Permit 4, CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC1999 -00496
rYpA DEVELOPMENT SERVICES DATE ISSUED: 8/11/99
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 • PARCEL: 1S135BA -00102
SITE ADDRESS: 10164 SW WASHINGTON SQUARE RD B4 -1
SUBDIVISION: OAKBURG ZONING: C -G
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: Electrical TI
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: 9 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:
. WINMAR OF OREGON INC SME INC OF SEATTLE
PO BOX 21545 927 RAINIER AVE SOUTH
SEATTLE, WA 98111 SEATTLE, WA 98144
Phone: Phone: 206 - 329 -2040
Reg #: SUP 2941S
LIC 122009
ELE 37 -755C
FEES Required Inspections
Type By Date Amount Receipt
Elect'I Service
PRMT BON 8/11/99 $112.40 99- 317565 Elect'l Final
5PCT BON 8/11/99 $7.87 99- 317565
Total $120.27
This Permit is issued subject to the regulations contained in the Tigard Muniapal 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 copies of these rules or direct questions to OUNC at (503)
246 -1987. �� — /�,
Permit Signature: `% �/ Issued By: plAjt
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: Yi 1 /( GK_IUY■ DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
CITY OF TIGARD Plan Check
Electrical Permit Application
131 t'5 SW HALL BLVD. Recd By
TIGARD OR 97223
Date Rec'd - II - 11
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print of Type Permit # at40146 - 2O 1'Lo
Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called
Ci_Ue 1q -D1 %
1. Job Address: ] 4. Complete Fee Schedule Below:
Name of Development Q S h 1A 4e.) S2 ,acre- Number of Inspections per permit allowed
Name (or name of business) L. fray vn� Service included: Items Cost Sum Address ! !9l 6V S,14/. (.t,/c,.► ,, ,, 6 s 12)
4a. Residential - per unit
1000 sq. ft. or less $ 117.75 4
City/State /Zip l : t9 r • 7 7
Each additional 500 sq. ft. or
r� portion thereof $ 26.15 1
Commercial Residential ❑ Limited Energy $ 60.00
Each Manufd Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders
information for COT data base). l Installation, alteration, or relocation
Electrical Contractor ...1/11 ...1/11 E ;/f a of ..sue #�P_ 200 amps or less L /
$ 64.25 2
Address g ' 201 amps to 400 amps $ 85.50 2
Address /X 1`d'n' r 01 ` S 9 401 amps to 600 amps $ 128.50 2
City Sit 412_ State (4-ire} Zip 9e, vV 601 amps to 1000 amps $ 192.50 2
Phone No. - O6 - 3a.9- 2.0 Over 1000 amps or volts $ 363.75 2
Job No. l& p- Reconnect only $ 53.50 2
Elec. Cont. Lice. No. 3 7- 7.5'S'L Exp.Date 10 /i ) ' ' 4c. Temporary Services or Feeders
OR State CCB Reg. No. 113- 069 Exp.Date y /1., ,/ /OD Installation, alteration, or relocation
COT Business Tax or Metro No. Exp.Date 200 amps or less $ 53.50 2
l � � ' b'" ` /�
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n - 401 amps to 600 amps $ 107.00 2
Over 600 amps to 1000 volts,
� / S Exp.Date 104 10 J see "b" above.
License No. ` �
Phone No. �U6- 3a `
9- 7.0 f D 4d. Branch Circuits
New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name Each branch circuit 9 $ 5 35 1- 14 i 15 2
b) The fee for branch circuits
Address without purchase of service
City State Zip or feeder fee.
Phone No. First branch circuit $ 37.50
Each additional branch circuit $ 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 included)
Each pump or irrigation circle $ 42 75
Owner's Signature Each sign or outline lighting $ 42 75
Signal circuit(s) or a limited energy
panel, alteration or extension $ 60.00
3. Plan Review section (if required): * Minor Labels (10) $ 107.00
Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over
4 or more residential units in one structure the allowable in any of the above
Service and feeder 225 amps or more Per inspection $ 50.00
Per hour $ 50.00
System over 600 volts nominal In Plant $ 59.00
Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 5. Fees:
5a. Enter total of above fees $
* Submit 2 sets of plans with application where any of the above apply. 174 Surcharge (.05 X total fees) $ 7.t
Not required for temporary construction services. / Subtotal $ I 1 4.6 I
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account #
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ • i I S. o I
i \dsts \forms \electric doc
ri?4./ :7---;
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
�t,
O BUP
Date Requested ,� g -kb- / 9 AM PM BLD
Location I (1 L 1 l Suite MEC
Contact Person — rn e nn Ph VIP'S% JDZ.2 PLM
Contractor Ph SWR (]
BUILDING en 0 Owner . 4 S 444 ( tj • - ELC C �i d ( IS
Retaining Wall} 4 4
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: ► SGN
�
Slab - SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation •
Drywall Nailing
Firewall r- I/� 4
Fire Sprinkler Par 144 l 1 Y O. G �-► C 1'" 1` Q- / 9 (.. ""
Fire Alarm �-
Susp'd Ceiling L— 1• C — Q g - o
Roof
Misc:
Final
PASS PART FAIL 1 h /
PLUMBING �l �e � SS 60 ! ,P r / s —
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer —c am
Rain Drains k e _ — q h
Final
PASS PART FAIL P r e Se a
MECHANICAL
Post & Beam
Rough In
•
Gas Line
Smoke Dampers
Final
PASS PART FAIL
Service
Rough In
UG /Slab
Low Voltage
Fire A
or'"'
PASS '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 Qr
Approach /Sidewalk r — �
Other Date Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.