Permit CITY OF TI GARD ELECTRICAL PERMIT
PERMIT #: ELC2002 -00028
_ DEVELOPMENT SERVICES DATE ISSUED: 1/28/02
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 1S126C0 -01107
SITE ADDRESS: 09520 SW WASHINGTON SQUARE RD H -6
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation or alteration of (8) branch circuits and (1) sign lighting.
Job No. 19632
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: 1
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/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 7 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:
PPR WASHINGTON SQUARE LLC ROSE CITY ELECTRIC CO INC
P.O.BOX 21545 4012 NE CULLY BLVD
SEATTLE, WA 98111 PORTLAND, OR 97213
Phone: Phone:
Reg #: O 61 1 7S
LIC 3567
ELE 26 -113C
FEES Required Inspections
Type By Date Amount Receipt Elect! Final
PRMT CTR 1/28/02 $146.80 2720020000(
5PCT CTR 1/28/02 $11.74 2720020000(
Total $158.54
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 et taig Copies of these rules or direct questions to
4:4) •
Permit Signature: q/ / , o ff, Issued
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• . 1 .� /`_ DATE:
LICENSE NO: . 9-7 5 7
Call 639 -4175 by 7:00pm for an inspection the next business day
,
,,f• .
Electrical PermitA Application A PP Date received: / A5 6 797 Permit no.: &Oa —
. ':.?i City of TigarfiECEIVED PLANNING Project/appl.no.: Expire date: . •
City ofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171 q
Fax: (503) 598 -1960 JAN 2 r D 2002 . Case file no.: _ . . _ . _ : ' Payment type:: _ _ '
Land use approval: CITY OF TIGARD - _ -- ' _. -- _ .. _ ..
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi - family enant improvement
0 New construction 0 Addition/alteration /replacement ❑ Other. 0 Partial
JOB SITE INFORMATION
Job address: 9,,TAC, LC)0 SLl 5 Sr H C Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: ,
Project name: G, • i P v- e^A" Description and location of work on premises: ( I „'
Estimated date of cbmpletton/inspection:
CONTRACTOR APPLICATION FEE SCIIEDU.E
. Job no: • ..• - 6 7i W _ Fee Max
Business name: ROSE CITY ELECTRIC CO INC _ Description Qty. (ea) Total no. iosp
New residential - single or mutli- family per
Address: 4012 NE CULLY BLVD dwelling unit Includes attached 'game.
City: PORTLAND I State: OR I ZW7213 Service included:
Ph5t@3 287 616 4 1 151) 3 282 1 ®ail: 1000 sq. ft or less • 4
CCB no.: 3 5 6 7 I Elec. bus. lic. no: 26-113C Each additional 500 sq. ft. or portion thereof
U L y /v�� - -0,--- Limited energy, residential 2
City /m e 1C. n .: Limited energy, non - residential - 2
v
Each manufactured home or modular dwelling ■
Signature of su rvising electrician (required) ,. . . Date /O • -0-V Service and/or feeder 2
Sup. elect.name(print): R L Gotham License no: 212 /S Services or feeders - installation, -
__ _:... alteration or relocation:
PROPERTY OWNER
200 amps or less 2
Name (print): 201 amps to 400 amps .. 2
Mailing address: 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - -
which is not intended for sale, lease, rent, or exchange according to Installation, alteration, or relocation:
ORS 447, 455, 479, in 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
Name: or extension per panel:
A. Fee for branch circuits with purchase of
Address: ` - service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase 8C
of service or feeder fee, first branch circuit: 1 7 2
Phone: Fax: E -mail: Each additional branch circuit: • 7 (p
PLAN REVIEW (Please check all that apply) Misc.(Service or feeder not included):
O Service over 225 amps-commercial 0 Health -care facility Each pump or irrigation circle 2
0 Service over 320 amps-rating of 1812 0 Hazardous location Each sign or outline lighting 1 S3 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 System over 600 volts nominal more residential units in one structure alteration, or extension' 2
0 Building over three stones 0 Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lightingplan 0 Other. ' Per inspection I I I
' Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdicdons accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ ((rJ
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ 7 Y
Credit card number: / / within 180 days after it has been State surcharge (8 %) $ p
Expires Name of cardholder as shown on credit earn accepted as complete. TOTAL $ /58 3'Y
$
Cardholder signature Amount 440-4615 (6/00/COM)
•
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
/� Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total `, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof - $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manuf'd Home or Modular ❑ Garage Door Opener*
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2 ❑ Vacuum Systems*
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2 .
Reconnect only $66.85 2
"temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918-260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. ❑ ,Audio and Stereo Systems
Branch Circuits n Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee. k ' - , .
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 n Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 n Landscape Irrigation Control'
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the allowable in any of the above Nurse Calls
Per inspection $62.50
Per hour _ $62.50
In Plant $73.75 0 Outdoor Landscape lighting*
Fees: '- ". ❑ Protective Signaling
f
Enter total of above fees $ n Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
- , Total Balance Due $
i:\dsts\forms\elc- fees.doc 10/09/00
CITY OF TIGARC 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested ' ZO AM PM BUP
Location ' 7 5 2 (2)/ - S Q- D. Suite /+ _6e - MEC
Contact Person Ph ( ) PLM
Contractor o f �P .12-- ( Ph ( ) 2-87 <0/6e/ SWR
BUILDING - Tenant/Owner ELC 0 .06.0d
Footing
Foundation ELC
Access: Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Eaiiing ing
� �J I � `C� u
Firewall
Fire Sprinkler
Fire Alarm \ I
Susp'd Ceiling �I
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole •
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL •
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
- SITE 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA /
Approach/Sidewalk Date - — Insp _ �� _ Ext
Other:
Final DO NOT REMOVE this Inspection record from the j ' site.
PASS PART FAIL •