Permit � CITY O F TI G A R D ELECTRICAL PERMIT
.4 46; ;-� DEVELOPMENT SERVICES PERMIT #: ELC98 -0461
���I DATE ISSUED: 08/06/98
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S126C0 -01109
SITE ADDRESS...:09500 SW WASHINGTON SQUARE RD
SUBDIVISION ZONING:C -G
1 BLOCK • LOT • JURISDICTION: TIG
Project Description : Installation of limited energy panel. Job no. 9376.
- -- 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 • 1
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 - 200 amp ° 0 W /SERVICE OR FEEDER: 0 PER INSPECTION : 0
201 - 400 amp 0 1st W/0 SRVC OR FDR.: 0 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
JC PENNEY type amount by date recpt
9500 SW WASHINGTON SQUARE PRMT $ 40.00 DEB 08/06/98 98- 308083
PORTLAND OR 97223 5PCT $ 2.00 DEB 08/06/98 98- 308083
Phone #:
Contractor:
ALLEN /FALK INC $ 42.00 TOTAL
9020 SW GEMINI
REQUIRED INSPECTIONS
BEAVERTON OR 97008 Ceiling Cover Elect'l Service
Phone #: 646 -0533 Wall Cover Elect'l Final
Reg #..: 47238
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 1:
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 952-001-0610 ro uh OAR 952 -001 -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling (503)245 -1967.
Permittee Signature: • Issued: te / /.��.�
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: p ' 4o - RA!
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY_ O Elertsical Permit Application Plan Chec
13125 SW HALL BLVD. Rec'd B � �-l u- 3
Date Rec'd 5J - z$
TIGARD OR 97223 AUG
1998 Date to P.E.
Phone (503) 639 -4171, x304 Date to DST ----- COMMUNITY DEVELOPf� or Type
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit # ELe..-?? - O /
Fax (503) 684 -7297 Called
1. Job Address: C. 4. Complete Fee Schedule Below:
Name of Development l . n'M a l SC.n Number of Inspections per permit allowed
Name (or name of business) 170 C .2YAhy r (� 1 Service included: Items Cost Sum
Address \ 5nn SVV WrASYNt t\ trt n St, . Rd • 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City/State /Zip T %3C1.(14 I OR as 3 Each additional 500 sq. ft. or
Commercial I' Residential El Limited thereof $25.00 1
Limited Energy $25.00
Each Manul d Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current lice nses 4b. Services or Feeders
Electrical Contractor \ \R v) / prA \ 1C 1.nc_ . Installation, alteration, or relocation
/ 200 amps or less $60.00 2
Address q0 an Gw r, P.rn∎ n ■ NI % vP _ 201 amps to 400 amps $80.00 2
City P p.avPxtn r\ State Da Zip °C nob 401 amps to 600 amps $120.00 2
Phone No. la4U - 0S33 601 amps to 1000 amps $180.00 2
Job No. q?-) A Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. 34-a5'$t_L.5 Exp.Date 10 /9
OR State CCB Reg. No. t- 7 SE Exp.Date f -1191 4c. Temporary Services or Feeders
COT Business Tax or ro 0nr)D7,555Exp.Date II 1 °19 Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Supr. Elec'n 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No h 7 SL 6 Exp.Date see "b" above.
Phone No. 1-t - O 5 f � 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 circuit $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circui $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required): * Signal circuit(s) or a lijg e,dennemy 1-10.00
panel, alteration or extension 1 $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:
Not required for temporary construction services. 5a. Enter total of above fees $ yD
,
5% Surcharge (.05 X total fees) $ O°
NOTICE Subtotal $ 00
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 1 ^
TIME AFTER WORK IS COMMENCED. El Trust Account # $ 1.4 . 00
Total balance Due
I: \DSTS \ELC96.APP Rev 9/96
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 .
BUP
Date Requested AM PM BLD
//��
_ Location C[ n LCAci , � l 55 1 Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC 9 : 1 (
Retaining Wall ELC 7 • ,
Footing Access:
Foundation FPS
Ftg Drain - SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam E 9.-7- d ��
Ext Sheath /Shear
Int Sheath /Shear � �
Framing �-t--( � I S- 6 + Z
Insulation
Drywall Nailing
Firewall nn //
Fire Sprinkler fT ii .cy' s i s c.o, e r' A0 re)i47
Fire Alarm C<
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 � q- 07 �� U r��d 3 22 °' • T be. p
Post & Beam C✓ l �
Rough In •
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
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
Other oach /Sidewalk Date 725 f7 Inspector .4 �iJ714.` Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.