Permit CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC1999 -00754
i% DEVELOPMENT SERVICES DATE ISSUED: 12/22/1999
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S101 DC -03900
SITE ADDRESS: 07150 SW SANDBURG ST
SUBDIVISION: SALEM FREEWAY SUBDIVISION ZONING: C -P
BLOCK: LOT : 004 JURISDICTION: TIG
Proiect Description: Installation of a 200 AMP service /feeder and one (1) branch curcuit.
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: 1 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:
PROGRESSIVE CASUALTY INS CO TICE ELECTRIC
6300 WILSON MILLS RD 2139 SE BELMONT ST
MAYFIELD VILLAGE, OH 44143 PO BOX 15009
PORTLAND, OR 97215
Phone: Phone: 233 -8801
Reg #: LIC 00000166
SUP 2586S
PLM 2586s
ELE 26 -126C
FEES Required Inspections
Type By Date Amount Receipt
Elect'I Service
PRMT GEO 12/22/199E $69.60 99- 320615 Elect'I Final
5PCT GEO 12/22/199 $5.57 99- 320615 ORIGINAL
Total $75.17
This Permit is issued subject to the regulations contained in the Tigard Municipal 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 IL f` / ISSUED BY: g �/
OWNER INSTALLATION ONCY
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: �J DATE: I - �� -
LICENSE NO: �� - G�
Call 639 -4175 by 7:00pm for an inspection the next business day
1.1 07, 99 TIE 10:49 FAN 503 598 1960 CIT1 OF' TIGARD GO 002
CITY OF TIGARD Electrical Permit Application e if
13125•SW HALL BLVD. REeE Recd By
•
Data Recd
TrARD OR 97223 "Ti Date to P.E.
Phone (503) 639-4171, x30DEC 2 1999 / Date to DST
Inspection (503) 639- 4 C 0 7 M MUNIiY DEVELOP Print of Type G % - Permit # G4-L49 (9 rl - coo 715-"/
Fax ,503) 598-1960 Incomplete or illegible will not be accepted Caned
1. Job Address: 4. Complete Fee Schedule Below:
Number of Inspections per permit allowed
Name of Development •
Name (or name of business) Pr ng-rpgivg. Co Service included: Items Cost Sum ..
Address 7150 SW Sandburg Rd 4a. Residential - per unit
Ci /State /Zt Ti OR 97223 1000 sq ft. or less $ 117 75 4
ty P Each acditionai 500 sq ft or
portion thereof 5 26.75 1
Comrrercial Eg Residential ❑ . Limited Energy $ 60 00
Each Manufd Home cr Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit Issuance, applicants must provide contractor license I 4b. Services or Feeders
information for COT data be). ; Installation, alteration, or relocation
Electrical Contractor ' ice Electric Co. 200 amps or lest 1 $ 64.25 64.25 2
PO Box 15009 201 amps to 400 amps $ 85.50 2
Address 401 amps to 600 amps $ 128.50 2
City Portland State OR Zip 97293 -5009 601 amps to 1000 amps $ 192.50 2
Phone No. 503 - 233 -8801 Fax 503 - 872 -8290 Over 1000 amps or volts $ 363.75 2
Job No. 99 _ 2 ?_33 Reconnect only $ 53.50 2
Elec Cont. Lice No. 26_ I Exp.Date 1 / /QQ 4c. Temporary Services or Feeders
OR State CCB Reg. No.
��� Exp.Date b ��
l U s Installation, alteration, or relocation
I COT Business Tax or Metro No. 2014 Exp.Date 01/00 200 amps or leas $ 53.50 2
f 201 amps to 400 amps $ 80.25 - 2
1
Signature of Supr EIeC' l''Yl Y �I��)/ 401 amps to Go amps $ 100.00 2
•
Over 600 amps to 1000 volts,
License No 2586S_ (% Exp.Date 1 01/00 See "b° abo°•
Phone No. 503 - 2'31 -R 1 New, Branch Circuits
80 New, aaeraUOn or extension per panel
a) The fee for branch circuits
2b. For owner installations: ! with purchase ofservice or
feeder fee.
Print Owners Name Each branch circuit 1 $ 5.3s 5.35 2
Address t) The fee for branch circuits
i without purchase of service
City , State Zip ' or feeder fee.
Phone No. First branch circuit 5 37.50 .
Each additional branch dreuit $ 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 in hided)
Each pump or irrigation circle $ 42.75
Owner's Signature _ Each sign or outline lighting $ 42.75 _
Signal dre,m(s) or a limited energy
(if required):* DanLl, e ls (10) or extension $ 60 00
3. Plan Review section
( Minor Labels (10) S 100 OC
Please check appropriate Item and enter fee in section 5B. 4f. Each additional inspection over
4 or more residenbal units n one structure the allowable In any of the above
5 Service and feeder 225 amps or more Per Inspection $ 50 00
S 0 00
System over 600 volts nominal In Plant $ 59.00
Class'flee area or structure containing special occupancy as
described in N E.C. Chapter 5 5. Fees:
5a. Enter total of above fees $ 69.60
Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $ S
Not required for temporary construction services. Subtotal $ 75.17
NOTICE 6b. Enter 25% of line 5a fur
Plan Review if required (Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $ 75.17
IS NO1 COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account #
AT ANY TIME AFTEP WORK IS COMMENCED. Total balance Due $ 75.17
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
' / BUP
Date Requested ,/ S 00 AM PM BLD
Location 15 .3 u [lam. ,, � I -( / /�� PA Suite MEC
Contact Person 0V:1A LL– / Ph R q ' f S gO PLM
Contractor ° ' — I Ph SWR
BUILDING TenanUOwnerPatCpc4 V■1 Q \,ZLSIAAL•l Y TA 421 I q99 —OO7 S
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: c1 9 ,
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear Q
} � e n
Framing 1 u'tv (Am Q. �M S
Insulation
61,4,\00i
� Q � � � f�
Drywall Nailing V ` A E 1/ 1 A - r` /\ 2 2 C 5 1 Fire Sprinkler V �l 1 V lJ 7 /
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL / nn J
PLUMBING F — Q 7 C / el PY4Ylc� WOKPhi) S
Post & Beam
Under Slab AT as /— io4 s
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final 7 ; J /
PASS PART FAIL / / C �' Yc P ,c/ , cl/ Jig 5 ' `f c r 2// P
MECHANICAL
Post & Beam QQ JJ
Rough In Q /- ern') / P` s --
Gas Line
Smoke Dampers r�
Final
PASS PART FAIL
LgCTRICAT.7
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
; PART FAIL
`SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ I 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 � TT
Date ate �V v Ins ∎, �, . � !. _ Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.