10525 SW 69TH AVENUE ADDRESS:
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CITY O� TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mach. Shear/Sheath Framir -Mech.
Plbg.Und/Flr/Slab Plbg,Top Out Insu -Elect.
Post/Beam Struct. Mech. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other: _
Date: '�2 Sic, A.M. RM.�� Entry:
,_1.
Address: 0_ I-- �G 9_
Tenant: _ Ste: MST:
BUP:
Con/Own: P��--eM�-1 t, _ MEC:
PLM:
ELC: -�-^ 3
THE FOLLOWING COR ECTIONS ARE REQUIRED: ELR:
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Inspector:
APPROVED —DISAPPROVED/CALL FOR REINSP. OF
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CITY OF TIGARD ELECTRICAL CO
PERMIT # : CLCG-0 Ila,::,
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 03/01/96
13125 SW Hail Blvd.Tigard,Oregon 97223.61//90 (15103)639.4171 PnRCEL: 1.S 17&ADJ 17.13100
%Tl' WDPE55. . . . 112725 BCW GOTH WE
uDD1VISION. . . . : VILLA RIDGE ZO.NING: R--4. 5
_OCK. I . . . . . . . . . LOT., . . . . . . . . . . . . ..G
project Description: install one branch circuit.
__. RECIDErNTIAL UNIT--- - - ---TEMP SRVC/Fc ELDERS---- -----MISCELLANEOUS
000 OF OR LESS. . . . : Iii 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0.i
11CH ADD' L 500SF. . . : 0 201 - 400 amp. . . . „ . . : 0 SIGN/OUT LINE LTC. . ; 0
IMITE<r. ENERGY. . . . . : 0 4011 - 600 amp. . . . . . . : 0 SIGNOL/F=ANEL. . . . . . . : 0
WF. HM/ SVG/FDR. . : 0 601+amps- 1000 volts. : 0 MINOR LABECL.
_._. . ERVlCE/FEEDER _.__..__ _._....... ._BRANCH CIRCUITS----- _,_._pDD' L INSPECTIONC
— 200 amp. . . . . . : 0 W/^ERVICE OR FEEDER: 0 PER INSPE:C:TION. . . . . :
01 400 amp. . . . . . . 0 1st i•1/O SRVC OR FDR. . i PER HOUR. . . . . . . . . . . .,
x 1 000 amp. . . . . . . 0 ECA ADD' L. BR RICH CIRC, 0 1N PLANT. . . . . . . . . . . .
01. -- 1000 amp . . . . : � � ...._.._ ._ _ . _ .. ..._..rLAlN Rcuti t., 7rrTIDN
.000 '- amp/v .,lt. . . . . : ) =� R.ErC UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . :
'econnect; only. . . . . 0 TVC/f DR ) m 225 OMPO. . . CLASS AREA11SPEC OCC. .
Anor ; --------------- ----------------------------------- FEE;
'Rhyl: WORKMAN type aiaaunt by dale r0cp.t
'.OS25 D1.1 69TH AVC PRMT 35. 00 CJr 03/C.11/96 07- 76563
1 P C T t 1. 7-7, C,7S 0S/01 /ry6 �v". 2765,,:7,
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unt r act or.; -----' -'_......_._.._,..._-.___... ...._.._.._._.__.,_._...... -----^-'----.._...—_ —-._._.._
_-HrF-(NIx ELECTRIC CO � 1S. 7�T TOTAL
C IJCX X 1 4 W L.
