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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC1999 -00700 P ik DEVELOPMENT SERVICES DATE ISSUED: 11/18/1999 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S103DD -01000 SITE ADDRESS: 13939 SW PACIFIC HWY * ** SUBDIVISION: ZONING: C -G BLOCK: LOT : JURISDICTION: TIG Project Description: Installation of two (2) temporary 200 AMP service /feeders for job trailer. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: 2 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: B C REAL ESTATE TUALATIN ELECTRIC B C NORTHWEST PO BOX 655 TULSA, OK 94135 WILSONVILLE, OR 97070 Phone: Phone: 682 -2955 Reg #: LIC 00065650 SUP 3483S ELE 3 -26C FEES Required Inspections Type By Date Amount Receipt Elect'l Service PRMT GEO 11/18/199. $107.00 99- 319871 Elect'I Final 5PCT GEO 11/18/199. $8.56 99- 319871 Total $115.56 • ORIGINAL 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 accord 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: 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: J d? DATE: Mi LICENSE NO: � 7 yS5.3 S Call 639 -4175 by 7:00pm for an inspection the next business day CITY OF TIGARD Electrical Permit Application Plan Check# 13125 SW HALL BLVD. Recd By TIGARD OR 97223 Date Recd Date to P.E. Phone (503) 639 -4171, x304 Date to DST Inspection (503) 639 -4175 Print of Type Permit # 0.-et / 6 't!9E" 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) \/0■\g't'z-e -x'13 Service included: Items Cost Sum Address \' 2 1 SW P -\ S"'■ C_ k 4a. Residential - per unit City/State /Zip 't'\ y.,ce), O(k. 9 a a3 1000 sq. ft. or less $ 117.75 4 Each additional 500 sq. ft. or portion thereof $ 26.25 1 Commercial V Residential ❑ Limited Energy $ 60.00 1 Each Manned 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 base). Installation, alteration, or relocation Electrical Contractor '1 n I� i2C..'t' C ; C 200 amps or less . $ 64.25 2 Address PO {Sc o(. (D66 201 amps to 400 amps $ 85.50 2 401 amps to 600 amps $ 128.50 2 City 1,J:\Sonv i Ilk_ State OR Zip 170 7O 601 amps to 1000 amps $ 192.50 2 Phone No. CD 'a a- acis S x `r Over 1000 amps or volts $ 363.75 2 Job No. tm1: L -- •nne •my $ 53.50 2 Elec. Cont. Lice. No. ..S - a 6SC- Exp.Date 10 -1 -00 .4c. Tempo . Services or Feeders OR State CCB Reg. No. OG546O Exp.Date 'l - ) -O oZ Installation, alteration, or relocation n 00 COT Business Tax or Metro No. Exp.D - ' . 200 amps or less ok $ 53.50 1 O`] 2 201 amps to 400 amps $ 80.25 2 r -- Signature ' Supr. Elec f / ` � 401 amps to 600 amps $ 107.00 2 / Over 600 amps to 1000 volts, 3 see "b" above. License No. � D 83 S E •.Date \ 0 - _ 0 4d. Branch Circuits Phone No. - • - .-._1 S 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 $ 5.35 2 b) The fee for branch circuits Address without purchase of service City State Zip or feeder fee. Phone No. First branch circuit $ 37.50 Each additional branch circuit • $ 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 circle $ 42.75 Owner's Signature Each sign or outline lighting $ 42.75 Signal circuit(s) or a limited energy 3. Plan Review section (if required):* panL alteration or extension $ 60.00 f � Minor Labels (10) $ 107.00 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 and feeder 225 amps or more 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: 5a. Enter total of above fees $ 10 7 * Submit 2 sets of plans with application where any of the above apply. 90J/A Surcharge (.05 X total fees) $ ' • 5(p Not required for temporary construction services. Subtotal $ 5b. Enter 25% of line 5a for NOTICE 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 # 54" AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ 1 6 ...-- i:\dsts\forrns\electric.doc 07/11/2000 Activities for Case #: ELC1999 -00700 2:12:07 PM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes ELCC800 Case Finaled 11/29/1999 JMT DONE No Hold JMT 11/29/1999 ELCC001 Application received 11/18/1999 GEO RECD No Hold GEO 11/18/1999 ELCC003 Permit created 11/18/1999 GEO DONE No Hold GEO 11/18/1999 ELCC730 Elect'I Service 11/19/1999 BP PASS No Hold VT 11/19/1999 Temp service - Pass ELCC799 Elect'I Final No Hold GEO 11/18/1999 ELCC500 (F)Issue permit 11/18/1999 GEO DONE No Hold GEO 11/18/1999 • Page 1 of 1 • 1 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested HI l4 (q9 AM PM BLD Location i39 3 p' � n �Q C��C.� y Suite MEC Contact Person f r--- /T Ph £2 �-C-CY / PLM Contractor 11 Ph SWR BUILDING Tenant/Owner i:,()alSr /q- 700 Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation '7� Drywall Nailing 7 >�hi. g -Sc r v1 [' P Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof 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 LECTRIC C ice Rog In UG /Slab Low Voltage Fire Alarm 'ART FAIL SIT 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 / 9 Approach /Sidewalk Other Date ` [ / ` — Inspector .1 Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.