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Permit CITY OF TIGARD ELECTRICAL PERMIT ! // . A\ DEVELOPMENT SERVICES PERMIT #: ELC99 -0111 1 4.-4 DATE ISSUED: 02/23/99 ! J• .. 13 S W Hall Blvd., Tigard, OR 97223 (503) 639.4171 PARCEL: 2S11ODB -00703 SITE ADDRESS...:15348 SW PACIFIC HWY SUBDIVISION •WILLOW BROOK FARM ZONING: BLOCK • LOT :002 JURISDICTION: TIG Project Description : Installation of limited energy panel. Job No. 11329 - -- RESIDENTIAL UNIT - - -- ----TEMP SRVC /FEEDERS - - -- MISCELLANEOUS 1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0 EACH ADD'L 5O0SF...: 0 201 — 400 amp • 0 SIGN /OUT LINE LTG..: 0 LIMITED ENERGY • 0 401 — 600 amp • 0 SIGNAL /PANEL • 1 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/O SRVC OR FDR.: 0 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 LES SCHWAB TIRE CENTERS INC type amount by date recpt PO BOX 667 PRMT $ 40.00 DEB 02/23/99 99- 313163 PRINEVILLE OR 97754 5PCT $ 2.00 DEB 02/23/99 99- 313163 Phone #: Contractor: ALLEN /FALK INC $ 42.00 TOTAL 9020 SW GEMINI REQUIRED INSPECTIONS BEAVERTON OR 97008 Elect'l Service Phone #: 646 -0533 Elect'l Final Reg #..: 47238 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 188 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Ore.' . . .res you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -0010 through OA' ' -001 -1987. You may obtain a copy of these rules or direct questions to OUNC by callin (503)246 -1987. / Permittee Signature: �� /�� U� Iss ed By: , _d 44,4 Vii, 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:(7 LA CE' - t '��" ON—J DATE: LICENSE NO: `j,5 V LF ++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day ++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + ++ + + + + + + ++ + ++ + + + + + + + + + + ++ RECr7VEQ �n TIGARD ,FEB 2 2 1999 Electrical Permit Application Plan Ch 13125 SW HALL BLV . Rec'd B TIGARD OR 97223 (;QPllMlfl�i►►t u��tLOPMENT �2 Date Recd - - G 7i Date to P.E. Phone (503) 639 -4171, x304 I � � Print or Type Date to DST Inspection (503) 639 -4175 Permit # ELL'9Y-0/// Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development 11\11 `\ IDUO bV'00K Cq,Y MS Number of Inspections per permit allowed Name (or name of business) L_e.S Service e included: Items Cost Sum Address 153 -k9 sw P -% c . Mvv N 4a. Residential - per unit 1000 City/State/Zip T i 9a� t) (k ql 'D%--t J Each additional it or less 5 s $11 0.00 4 ty /S /Zi P I Each additional 500 sq. ft. or Commercial ICI Residential El Limited thereof $25.00 1 Limited Energy $25.00 Lo + a Each Manuf'd Home or Modular Dwelling Service or Feeder $68.00 2 2a. Contractor installation only: (Attach copy of all current Iicpnses 4b. Services or Feeders Electrical Contractor t tQ. n I VG ' y' _ Installation, alteration, or relocation Q 200 amps or less $60.00 2 Address O' O S�f r�4.M■h. i r.\V4. 201 amps to 400 amps $80.00 2 City ONAaVQX'4r ve) State OR Zip 9 401 amps to 600 amps $120.00 2 Phone No. 5o3 - lo4ln - oS33 601 amps to 1000 amps $180.00 2 Job No. 1139.c1 Over 1000 amps or volts $340.00 2 Reconnect only $50.00 2 Elec. Cont. Lice. No. I4-a58C1.1: Exp.Date 10 / OR State CCB Reg. No. Lri a38 Exp.Date LI 95 4c. Temporary Services or Feeders COT Business Tax or Metro No. 3555 E / •.Date 11 I '1 Installation, alteration, or relocation 200 amps or less $50.00 2 Signature of Supr. Elec'n /, % 201 amps to 400 amps $75.00 2 / 401 amps to 600 amps 2 Over 600 amps to 1000 volts, License No. g�3 Exp.Date (CYO see "b" above. Phone No. 503 - 5 0 3 - C . 6 4 - 1 1 0 - 0 � 3 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 circ $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 circui $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 limitedsnecay panel, alteration or extension t $40.00 Li 0. 0 2 Minor Labels (10) $100.00 Please check appropriate item and enter fee in section 5B. 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: yo Not required for temporary construction services. 5a. Enter total of above fees $ 5% Surcharge (.05 X total fees) $ 4 : O NOTICE Subtotal $ 5b. Enter 25% of line 5a for PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $ 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 # _ 1-1Q.00 Total balance Due $ I: \DSTS \ELC96.APP Rev 9196 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP • Date Requested AM PM BLD Location /5 3 / Suite MEC Contact Person llv// Ph PLM Contractor f/ Ph SWR BUILDING ena Owner ELC / 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 Drywall Nailing h /f'Y!! a C7 .I•2 101 y Sy �eI'Y) S� c.t� r l !� Firewall Cl / / / y Fire Sprinkler L? h Y lilt. p( <j . Fire Alarm Susp'd Ceiling Roof Misc: /77[ �S�/ �� r� V11 S LTAOP4 Y Lr l! Final / / / PASS PART FAIL 4,O 1� C4 �7 d C ' N P — PLUMBING Post & Beam Under Slab Top Out Water Service 4 1— 7 S S Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam (� Rough In Gas Line Smoke Dampers Final d.1 FAIL ELECTRICAL • a 1 J Rough In U UG /Slab Low Voltage Fi rm S ART 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 Date` — 4a ? —?Y /� Inspector .Yi1yr D.� Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.