Permit CITY OF T I G A R D ELECTRICAL PERMIT
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PERMIT #: ELC2001 -00158
DEVELOPMENT SERVICES DATE ISSUED: 3/20/01
` li 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 25101 DD -00101
SITE ADDRESS: 06975 SW SANDBURG ST
SUBDIVISION: TIME SQUARE ZONING: C -P
• BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation S/ ° one branch 9-r -3 ,_, 0 2.
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:
MANF HMI 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: 1 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:
WESTON HOLDING CO LLC K T ELECTRIC INC
2154 NE BROADWAY P.O. BOX 7365
PORTLAND, OR 97232 BEND, OR 97701
Phone: Phone: 541 - 382 -0882
Reg #: ELE 9 -247C
SUP 4784S
LIC 145488
FEES Required Inspections
Type By Date Amount Receipt
Ceiling Cover
PRMT CTR 3/20/01 $46.85 2720010000( Wall Cover
5PCT CTR 3/20/01 $3.75 2720010000( Elect'l Final
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Speaalty 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: 4,9
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: 3'20'eu
LICENSE NO: f7t 9'5
Call 639 -4175 by 7:00pm for an inspection the next business day
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Electrical Permit Application
Date received: 3/iQ 0 / Permit no.: (Leto' -GO 15
a.rrp - .ti t ) � 1 ( - ,,L .. City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: Byie no.:
Phone: (503) 639 - 4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory Commercial/industrial ❑ Multi- family ❑ Tenant improvement
0 New construction O Addition/alteration /replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: G 9 1 S' & • Sand &e 7 . )2Q. Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: AT +1 3 - (T • 'Description and location of work on premises: , A Ica" 00vy i .
Estimated date of completion/inspection: 3-I b -0 I
CONTRACTOR APPLICATION FEE SC11E1)11LE
Job no: Fee Max
Business name: )(, 7 , Cdr c r Description Qty. (ea.) Total no. insp
U, New nt�dential -single ormulti- familyper
Address:
y Doi 7,3/.S- dwelling unit. Includes attached garage.
City: 13 cur-, I State: OK. I ZIP: 97 70b Service included:
Phone:Yo - )b1' O&{u I Fax:6gi -369 E- mail:krankri “.vm I'tfl[, sq. ft. or less 4
I Elec. bus. lic. no: 9 et 7 Esc additional 500 sq. ft. or portion thereof
CCB no.:/6--4,fig. Limited energy, residential 2
City/ etro lic. no.: Limited energy, non- residential 2
. / y _ C / , Each manufactured home or modular dwelling
ignature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): / //y rHi.•tig s.” Licenseno:4760 S. Services or feeders—Installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - , .
which is not intended for sale, lease, rent, or exchange according to htstalladon , alteration, orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: - I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 1 2
Phone: Fax: E -mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps- commercial 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps - rating of I &2 O Hazardous location Each sign or outline lighting 2
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories O Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable In any of the above:
O Egress/lightingplan 0 Other. Per inspection
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other c� D
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ y� • O s
O Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number / / within 180 days after it has been State surcharge (8 %) .... $ 3. 'S
Expires accepted as complete. TOTAL $ Si e . (. el
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6A0/COM)
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 _ 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular ❑ Garage Door Opener
Dwelling Service or Feeder $90.90 _ 2
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2 El Vacuum Systems
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 -260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, ❑
see "b" above. Audio and Stereo Systems
Branch Circuits • ❑ Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service In Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00 ❑
Medical
Each additional inspection over
the allowable in any of the above ❑ Nurse Calls
Per inspection $62.50
Per hour $62.50
In Plant $73.75 n Outdoor Landscape Lighting'
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Fees: ❑ Protective Signaling
Enter total of above fees $ n Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee
* No licenses are required. Licenses are required for all other installations
See "Plan Review" section on $
front of application.
Fees:
Total Balance Due $
• Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
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i:\dstsUbrms\elc- fees.doc 10/09/00
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
/, BUP
Uv� Date Requested �� AM PM BLD
Location 1?Q7S SC') S Suite MEC
Contact Person Ph PLM
Contractor 9r_z_f).___ Ph 5 — 4e/0 4446- SWR
BUILDING Tenant/Owner ELC - 24e( --
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: � �� f i t' Slab l/ 9 SIT
Post &Beam
Ext Sheath /Shear (.
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler A 4 - � /J T� S vc% /"C
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
PA T FAIL
C RI
Rough In
UG /Slab
Low Voltage
Fir- rm
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or AS PART 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 l/
Other Date 7` - o/ Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
'1,5,2./, 1 '•-
, , '� . PR35 A
y I.
C/"
Site Name: Tigard
Site #: PR35
. Address: 6975 SW Sandberg Rd. , Tigard
Pots Line: 503 - 624 - 9570
• Elect. Outage: 503 - 643 - 5454
Special Notes: CKT ID: 2DHDB109063GTE (after 6/16/99 new ckt ID i
s 85.HCGS.405477..GTEW)
CKT ID: 2DHDB109062GTE (after 6/16/99 new ckt ID i
s 85.HCGS.405475..GTEW)
CKT ID: 2DHDB109294GTE (after 6/16/99 new ckt ID i
s 85.HCGS.405481..GTEW)
This site is located on the 3rd floor. There is a
lockbox at .
the front door. There is a key in the box that wil
1 give you
access to the front door and the Telco Room which
is located .
on the 1st. floor. Site is located on the 3rd floo
r.
Directions: From downtown Portland, travel South on I -5. Take
Hwy 217
exit. Take a right traveling towards Beaverton
. Take first
exit, SW 72nd. Go left on SW 72nd. Travel Sout
h on 72nd.
for approx.'1 mile. Sandburg Rd. is on the .lef
t. Take a
left at Sandburg Rd. and go to the very end of
the road.
The site is located in the building directly a
head of you.
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