Permit I' CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00036
oPip DEVELOPMENT SERVICES DATE ISSUED: 01/25/2000
�I I� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 103 D D -01000
SITE ADDRESS: 13939 SW PACIFIC HWY * **
SUBDIVISION: ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install 1 temporary 200 amps or less Service /Feeder and 2 branch curcuits.
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: 2 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:
WALGREENS TUALATIN ELECTRIC
13939 SW PACIFIC HWY PO BOX 655
TIGARD, OR 97223 WILSONVILLE, OR 97070
Phone: Phone: 682 -2955 ORIGINAL
Reg #: LIC 00065650 -
SUP 3483S
ELE 3 -26C
FEES Required Inspections
Type By Date Amount Receipt Elect'l Service
PRMT KJP 01/25/200C $64.20 00- 321389 Elect'l Final
5PCT KJP 01/25/200C $6.00 00- 321389
Total $70.20
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 ISSUED BY: " / "Yg eit.40 , 62,
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: Q1A._ DATE: 1 /a 6 / 6 0
LICENSE NO: 3 `i S
Call 639 -4175 by 7:00pm for an inspection the next business day
11/29/99 MON 12:44 FAX 503 598 1980 CITY OF TIGARD IZ 002
r LITY OF TIGARD Electrical Permit Ap
Plan Check P
13125 SW HALL BLVD. Recd By
TIGARD OR 97223 Date Recd
Phone (503) 639 - 4171, x304 Date to P.E.
• Date to DST
Inspection (503) 639 -4175 Print of Type Permit #g J.L7.-o c -Oo O 3 ,6
Fax (503) 598 -1960 Incomplete 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) L-t' /ly;rev..,,-.1 S Service included: Items Cost Sum y
Address `3 939 $. 141 t'' W e_ /7/k.„. 4a. Residential - per unit
•
City/State/Zip J' , (J' ' 1000 sq. ft. or less $ 117.75 4
Each additional 500 sq. ft. or
portion thereof $ 26.75 1
Commercial Residential ❑ - Limited Energ $ 60.00
Each Manutd Home or Modular
2a. Contractor Installation only: Dwelling Service or Feeder . $ 72.75 2
(Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders
Information for COT data Installation, alteration, or relocation
Electrical contractor , /- --/.. P 200 amps or less $ 6425 2
Address A &' Y 6 S-S"" 201 amps to 400 amps $ 85.50 2
City / Sr..rj y, //e° State 0 g Zip 97 0 70 401 amps to 600 amps $ 128 5 - 2
601 amps to 1000 amps $ 192.50 2
Phone No. /„ a - P 95- 3 - Over 1000 amps or volts - $ 363.75 2
Job No. o '7 ' l' Reco ly $ 33.50 2
Elec. Cont. Lice. No. 3 - G p'G Exp.Date _ /O-/-e'6 i)` T
qc 'I% ply services or Feeders
OR State CCB Reg. No. C9/0 $ G 4'a Exp.Date C- a -a i irate a r on. alteration, or relocation
COT Business Tax or Metro NO. �_, ,;* re 200 amps or less / $ 53.50 ,c3 5 -b 2
jV�� 201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n 401 amps to 000 amps $ 100.00 2
Over 600 amps to 1000 volts,
see S , / ran h above.
License No. ; ate / /_d / 4d. Branch circuits
Phone No. , , - .. 11 7
Exp.D New, alteration or extension per panel •
a) The fee for branch drcults
2b. For owner instal, ns: with purchase of service or
feeder fee. Print Owner's Name Each branch circuit V" $ 5.35 �O ?' 2
Address b) The fee for branch drcuits
without purchase of service
City State Zip • _ or feeder fee. •
Phone No. First branch dreult • $ 37.50
Each additional branch circuit S 5.35
The Installation is being made on property I own which is not 4e. Miscellaneous •
intended for sale, lease or rent (Service or feeder not Included)
Each pump or irrigation drde $ 42.75
Owner's Signature • Each sign or outline lighting $ 42.75
Signal dreuit(s) or a limited energy
* panel, alteration or extension $ 60.00
3. Plan Review section (if required): Minor Labels (10) • $ 100.00
Please check appropriate item and enter fee In section 5B. 4f. Each additional inspection over •
4 or more residential units in one structure the allowable In any of the above
•
Service ce and feeder 225 amps or mom Per inspection $ 50.00 •
Per hour $ 50.00
System over 600 volts nominal • In Plant • $ 59.00.
Classified area or structure containing special occupancy as
described In N.E.C. Chapter 5 5. Fees: o G
5a. Enter total of above fees $ ,�
* Submit 2 sets of plans with application • whom any of the above apply. 8% Surcharge (.08 X total fees) $ •
Not required for temporary construction services. Subtotal S
NOTICE 5b. Enter 25% of line He for •
•
Plan Review if required (Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account # G
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due . $ d "9- e-
i:ldstslfomulelectric.doc
1
07/11/2000 Activities for Case #: ELC2000 -00036
2:12:27 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 01/25/2000 KJP RECD No Hold KJP 01/25/2000
ELCC003 Permit created 01/25/2000 KJP DONE No Hold KJP 01/25/2000
ELCC730 Elect'I Service 01/25/2000 01/25/2000 01/26/2000 BRP PASS No Hold AKJ 01/26/2000
ELCC799 Elect'I Final 01/25/2000 01/25/2000 No Hold KJP 01/25/2000
ELCC500 (F)Issue permit 01/25/2000 KJP DONE No Hold KJP 01/25/2000
ELCC800 Case Finaled 01/26/2000 AKJ DONE No Hold AKJ 01/26/2000
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested )— &/ d 0 AM PM BUD
Location /3 93 9 p a . C i / 4 i 7, . Suite MEC
/' 76
Contact Person -1 12-4. Ph 6 -. e2-6.1.,>7 PLM
Contractor (; c Ph / SWR J
BUILDING Tenant/Owner tV�Jf fe. 1 EL Q�� - JQ-�C .
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: T
Slab eh,0 O Vg Y'�/ Ya /C L° SIT
Post & Beam /
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof 1
Misc: / ,
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
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 •
ELECTRIC
ervice
Rough In
UG /Slab
Low Voltage
iru::: rm
al
' "it S • ' RT FAIL
SITE
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 /721 . D0 Inspector � / :� _ "ed.t ./ A Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.