Permit CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC2000 -00317
r& DEVELOPMENT SERVICES DATE ISSUED: 06/09/2000
II 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S112DA -00800
SITE ADDRESS: 15055 SW SEQUOIA PKWY 140
SUBDIVISION: ZONING: I -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of service and branch circuits
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 HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 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:
PACIFIC REALTY ASSOCIATES ROSE CITY ELECTRIC CO INC
15350 SW SEQUOIA PKWY #300 -WMI 4012 NE CULLY BLVD
PORTLAND, OR 97224 PORTLAND, OR 97213
Phone: Phone:
287 -6164
Reg #: SUP 2127S
LIC 00003567
ELE 26 -113C
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT JMT 06/09/200C $74.95 00002840
5PCT JMT 06/09/200C $6.00 00002840
Total $80.95
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 ob ain copies of these rules or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE 7- _ 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: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
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•
CITYF TIGARD Electrical Permit Appli Plan Check #
7 � 3125 SW HALL BLVD. VED Recd By 9Y11/7
TIGARD OR 97223 V Date Rec'd
�QI Date to P.E.
Phone (503) 639 -4171, x304 3 ® 2 0Qg ∎ Date to DST s
Inspection (503) 639 -4175 Print of Type - � 'DEVEL Permit # �. 0 -
Fax (503) 598 - 1960 Incomplete or illegible will not be accepted/11E47 Called
1. Job Address: 4. Complete Fee Schedule Below: •
Name of Development Number of Inspections per permit allowed
Name (or name of business) • # i� T Service included: Items Cost Sum 4'
Address S 1 S•Ci _ _ , /. IP . 4a. Residential - per unit
1000 sq. ft. or less $ 117.75 4
City/State /Zip Each additional 500 sq. ft. or
portion thereof $ 26.25 1
Commercial ' 2I Residential ❑ Limited Energy $ 60.00
Each Manuf'd 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). f Installation, alteration, or relocation
Electrical Contractor ( ., e'eCh(2 200 amps or less ii $ 64.25 & 2
Address "I 01 Z 11)6_ t-( v 201 amps to 400 amps $ 85.50 2
City .. Yo r-{. (a.,i o f State Zip 401 amps to 600 amps $ 128.50 2
601 amps to 1000 amps $ 192.50 2
Phone No. _ - • • Over 1000 amps or volts $ 363.75 2
Job No. NI. Reconnect only $ 53.50 2
Elec. Cont. Lice. No. , WM Exp.Date 6 d oe 4c. Temporary Services or Feeders
C!
OR State CCB Reg. No. & Ex..Date . . ' Installation, alteration, or relocation
COT Business Tax or Metro NOD D01O41` Ex. .Da r - el 200 amps or less $ 53.50 2
l� 201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n o` ; �� ' ' 401 amps to 600 amps $ 107.00 2
Over 600 amps to 1000 volts,
see "b" above.
License No. d I al S Exp.Date 10/11.0
Phone No. Z 1'7 - (p ( 64.1 4d. Branch Circuits
New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee. -f
Print Owner's ' / s Name Each branch circuit $ 5.35 l 0 ' ° 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 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):*
panel, alteration or extension $ 60.00
Minor Labels bels (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:'
7 91- 5a. Enter total of above fees $ ,-"'
* Submit 2 sets of plans with application where any of the above apply. 5% Surcharge (.05 X total fees) $
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 #
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due , $
is \dsts \forms \electric. doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested (0/72/00 AM PM BLD
Location 150 l� Suite / / MEC
Contact Person Ph gC(e^32.2,'7 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC 71:00 -190V
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
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
CARD)
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 P FAIL
EECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
',ern
• S PART FAIL
S
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk
Other Date i - / /.. Ins Ext
Final
PASS PART FAIL • 0 NOT REMOVE this inspection record from the job site.