Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC1999 -00517
41 DEVELOPMENT SERVICES DATE ISSUED: 8/19/99
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S112DD -01600
SITE ADDRESS: 15575 SW SEQUOIA PKWY 180
SUBDIVISION: ZONING: I -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: Add 11 branch circuits for a TI.
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: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/0 SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 10 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVCIFDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
PACIFIC REALTY WILLAMETTE ELECTRIC INC
15350 SW SEQUOIA PKWY PO BOX 230547
SUITE 300 TIGARD, OR 97281
TIGARD, OR 97223
Phone: Phone: 624 -3631
Reg #: LIC 000750
SUP 1965S
ELE 34 -283C
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT GEO 8/19/99 $91.00 99- 317786 Elect'l Final
5PCT GEO 8/19/99 $6.37 99- 317786 ORIGINAL
Total $97.37
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 obtain copies of these rules or dire questions to OUNC at (503)
246 -1987.
Permit 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 C�
SIGNATURE OF SUPR. ELEC'N: J DATE.
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
CITY OF TIGARD Electrical Permit Application Plan Check #
1 W HALL BLVD. Rec'd By
TIGARD OR 97223 Date Rec'd
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST fir,
Inspection (503) 639 -4175 Print of Type Permit #FGL# /Ty g- co 5l -7
Fax (503) 598 -1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below: •
n
Name of Development I" q T- C t A , < T Number of Inspections per permit allowed
Name (or name of business) A, it T., e. c 6. Service included: Items Cost Sum
Address / C 9 j sty Se v 0'i r<L 14 k,,u 4a. Residential - per unit
City /State /Zip T AA_ S ✓ l ed 1000 sq. ft. or less $ 117.75 4
S Each additional 500 sq. ft. or
portion thereof $ 26.25 1
Commercial 0 Residential ❑ 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). �r Installation, alteration, or relocation
Electrical Contractor /A). `I.ex i .i /rf 7e r i t r C 41 -- C- 200 amps or less $ 64.25 2
Address PO geu. 2.34 4-1-1 201 amps to 400 amps $ 85.50 2
401 amps to 600 amps $ 128.50 2
City 't , (re? r) State _ !Jti Zip (3 7 ZS- / 601 amps to 1000 amps $ 192.50 2
Phone No! L 24 _ " /,. l Over 1000 amps or volts $ 363.75 2
Job No. 473 g Reconnect only $ 53.50 2
Elec. Cont. Lice. No. 3q - Z ts3 C- Exp.Date id - r - 9 5 . 4c. Temporary Services or Feeders
OR State CCB Reg. No. ?SD •'c1 Exp.Date g - 6 -O / Installation, alteration, or relocation
COT Business Tax or Metro No. /c5 4. E p.Date g' i -DO 200 amps or less $ 53.50 2
AL._ 201 amps to 400 amps $ 80.25 2
401 amps to 600 amps $ 107.00 2
AL._ AL._ Signature of Supr. Elec'n
Over 600 amps to 1000 volts,
License No. /9t S S Exp.Date i D - / - 0/ see "b" above.
Phone No. 62 - 36 3 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.
Print Owner's Name Each branch circuit $ 5.35 2
Address b) The fee for branch circuits
without purchase of service co,
City State Zip or feeder fee. 3 -/
Phone No. First branch circuit $ 37.50 -/
Each additional branch circuit /0 $ 5.35 s----3 .. =
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:
5a. Enter total of above fees $
* Submit 2 sets of plans with application where any of the above apply. 7 -59i Surcharge (o } X total fees) $ 6/
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 # '3
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ 9
A4"P /9qq• _ `fg
i:\dsts\forms\electric.doc
02/17/2000 Activities for Case #: ELC1999 -00517
3:36:26 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 08/19/1999 GEO DONE No Hold GEO 08/19/1999
ELCC003 Permit created 08/19/1999 GEO DONE No Hold GEO 08/19/1999
ELCC720 Wall Cover 08/19/1999 08/19/1999 08/23/1999 CD PASS No Hold AKJ 08/23/1999 wall cover 2 outlets only
ELCC799 Elect Final 08/19/1999 08/19/1999 10/01/1999 CD PASS No Hold AKJ 10/03/1999
ELCC500 (F)Issue permit 08/19/1999 GEO DONE No Hold GEO 08/19/1999
ELCC720 Wall Cover 09/06/1999 09/06/1999 09/03/1999 CD PASS No Hold AKJ 09/06/1999 main office area
ELCC800 Case Finaled 10/03/1999 AKJ DONE No Hold AKJ 10/03/1999
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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
p Cf BUP
Date Requested 1 01- ! I AM PM BLD
Location (S' ") S S14 ?L__ Suite 1 O 0 MEC
Contact Person LOT t [ (P L, Ph ( D 2 / -3(, 3/ PLM
Contractor Ph SWR C,
BUILDING Tenant/Owner ELC 1 / 4 [ q-- s (7
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 I A
Fire wall
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
(LECTRIcXr
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
jir. PART FAIL
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 1 /
Approach /Sidewalk
Other Date / 4 7 Inspector _ Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. /