Permit f CITY OF TIGARD ELECTRICAL PERMIT
a „, DEVELOPMENT SERVICES PERMIT #: ELC97 -0779
I I I ' DATE ISSUED: 11/24/97
'� 13 125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171
PARCEL: 1S126C0 -01107
SITE ADDRESS... :09463 SW WASHINGTON SQUARE RD
SUBDIVISION • ZONING:C —G
BLOCK • LOT ' • JURISDICTION: TIG
Project Description: Installation of one branch circuit; connect display cases.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD' L 500SF...: 0 201 — 400 amp ° 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY ° 0 401 — 600 amp • 0 SIGNAL /PANEL : 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
O — 200 amp ° 0 W /SERVICE OR FEEDER: 0 PER INSPECTION ° 0
201 — 400 amp • 0 1st W/0 SRVC OR FDR.: 1 PER HOUR ° 0
401 — 600 amp 0 EA ADD'L BRNCH CIRC: 0 IN PLANT • 0
601 — 1000 amp : 0 PLAN REVIEW SECTION
1000+ amp /volt : 0 ) =4 RES UNITS > 600 VOLT NOMINAL..:
Reconnect only : 0 SVC /FDR >= 225 AMPS..: CLASS AREA /SPEC OCC.:
Owner: FEES
SUNGLASS HUT type amount by date recpt
9463 SW WASHINGTON SQUARE PRMT $ 35.00 TJH 11/24/97 97- 301198
TIGARD OR 97223 SPCT $ 1.75 TJH 11 /24/97 97- 301198
Phone #:
Contractor:
DYNALECTRIC $ 36.75 TOTAL
2904 SW FIRST AVE.
REQUIRED INSPECTIONS
PORTLAND OR 97201 Ceiling Cover Elect'1 Service
Phone #: 503 -226 -6771 Wall Cover Elect'1 Final
Reg #.. : 066793
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001 -0010 through OAR 952-001 -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling (503)246 -1987.
Permittee Signature: � ssued By: $AAI Cy 7.L_.)
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: i / �!_� ;_J DATE: V.24/97
LICENSE NO: 2.950 S
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + ++ + + + + + + ++
Cd
CITY OeTIGARD Electrical Permit Application Plan Check # N
13125 SW HALL BLVD. Rec'd By ..s... •1 *i
Date Rec'd l ' • '7
TIGARD OR 97223 Date to P.E. >\1' A
Phone (503) 639 -4171, x304 Date to DST 1 i _4 fig Print or Type /
Inspection (503) 639 =4175 Incomplete or illegible will not be accepted Permit # D 77g
Fax (503) 684 -7297 Called
1. Job Address: epon"4" 4. Complete Fee Schedule Below:
/ / DI 3 play
Name of Development Sl4n. q/q 1-44, Number of Inspections per permit allowed
Name (or name of business) s Art l4 Service included: Items Cost Sum
Address �OIS � I A. -ovl .S kite 0.541. Sit) 4a. Residential - per unit
II 1000 sq. ft. or less $110.00 4
City/State /Zip I ti Ar-cL !yam � � Each additional 500 sq. ft. or
Commercial 14 Residential ❑ Limitmit portion Limited thereof $25.00 1
ed Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current lice ses). 4b. Services or Feeders
1 I alteration, or relocation
Electrical Contractor Alt L C. 200 amps or less $60.00 2 -
Address 210 4 1 Sw rt r.S f /44M-- 201 amps to 400 amps $80.00 2
City Po r- and State 6'R Zip 97 Zo / 401 amps to 600 amps $120.00 2
Phone No. 22 6 - 4 1 601 amps to 1000 amps $180.00 2
Job No. / -S 7 A7 Over 1000 amps or volts $340.00 2
ZV _ 5 9 Reconnect only $50.00 2
Elec. Cont. Lice. No. Exp.Date lb it l QR
OR State CCB Reg. No. (o(i7 93 Exp.Date 5/ q $ 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Z 5 '1 5 Exp.Date 2./i / 98 Installation, alteration, or relocation
200 amps or less $50.00 2
-
Signature of Supr. Elec'n t„( 201 amps to 400 amps $75.00 2
((jj _ �� L� 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. 2q50 S Exp.Date Mil I q 6 see "b" above.
Phone No. 22-47- Lo 7 7
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circu $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit 1 $35.00 SS 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irngation circle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):'` Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00
* Submit 2 sets of plans with application where any of the above apply. 5. Fees: 3s co
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ / • 75
, NOTICE Subtotal $
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # $ 3 i _.75
Total balance Due
I \DSTS \ELC96 APP Rev 9/96
• - ,;: • • "
_
*
.• •
•
. .
• .
. .
I ;
_ r „.. • ., • 7
•
• — • n
L.
•
RECEIVED
• ,
NOV 2 4 1997
• commuNITY
DEVELOPMEN:
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Q/ Date Requested 1� AM PM BLD
Location - 1 -7 V 1 ? 7 LA S ' 1 - Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner • ELC 9
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
Fire wall / /I . Sys �e iii s Y l'
Fire Sprinkler / VV" ��� e5 ,® /
y
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
P 1111•:-• FAIL
Rough In
UG /Slab
Low Voltage •
F arm
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
Approach /Sidewalk Date Other ae 7 — A Y
Inspector 1 %. Ext
.yf
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.