Permit CITY O F TI GAR D ELECTRICAL PERMIT
Y PERMIT #: ELC1999 -00697
.,lrc DEVELOPMENT SERVICES n DATE ISSUED: 11/18/99
i
'- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4
/ PARCEL: 2S110CD -00104
SITE ADDRESS: 11735 SW QUEEN ELIZABETH STS
SUBDIVISION: KING CITY NO. 2 / 4/ ZONING:
BLOCK: LOT : • yyIIISDICTION: KIN
Project Description: Installation of one signal circuit or limited energy panel.
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: 1
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:
JACK MEDAK MARKMAN INC
4029 NE SANDY BLVD 9955 SE ASH ST
PORTLAND, OR 97212 PORTLAND, OR 97216
Phone: Phone: 255 -9923
Reg #: ELE 26- 838CRE
LIC 12857
SUP 2532RET
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT DEB 11/18/99 $60.00 KING CITY Elect'l Final
5PCT DEB 11/18/99 $4.80 KING CITY
Total $64.80
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 ado• -• . • - Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain •• • es of these rules •r;• irect questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE 4/ �� � S' UED BY: !i 14 'Ji
OWN - INSTALLATION 0
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 639 -4175 by 7:00pm for an inspection the next business day
NOV -17 -99 WED 04:02 PM City of King City FAX:503 639 3771 PAGE 2
CITY OF TIGARD Electrical Permit Application ' r
13125 SW HALL BLVD. R By � -
TIGARD OR 97223 Date Recd
Date to P.B.
Phone (503) 639 -4171, x304 Date to DST I I 1. 7" 1- 75 .
•
Inspection (503) 639 -4175 Print of Type Permit# CLC 1 f5 7 9" - 0 6 4 . 9 7
Fax (503) 598 -1960 Incomplete or illegible will not be accepted Called
• 1: Job Address: 4. Complete Fee Schedule Below:
Name of Development t '.J(Q,'? Number of Inspections per permit allowed
Name (or name of business) ( Service.included: Items Cost Sum I
Address 3C & J Q-Q'4 E \l • , 4a. Residential - per unit
1000 sq, ri, or less $ 117.75 4 .
City /State/Zip K t. C Each additional 500 sq, ft. or
portion thereof 5 26.75 1
Commercials r� Residential I_..t Limited Energy $ 60.00
Each Manufd 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 , (&44 \lht4 tot, � T- 200 amps or less . $ 64.25 2
Address 9� R S , S e s S4c-- 201 amps to 400 amps $ 135.50 2 •
401 amps to 600 amps $ 128.50 2
City c State Oqk Zip Z a.( 601 amps to 1000 amps Si 192.50 2
Phone No. - 1.-s - S9 Over 1000 amps or volts _ $ 363,75 2
Job No. C2t,___ /0-/- //99 Reconnect only $ 53.50 2
Elec. Cont. Lice. No. Xto. - V3 iir Ctxp.Date tte - L - UAW 4c. Temporary Services or Feeders •
OR State GCB Reg. No. s "1 Exp.Date 1 - - (1" - Zatlb Installation, alteration, or relocation •
CO Business Tax or Metro No. ( ble4 Q Exp.Date V L -1 • 200 amps or less $ 53,50 2
201 amps to 400 amps $ 80.25 2
Si natu of Su r. E ec'n 401 amps to 600 amps $ 100.00 2
9 F (2 Over 600 amps to 1000 volts, -
/tiJ see "b" above.
•
License No. Exp.Date IaD t'') - o , l Z •
SS Q 4d. Branch Circuits
Phone No.
,2 _ i --- New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
. feeder fee.
Print Owners Name - Each branch circuit $ 5.35 _ 2
Address b) The fee for branch circuits
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 de. Miscellaneous
intended for sale, lease or rent. (Service or feeder not included)
Each pump or Irrigation cede $ 42.75
Owners Signature Each sign or outline lighting $ 42.75
Signal circult(s) or a limited energy
required):* PanL alteration or extension l $ 00.00 (cis) '
3, Plan Review section (if if Minor Labels bels (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 and feeder 225 amps or more Per inspection $ 50.00
Per hour $ 50.00
_,_ System over 600 volts nominal In Plant - 5 59.00
Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 5. Fees: .
Sa- Enter total of above fees $ fg___
* Submit 2 sets of plans with application where any- of the above apply. 8% Surcharge (.08 X total fees) $
Not required for temporary construction services. Subtotal $ (o q.
5b. Enter 25% of line Sa 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 0 Trust Account # (04%1'6
A7 ANY TIME AFTER WORK IS COMMENCED. Total balance Due $
is \dsLa orma \cluaric.doc y 0.s Peal` .„:-k- -t- • A� Iv�._ CA. 5 4 k.5-
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01/05/2000 Activities for Case #: ELC1999 -00697
11:14:03 AM
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Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC510 (F)Reprint permit 12/08/1999 GEO -DONE No Hold GEO 12/08/1999
ELCC001 Application received 11/17/1999 DEB FAXD No Hold DEB 11/18/1999
ELCC003 Permit created 11/18/1999 DEB DONE No Hold DEB . 11/18/1999
ELCC730 Elect'I Service 11/18/1999 11/18/1999 No Hold DEB 11/18/1999
ELCC799 Elect'I Final 11/18/1999 11/18/1999 12/30/1999 BRP PASS No Hold AKJ 01/02/2000
ELCC500 (F)Issue permit 11/18/1999 DEB DONE No Hold DEB 11/18/1999
ELCC800 Case Finaled 01/02/2000 AKJ DONE No Hold AKJ 01/02/2000
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Page 1 of 1 •
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested
Z20 / 9 9 AM ?L PM BLD
Location 1 1 ?S QIA MEC
Contact Person Ph. 2-SS--?1i3 PLM
Contractor • Ph SWR
BUILDING - Tenant/Owner ELC 1q9 9' -0 0 L 9 7
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: /�� �J .6` n _ n " Ai &
Slab NA / ll�C -(� SIT •
Post & Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing •
Drywall [ qc _ D ^ > ?7 — 4 smeLe
Drywall Nailing (� �j 7
Firewall
Fire Sprinkler •
Fire Alarm
Susp'd Ceiling //
. Roof E L - (7 c
C — 2 0 / • ", ' . (0 I
Misc: c
Final
PASS PART FAIL _._. 7 q CI O 3 / 5'e . 10 Z
PLUMBING — 4 _ —
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
C'ECECTRICAt>
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
1 PART FAIL
Backfill/Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. ' -y 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 X33 --q Inspector , ��, / • _ Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.