Permit CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC1999 -00376
' A DEVELOPMENT SERVICES DATE ISSUED: 6/23/99
ref II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 1
1A, Nt � PARCEL: 1S126C0 -01107
SITE ADDRESS: 09689 SW WASHINGTON SQUARE RIP `V
SUBDIVISION: ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of one branch circuit, for track lighting. Job No. 3027 -70.
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/O SRVC OR FDR: 1 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:
WASHINGTON SQUARE INC PHOENIX ELECTRIC CO
PO BOX 21545 7379 SW TECH CENTER DR.
SEATTLE, WA 98111 - TIGARD, OR 97223
Phone: Phone: 684 -3600
Reg #: LIC 00052288
SUP 4140S
ELE 34 -247C
FEES Required Inspections
Type By Date Amount Receipt Elect'l Service
PRMT DEB 6/23/99 $37.50 99- 316371 Elect'I Final
5PCT DEB 6/23/99 $1.87 99- 316371
Total $39.37
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 co pie e rules or direct questions to OUNC at (503)
246 -1987.
Permit Signature: d / � ` Iss ed 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 /
•
SIGNATURE OF SUPR. ELEC'N: _ ��- {'��- -� DATE: 6 - -YY
LICENSE NO: / 7'() 5
Call 639 -4175 by 7:00pm for an inspection the next business day
JUN -22 -99 TUE 10:04 AM PHOENIX ELECTRIC CO FAX NO, 15036843611 P. 02
CITY OF l'iGARD Electrical Permit Application Plan C
13125 SW HALL BLVD. RECEIVED Roc'd I
TIGARD OR 97223 Date Recd (17'a.3 --1
Phone (503) 639 -4171, x304 JUN 2 2 1999 Date to P,E.
Inspection (503) 639 -4175 Print or Type Date to DST
Permit .
Fax (503) 684 -7297 COMMUNITY DEVetlete or ille will not be acce Called u E9qQ Q73%
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) \\ (l�_ - mi \ hYlf> Service Included: Items Cost Sum
Address n . < \ '3 ■ .l ' Y�1 V\ Avr 4a. Residential - per unit
L) 1000 sq. IL or less x110.00 4
City /State /Zip t C� ‘ N ,_ _ Each additional 500 sq, ft, or
portion thereof $25.00 1
Commercial Residential 111 L Ener $25.00
-
\. Each Manur Home or Modular
'r f t" Dwelling Service or Feeder $68.0c1 2
2a. Contractor ins lation only:
(Attach copy I current,llcense 4b. Services or Feeders
Electrical Contracto ' • a 0 cam. s ( • Installation, alteration, or relocation
Address n �» V r e , o � �-. a util� v 200 amps or less $60.00 2
1 - 201 amps to 400 amps $80.00
City ti tats (APL, Zip 97 �-, 401 amps to 600 amps $120,00 2
Phone NO ' c (L( (. (7 U 601 amps to 1000 amps $160.00 2
Job No. �)( ) v . I - -7 () - Over 1000 amps or volts $340,00 2
Elec. Cont. Lice. No. - q )LExp.Date Reconnect only $x0.00 _ g
OR State GCB Peg. No. " a mo t,' Exp.Date _ 4c. Temporary Services or Feeders
COT Business Tax or Metro No. _ ( . Exp.Date_ Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Supr. Elec'n /� c 04 201 amps to 400 amps $75,00 2
401 amps to 600 amps $100,00 2
Over 800 amps to 1000 volts,
License No. i % 4. 1 Q S Exp.Date see "b•• above.
Phone No. ( n ;1 ory) 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 fce,
Address Each branch circuit $5.00 - 2
b) The fee for blanch circuits
City State, , Zip without purchase of 37, 50
Phone No. service or feeder fee. .�
First branch circuit 1 $35.00 • 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. 4o. Miscellaneous
• (Service or feodor 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 limited energy
panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section SB,
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: 70
Not required for temporary construction services. 5a. Enter total of above fees 3� $ -so • -, �
5% Surcharge (.05 X total fees) e $ •
NOTICc Subtotal ! $
5b. Enter 25% 'Of line 5a for
PERMITS 6ECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if renuired (Scc.3) $ /
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK J Subtotal $ r
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY c ,�/
TIME AFTER WORK IS COMMENCED. Trust Account Il ,- aa-s� b
Total balance Due 39.51 a
I;\PST61EiC96 APP Rev P106
• •
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 7 --22'7 ( �{ AM PM BLD
Q A G
Location 16 I - Suite MEC
Contact Person Snet4 Ph (.PgLi'7L OhD PLM
Contractor )) 'Ph SWR �7
BUILDING T l) Owner &, LYI„ic4On L ELC / /qq — a0 a s6
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 _ - - / / —= ��.. L
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof /1
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam 4 ■ -
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
<LECTRT2
Service •
Rough In -
UG /Slab
Low Voltage
Fire Alarm
` ART 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
Other Date — Inspector i/ _ . — Ext
Final -
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.