other: • _r1 • d ' i • /4.
Date: 1 / 5 14o A.M. P.M. Ent
Address: /1 ! 7/ / i
Tenant: Ste: MST:
C BUP:
Con /Own: d �J J MEC:
PLM:
ELC: J
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
C
• 4 iff,W -11..- _4 dir° ,/e/3 / a s i‘
Inspector: i r/,/(JTic Date: 1 / ,...
APPROVED _ DISAPPROVED /CALL FOR REINSP. CF CO