------ REQUIRED T N �,7,TCCT TONE,
"'1r1t_nT'_h1 1,1P 9701 , 1:1 ut' l mervice
-hone 4: Elect, 1 r`irial
_eg 4. . :
",is persit is issued subject to the regulations contained in the
-i jard Municipal Code, State of Jre. Specialty Codes and all other Perr,i t t e r, S i g-•lait u..e
pplicable laws. All work will be done in acccrdance with
approved plans. This per-sit will expire if work is r.t started
ithin 180 da}s of isivar,ce, or if work is suspended for sure �_�,r_!C-T Lt,
4an; 1.90 As, ed C,.r,
__..... .rlL,"bVR WTAl...E.ATION ONLY _.__. . . ..... .....
!.Ie installation is being mWe on property I own which is not intended fol
ale lease, T,.. rcrt-
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_ _..EOr,1TRAC:TCr' INSTAL_ TION 0" Y
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f--' T CNPT'UREy. Or 3UP R. ELECI N: �.G11�_. F"'i,TL.
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Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Permit # i�L69,;-0/33
Date Is,,;ued .3- / - 96 _
Ph (503) 639-4171
CITY Of TIGARD FAA (503) 684-7297
TDD No. (503) 684-2772
Inspection (503) 539-4175
1. Job Address: 4. Complete Fee Sc,heduie Below:
Name of Development \r1 Number of Insp-.0ions per permit allowed
Address 8_S� -a,- �-�� __ `service ncluded Items Cost(ea) Sum
City/State/Zip— _- 1\QC LrrA �r q� �J_ aa. Residential -per unit
13 1000 sq. ft. or less $110.00
Name (or name of business) �- r Lt-,— Each additional 500 sq ft.or $25.00
portion thereof
Limited Energy 525 00
Commercial F1 Residential Each Manufd Home or Modular
Dwelling Service oI Feeder $68.00
2a. Contractor ' stall tion only:
� 4b. Services or Feeders
\ ' Installation,alteration,or relocation
Electrical ContractorTO _ 200 amps or less $80.00 _ 2
0
201 amps to 400 amps $8 .00 2
Address `l��� S�� ��,�� La, _ $120.00 2
401 amps to 600 amps
City StatenL Zip nQ3 501 amps to 1000 amps $180.00 _ 2
Phone N c2 `f c ver 1000 amps or volts $34000 � 2
Job NO.
S 5` Raconnect oily $50.00 _ 2
.a__��s._�
contractor's license NO. _..- -- 4c. Temporary Services or Feeders
Contractor's Board Reg. No. 07-1)�Y _ Installation,alteration,or relocation 2
Signature of Supr. Elec'n_ as
200 amps or le
201 amps to les400 amps 550.00
License No._ ! ,[L one No. mpsto60m $7500
oe0omo vons s0o 00 -
2b. For owner hnstallations: see"b"above.
4d. Branch Circuits
Print Owner's 'Jame __ �� flew,anerr,tlon or extension per pane
Address _ - a)The lee for branch circuits with
- ---- purchase of service or feeder fee.
City _ --_ State Zip - - Each branch circuit $5.00
Phone No. b)The fee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder fee.
First branch circuit $3500 L
not intended for sale, lease or rent. Fach additional branch circuit $500
Owner's Signature 4e. Miscellaneous
-- z
(Service or feeder not Included) 2
3. Plan Review section (if required): Each pump or Irrigation circle $40.00
Each sign or outline lighting $4000 - 2
Signal circult(s)or a limited energy
Please check appropriate Item and enter fee in section 93 panel,alteration or exiens on $4000
4 or more residential units in one structure Minor Labels(10) $10000
Service and feeder 225 amps or more 4f.Each additional Inspection over
System over 600 volts nominal
a Classified area or structure containing special occupancy the allowable In any of the above
Per
V) as described in N C. Cha ter 5 Per hour hourlion $35 00
P $55 00
In Plant $5500
Submit 2 sets of plans with a-tplication where any of the above
.—t apply. Not required for temporary construction services. 5. Fees: *SF-
5a. Enter total of above fees $
NOTICE 5%Surcharge (.05 X total fees) g
Imo, Subtotal $
J PERMITS BECOME VOID IF WORK OR CONSTRUCTION
5b. Enter 25%�of line A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF Plan Review If required (Sec.3) $
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Subtotal g
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS _
COMMENCED —ft..dWv*, ❑ Trust Account#
Balance Due $